曾斌芳辨治慢性乙型病毒性肝炎制方用药规律

Zeng Binfang's Rule of Prescription in Treatment of Chronic Hepatitis B virus

目的:建立慢性乙型病毒性肝炎的临床医案数据库,挖掘曾斌芳教授治疗慢性乙型病毒性肝炎的临证遣方用药经验。方法:本研究利用复杂网络分析及点式互信息法等数据挖掘方法,对曾斌芳教授治疗慢性乙型病毒性肝炎的用药特点、配伍规律、核心方等隐性知识进行挖掘研究。结果:本研究共收集132例、277诊次的慢性乙型病毒性肝炎患者的临床数据。慢性乙型病毒性肝炎常用药物按节点度排序:药物组成以小柴胡汤合四物汤为基础方,配以疏肝健脾、滋阴软坚散结、清热解毒利湿之品。常用药物四气五味归经特点:四气中以微寒、温、平为主;五味中以甘、苦、辛为主;归经以脾经、肺经、肝经为主;常用药物相关度配伍体现了疏肝理气和血的治疗思路。用药规律充分体现了"治未病"的防治思想,以"肝苦急,急食甘以缓之""见肝之病,知肝传脾,当先实脾"为治则,以甘味之药补脾和中、缓肝之急,防"肝病传脾"之变;"肝欲散,急食辛以散之,以辛补之"为治则,以辛味之药疏肝理气和血;以苦味之药清热解毒利湿。点式互信息法分析显示:慢性乙型病毒性肝炎常用药物中疏肝理气药与活血养血药配伍相关度最高,体现了疏肝理气和血的治疗思路。复杂网络分析方法显示:慢性乙型病毒性肝炎的基本核心方以小柴胡汤合四物汤为主,以和血柔肝健脾为法。结论:曾斌芳教授治疗慢性乙型病毒性肝炎的制方用药特点体现了"和血柔肝健脾"的治疗原则,印证了慢性乙型病毒性肝炎"肝病传脾、血络不和"的病机核心。

Objective:To establish a clinical medical record database for chronic hepatitis B virus and explore the experience of Professor Zeng Binfang in treatment of chronic hepatitis B.Methods :This study used the data mining methods such as complex network analysis and point mutual information method to explore the characteristics of drug treatment,compatibility rules and core knowledge of Professor Zeng Binfang in treatment of chronic hepatitis B.Results:The clinical data of 132 patients with 277 consecutive cases of chronic hepatitis B were collected.The commonly used drugs for chronic hepatitis B are sorted according to the degree of node:the composition of the drug is based on Xiaochaihu Decoction and Siwu Decoction,together with Chinese herbal medicines functioning in Shugan Jianpi,Ziyin Ruanjian Sanjie,Qingrejiedu and Lishi.The characteristics of the commonly used drugs are as follows :being mild cold or warm in Siqi,being sweet,bitter or pungent in flavor and going to Spleen,Lung and Liver in Guijing. The drug compatibility reflects the treatment thinking of soothing and regulating Liver Qi and activating Blood circulation.The law of medication fully embodies the thinking of prevention of disease.The treatment principle is based on the rules such as "Liver is in need of sweet food when its Qi is excessive","seeing the disease of Liver then knowing to strengthen Spleen as soon as possible,and "when Liver Qi is to be dispersed eating food or drugs being pungent to cure".In other words,using pungent drugs to soothe the Liver Qi and using durgs with bitter taste to clear Heat,detoxification and dispel Phlegm.It was found with point-based mutual information analysis that the commonly used drugs for chronic hepatitis B virus have the highest correlation between the TCM treatment of Shugan Liqi and Huoxue methods.It was found by using complex network analysis methods that the basic and core prescription in treatment of chronic hepatitis B is the following:It is mainly based on Xiaochaihu Decoction and Siwu Decoction,with the method of Hexue,Rougan and Jiangpi.Conclusion:Professor Zeng Binfang's prescription in treatment of chronic hepatitis B reflects the principle of Hexue,Rougan and Jiangpi,which confirms the core pathogenesis of chronic hepatitis B as "Liver disease transferring to Spleen due to Blood network disorder".