基于医案研究的国医大师湿证辨证规律与用药探索  

Syndrome Differentiation Rules and Medication of Diseases with Dampness Syndrome by TCM Masters Based on Medical Records

作　　者：黄燕 张逸雯 胡镜清 HUANG Yan;ZHANG Yiwen;HU Jingqing(School of Basic Medical Sciences,Hubei University of Chinese Medicine,Wuhan 430070,China;Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100070,China;National Key Laboratory of Dampness Syndrome of Traditional Chinese Medicine,Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510120,China;China Traditional Chinese Medicine Technology Development Center,Beijing 100020,China;XIN-Huangpu Joint Innovation Institute of Chinese Medicine,Guangzhou 510000,China)

机构地区：[1]湖北中医药大学基础医学院,武汉430070 [2]中国中医科学院中医基础理论研究所,北京100070 [3]广州中医药大学第二附属医院省部共建中医湿证国家重点实验室,广州510120 [4]中国中医药科技发展中心,北京100020 [5]广东省新黄埔中医药联合创新研究院,广州510000

出　　处：《世界中医药》2024年第17期2616-2620,共5页World Chinese Medicine

基　　金：国家重点研发计划“中医药现代化研究”重点专项(2019YFC1708500);省部共建中医湿证国家重点实验室专项(SZ2020ZZ24)。

摘　　要：目的:探讨国医大师对湿证的辨证及用药特点。方法:通过检索古今医案云平台V2.3.5现代医案库、名医医案库,国家知识基础设施数据库(CNKI),中国学术期刊数据库(CSPD),中国生物医学文献数据库(CBM)中检索湿证相关论文及医案进行病-证-方的数据挖掘。结果:共纳入文献358篇,专业书籍12部,古今医案云平台名医医案1296案,共计纳入国医大师治疗湿证医案2195案,涉及国医大师88位。涉及西医疾病84种、中医疾病67种,将证候归类为湿热、湿浊、寒湿、夹痰、夹瘀、夹风、夹毒、兼脾虚、兼阴虚等15种,得出高频中药26味并聚类为4组,网络分析得出了核心药物药对为茯苓-白术,核心药物组合为茯苓、白术、黄芪、甘草、当归、川芎、白芍、薏苡仁、陈皮。结论:国医大师湿证医案西医疾病多涉及炎症及自身免疫疾病,证候以湿热为核心证候,兼夹证候以脾虚、血瘀、肾虚为主,病机多为复杂病机。治疗以健脾除湿、调气活血为核心,辅以清热解毒、化痰、滋阴等药物。Objective:To explore the syndrome differentiation and medication characteristics of traditional Chinese medicine(TCM)masters in treating dampness syndrome.Methods:Data mining was conducted on dampness syndrome-related papers and medical cases through the Ancient and Modern Medical Record Cloud Platform V2.3.5 database,case database of famous doctor,CNKI,CSPD,and CBM to explore disease-syndrome-formula relationships.Results:A total of 358 articles,12 professional books,and 1296 cases from the Ancient and Modern Medical Record Cloud Platform were included,amounting to 2195 cases with dampness syndrome treated by 88 national TCM masters.These cases involved 84 Western medical diseases and 67 TCM diseases.The syndromes were classified into 15 types,including dampness-heat,dampness-turbidity,cold-dampness,combined phlegm,combined stasis,combined wind,combined toxin,and accompanying spleen deficiency or yin deficiency.Twenty-six frequently used Chinese herbal drugs were clustered into four groups,with network analysis revealing the core drug pair as Poria-Atractylodis Macrocephalae Rhizoma,and the core drug combination was Poria,Atractylodis Macrocephalae Rhizoma,Astragali Radix,Glycyrrhizae Radix et Rhizoma,Angelicae Sinensis Radix,Chuanxiong Rhizoma,Paeoniae Radix Alba,Coicis Semen,and Citri Reticulatae Pericarpium.Conclusion:The dampness syndrome cases treated by TCM masters often corresponded to Western diseases involving inflammation and autoimmune disorders.The core syndrome was dampness-heat,often accompanied by spleen deficiency,blood stasis,or kidney deficiency,reflecting complex pathogenesis.The treatment focused on strengthening the spleen and eliminating dampness,regulating qi,and invigorating blood,supplemented by drugs for clearing heat,removing toxins,resolving phlegm,and nourishing yin.

关 键 词：国医大师 湿证 医案 辨证 用药规律 复合病机 湿热证 炎症性疾病 

分 类 号：R241[医药卫生—中医诊断学] R242[医药卫生—中医临床基础]