基于数据挖掘分析《吴鞠通医案》痰饮病的症脉药特点  

Analysis of Characteristics of Symptoms,Pulse,and Medication of Phlegm Rheum Diseases in Wu Ju Tong Yi An Based on Data Mining

作　　者：张明方 仲芳 王彩云 郭晶磊 ZHANG Mingfang;ZHONG Fang;WANG Caiyun;GUO Jinglei(School of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Siyang Traditional Chinese Medicine Hospital,Siyang Jiangsu 223700,China;Shanghai University of Engineering Science,Shanghai 201620,China)

机构地区：[1]上海中医药大学中医学院,上海201203 [2]泗阳中医院,江苏泗阳223700 [3]上海工程技术大学,上海201620

出　　处：《新中医》2024年第21期43-49,共7页New Chinese Medicine

基　　金：上海市教育委员会科研创新计划项目(2021-01-07-00-10-E00143)。

摘　　要：目的:分析《吴鞠通医案》中痰饮病的症脉及用药特点。方法:将医案症状、脉象、剂量规范化,采用频数统计、关联分析、聚类分析、分类统计方法探究医案中的用药特点及症药关系。结果:痰饮病用药以半夏、陈皮、桂枝等辛温为主,同时注重枳实、石膏等寒凉药的使用;症状上呈现咳-痰-喘的密切相关,并在脉象上呈现脉弦细和脉洪大两组关联。症药关系体现脉弦细时偏温肺化痰,如生姜、五味子;脉洪大时倾向清热祛痰,如石膏、茯苓皮。常用药物剂量的使用超过药典剂量,石膏最为明显,超出药典剂量10倍之多,且主要在脉洪大及痰症的应用当中,半夏、桂枝使用则超出5倍,更多体现在脉弦细及咳喘症状时。结论:吴鞠通治疗痰饮遵循温化大法并重视清法寒凉药使用,用青龙汤去麻辛防伤阴,桂枝加量以解表;半夏大剂量使用重在祛痰护胃,脉洪大、痰热时大剂量使用石膏。Objective:To analyze the characteristics of symptoms,pulses,and medication of phlegm rheum diseases in the Wu Ju Tong Yi An(Wu Ju-tong's Case Records).Methods:The symptoms,pulse,and dosage in medical records were standardized;frequency statistics,correlation analysis,cluster analysis,and classification statistics were used to explore the characteristics of medication and the relationship between symptoms and medication in the medical records.Results:The main Chinese medicinals used for phlegm rheum disease were Pinelliae Rhizoma,Citri Reticulatae Pericarpium,Cinnamomi Ramulus,and other acrid-warm medicinals,and attention was also paid to the use of cold and cool medicinals such as Aurantii Fructus Immaturus and Gypsum Fibrosum;there was a close correlation between cough,phlegm,and panting in symptoms;two correlations were found in terms of pulse,namely wiry and thready pulse and surging and large pulse.The relationship between symptoms and medication was reflected in the fact that,when the pulse was wiry and thready,it tended to use medicinals that can warm the lung and resolve phlegm,such as Zingiberis Rhizoma Recens and Schisandrae Chinensis Fructu;when the pulse was surging and large,it tended to clear heat and remove phlegm with medicinals such as Gypsum Fibrosum and Poriae Cutis.The dosages of commonly used medicinals exceeded the dosage recommended by pharmacopeia,with Gypsum Fibrosum being the most obvious,exceeding the pharmacopeia dosage by as much as 10 times,and it was mainly used in the application of surging and large pulse and phlegm symptoms;Pinelliae Rhizoma and Cinnamomi Ramulus exceeded the dosage of the pharmacopeia by 5 times,mainly manifested in the treatment of wiry and thready pulse and cough and panting symptoms.Conclusion:In the treatment of phlegm rheum,WU Jutong followed the principle of warming and removing,and paying attention to the use of heat-clearing and fire-draining methods and cold and cool medicinals.In the application of Qinglong Decoction,he removed acrid medicinals to preve

关 键 词：痰饮病 《吴鞠通医案》 数据挖掘 量化 

分 类 号：R255.8[医药卫生—中医内科学]