清代医家王孟英应用瓜蒌治疗胸痹经验的数据挖掘和网络药理学探讨

Data Mining and Network Pharmacology of Qing Dynasty Physician Wang Mengy⁃ing′s Experience in Treating Chest Discomfort with Trichosanthis Fructus

目的基于数据挖掘,探究清代医家王孟英用瓜蒌治疗胸痹的特点,并通过网络药理学进一步探究其核心药物治疗冠心病潜在的作用机制。方法从王孟英的医案中筛选应用瓜蒌治疗有胸痹症状(如“胸闷”“心下拒按”等)者的医案,通过Excel 2019软件进行频数统计、SPSS Modeler 18.0软件进行关联规则分析。通过中药系统药理学数据库与分析平台(TCMSP)、GeneCard数据库筛选中药的有效成分、作用靶点及冠心病靶点,通过Cy⁃toscape软件、STRING数据库建立网络关系图,通过Metascape数据库进行KEGG富集和GO富集。结果纳入医案61例,常见便秘、胸闷、气逆等症,瓜蒌常配伍清热化痰理气的药物,性味苦寒最多,归肺经者最多,核心药物组为瓜蒌-半夏-黄连-竹茹。网络药理学分析得到瓜蒌-半夏-竹茹-黄连的活性成分43个,核心作用靶点8个,通路主要富集在TNF通路、IL-17通路、HIF-1通路、MAPK通路、PI3K-Akt信号通路。结论王孟英常用瓜蒌治疗胸痹,重视涤痰热与运枢机,核心药物为瓜蒌-半夏-竹茹-黄连,常配伍调畅肺胃气机之品。瓜蒌-半夏-黄连-竹茹通过括槲皮素、小檗碱、植物甾醇、黄芩甙元、羟基芜花素、香草醛等多种活性成分,作用于IL-6、TNF、AKT1、VEGFA、IL-1B、TP53、PTGS2、PPARG等靶点,可能通过TNF信号通路、IL-17信号通路、HIF-1信号通路、MAPK信号通路、PI3K-Akt信号通路,调控炎症反应、促进血管新生、调节糖脂代谢等多种途径调节冠心病。

Objective To explore the characteristics of Qing Dynasty Physician Wang Mengying′s treatment of chest discomfort with Trichosanthis fructus by data mining and analyze the potential mechanism of core medicine combina⁃tions by network pharmacology.Methods The medical records of patients with chest discomfort symptoms(such as chest distress and refusal to press under the heart)were selected from Wang Mengying′s medical records,and frequency statistics were performed by Excel2019 software.Association rule analysis was conducted by SPSS Modeler18.0 software.The effec⁃tive components,action targets,and coronary heart disease targets of TCM were screened by TCMSP and GeneCard data⁃base.A network was established by Cytoscape software and STRING database,and KEGG enrichment and GO enrichment were conducted by Metascape database.Results 61 medical records were obtained.Constipation,chest distress,and Qi re⁃verse were the most common symptoms.Trichosanthis fructus were often used with heat-cleaning,phlegm-removing,and qi-regulating dugs,among which drugs with cold herb properties and bitter taste were most common to be seen and mainly concentrated on lung meridian.The core drug combination was Trichosanthis fructus-Pinelliae rhizoma-Coptidis rhizoma-Bambusae caulis in taenias.Network pharmacological analysis showed 43 active ingredients and eight core targets of the core drug combination,which mainly affected the TNF signal pathway,IL-17signal pathway,HIF-1 signal pathway,MAPK signal pathway,and PI3K-Akt signal pathway.Conclusion Trichosanthis fructus were commonly used to treat chest discomfort by Wang Mengying,and great importance was attached to heat-cleaning,phlegm-removing,and qi-regulating.The core drugs were Trichosanthis fructus-Pinelliae rhizoma-Coptidis rhizoma-Bambusae caulis in taenias,of⁃ten used with the drugs of regulating lung and stomach qi.Through a variety of active ingredients including quercetin,(R)-Canadine,beta-sitosterol,baicalin,hydroxylrupidemin,vanillin,and so on,this core drug combination affected IL-6,TNF,AKT1,VEGFA,IL-1B,TP53,PTGS2,PPARG,and other targets.Coronary heart disease may be improved by regulating urnal of Integrated Traditional and Western Medicine 2023,Vol.18,No.9 inflammatory response,promoting angiogenesis,and regulating glucose and lipid metabolism through the TNF signaling path⁃way,IL-17 signaling pathway,HIF-1 signaling pathway,MAPK signaling pathway,and PI3K-Akt signaling pathway.