沈敏鹤辨证治疗脑肿瘤用药规律分析

Analysis on Laws of Syndrome Differentiation Prescription by SHEN Minhe to Treat Brain Tumor

目的总结沈敏鹤辨证治疗脑肿瘤的用药规律。方法纳入2012年2月至2014年2月沈敏鹤门诊脑肿瘤患者75例、624诊次,采集患者临床信息,建立临床方剂基础数据库,对药物频数、药物分类、药物性味采用描述性分析,并对频数最高的50种药物进行系统聚类分析。结果 75例患者624诊次共用药245种,累计用药频次7017,其中用药频次最高者为全蝎,其后依次为茯苓、川芎、陈皮、枸杞子、炙甘草、炒白术、郁金、制半夏;药物类别使用频次最高者是补虚药,其次为平肝熄风药、活血化瘀药、清热药及利水渗湿药;药性使用频次最高者为平性,药味使用频次最高者为甘味。聚类分析将药物分为29类,涉及方剂半夏白术天麻汤、杞菊地黄丸、补阳还五汤,涉及药对郁金与石菖蒲,砂仁与豆蔻、女贞子与墨旱莲、川芎与葛根、枳实与厚朴、钩藤与石决明、天花粉与麦冬。结论沈敏鹤治疗脑肿瘤常以补益脾肾为主,随证辅以熄风通络、活血化瘀、解毒抗癌、化痰利水之法,临证用药善于甘、辛、苦、平配伍。

Objective To conclude SHEN Minhe＇s laws of syndrome differentiation prescription in the treatment of brain tumor. Methods Records of 75 patients with brain tumor,who visited SHEN Minhe＇s clinic from February2012 to February 2014,with 624 clinical visits in total,were collected. Clinical information was collected and clinical prescription database was established to conduct descriptive analysis on the cumulative frequency,categories,and natures and tastes of medicinals. Also cluster analysis was applied to 50 medicinals with the highest frequency.Results Totally 245 medicinals were prescribed in 624 clinical visits with 75 patients. The cumulative frequency of medicinals was 7017,in which Quanxie（ Scorpio,全蝎） had the highest frequency,followed by Fuling [Poria cocos（ Schw.） Wolf,茯苓],Chuanxiong（ Ligusticum chuanxiong hort,川芎）,Chenpi（ Citrus reticulata Blanco,陈皮）,Gouqizi（ Lycium barbarum L.,枸杞子）,Honey cooked Gancao（ Radix Glycyrrhizae,炙甘草）,stir-fried Baizhu（ Atractylodes macrocephala,炒白术）,Yujin（ Curcuma petiolata,郁金）,proccessed Banxia（ Pinellia ternata,制半夏）. The most frequently used medicinal category was tonify deficiency medicine,followed by the categories of suppressing liver to stop liver-wind,activating blood to dissolve stasis,clearing the heat,and clearing damp and promoting diuresis. The most frequently used nature was neutral,while the most frequently appeared flavor was sweet.The medicines were classified into 29 categories by cluster analysis,involving formulas including Banxia Baizhu Tianma Tang,Qiju Dihuang Wan,Buyang Huanwu Tang,and medicinal pairs including Yujin（ Curcuma petiolata,郁金）and Shichangpu（ Acorus tatarinowii,石 菖 蒲）,Sharen（ Amomum villosum Lour.,砂 仁） and Doukou（ Alpinia katsumadai,草豆蔻）,Nüzhenzi（ Ligustrum lucidum Ait.,女贞子） and Mohanlian（ Herba Echiptae,墨旱莲）,Chuanxiong（ Ligusticum chuanxiong hort,川芎） and Gegen（ Puerariae Radix,葛根）,Zhishi（ Citrus aurantium L.,枳实） and Houpo（ Magnolia officinalis Rehd. et Wils.,厚朴）,Gouteng [Uncaria sinensis（ Oliv.） Havil.,钩藤]and Shijueming（ Concha Haliotidis,石决明）,Tianhuafen（ Trichosanthis Radix,天花粉） and Maidong（ Ophiopogon japonicus,麦冬）. Conclusion In the treatment of brain tumor,Dr. SHEN Minhe mainly invigorates the spleen and kidney with the supplemental methods and associates with methods of stopping liver-wind and unclogging meridians,activating blood to remove stasis,resolving toxins to resist cancer,and expelling phlegm and alleviating water retention. And he is good at prescribing Chinese medicines with nature of sweet,pungency,bitter and neutral as compatibility in clinic.