基于单兆伟教授临证医案的胆汁反流性胃炎用药经验解构分析

Analysis on the experience of medicine administration for Bile Reflux Gastritis based on professor SHAN Zhao-wei's clinical cases

目的:探讨名医单兆伟教授治疗胆汁反流性胃炎的用药经验。方法:临床采用Medcase V3.2数据记录挖掘系统对2011-2013年单兆伟教授诊疗医案实时记录,构建单教授医案数据库,以"胆汁反流性胃炎"为核心检索词,进行库内多维度数据检索,将结果导出为二级数据病种专库,对用药经验解构分析。结果:数据专库中,临证医案415诊次,涉及中药153味,累计用药频次4 122次,单处方药均数为10;高频药物依次为白术、薏苡仁、仙鹤草、太子参、半夏、蛇舌草、麦冬、浙贝母、百合、葛根;涉及药性类别前8类依次为补虚、清热、利水渗湿、化痰止咳平喘、止血、解表、理气、消食。结论:单兆伟教授治疗胆汁反流性胃炎着眼于脾胃虚弱的发病之本,气机升降失调的病机关键,热邪、湿邪、痰邪、气滞、食滞的病理因素,临证多以健脾益胃、调畅气机立法,组方遣药主张轻灵、平和的孟河特色。

Objective： To explore the medication experience of professor SHAN Zhao-wei in treating Bile Reflux Gastritis （BRG）. Methods：All the clinical cases which were diagnosed and treated by Prof. SHAN Zhao-wei in 2011 - 2013 have been recorded into Medcase V3.2 database in real-time. The database was searched in multiple dimensions by taking ＇BRG＇ as the key word, with the related data retrieved from and constituted a secondary single disease database; medication experience for BRG was analyzed. Results：There were 415 cases treatment in the secondary single disease database, 153 Chinese herbal medicines were used with 4 122 times of using in total; averagely 10 herbal medicines constitute a prescription. High frequently used herbal medicines were, in frequency order, Rhizoma Atractylodis Macrocephalae, semen coicis, Herba Agrimoniae, radix pseudostellariae,Rhizoma Pinelliae, Hedyotis diffusa, Radix Ophiopogonis, Thunberg Fritillary Bulb, bulbus lilii and Radix Puerariae; The herbal medicines used could be categorized into ten types： tonifying, cleating away heat, clearing damp and promoting diuresis, eliminating phlegm and relieving cough and asthma, hemostasis, diaphoretics, regulating Qi, promoting digestion, blood activating and stasis resolving, mind calming. Conclusion： When treating BRG, professor SHAN Zhao-wei mainly focused on the essential cause spleen and stomach weakness, with the key etiology of dis-harmonization of the ascending and descending activity of Qi, taking consideration the pathological factors such as heat, damp, phlegm, stagnation and food retention as well. The treatment method was mainly to tonify spleen and stomach and to regulate Qi, the formulation selected and medication used were more light and mild in property that embodies the feature of Menghe medical school.