基于隐结构模型的名老中医辨治鼻渊用药规律研究

Research on the regularity of pharmaceutical use in differentiation and treatment of sinusitis by famous old TCM experts based on hidden structural model

目的:探究名老中医辨治鼻渊的病机、证候分型演变和用药规律。方法:以现代名老中医肺病数据库中349例鼻渊医案为数据源,先用Lantern 3.1.2软件建立症状和药物的隐结构模型再进行诠释,最后对挖掘结果进行分析讨论。结果:349例鼻渊医案频次≥5的症状59种、频次≥10的药物91味,常见的症状有鼻塞、鼻衄、头痛、流黄涕、头晕等;症状隐结构模型得到9个隐变量,含18个隐类,药物隐结构模型得到27个隐变量,含54个隐类。鼻渊病位有肺、脾、胃、胆,病理因素有外邪、湿热、气虚等,证型有脾气虚弱、痰湿阻肺、脾胃湿热、胆腑郁热、肺经郁热、肺阳虚、肺脾两虚、脾肾两虚,新发现外感风寒或风热、肺胃阴虚。名老中医辨治鼻渊的常用核心药物有辛夷、苍耳子、白芷、细辛、白术、防风、黄芪、山药、生地黄、赤芍、连翘等,核心方剂有苍耳子散、补中益气汤、温胆汤(霍胆丸)、四妙散(四妙勇安汤)、麻黄细辛附子汤(温肺止流丹)等。结论:本研究对鼻渊用药规律的探究对临床有一定的参考价值。

Objective:To explore the pathogenesis,the evolution of syndrome types and the law of medication in the differentiation and treatment of rhinorrhea by famous old TCM doctors.Methods:Based on 349 cases of sinusitis in the database of lung diseases of modern famous and veteran Chinese medicine,the hidden structure model of symptoms and drugs was established by Lantern 3.1.2 software and then interpreted.Finally,the mining results were analyzed and discussed.Results:There were 59 kinds of symptoms and 91 flavors of drugs with frequency(≥5)and frequency(≥10)in 349 cases of sinusitis.The common symptoms were nasal obstruction,epistaxis,headache,runny nose,dizziness,etc.Symptom implicit structure model got 9 hidden variables,18 hidden variables,drug implicit structure model got 27 hidden variables,54 hidden variables.The location of nasal origin is lung,spleen,stomach and gallbladder.Pathological factors include exogenous pathogens,dampheat and qi deficiency.Syndrome types include spleen qi weakness,phlegm-dampness obstructing lung,spleen-stomach dampheat,gallbladder-organ stagnation heat,lung-meridian stagnation heat,lung yang deficiency,lung-spleen deficiency,spleen-kidney deficiency,and newly found exogenous wind-cold or wind-heat,lung-stomach yin deficiency.The core medicines commonly used in the differentiation and treatment of rhinorrhea in famous old TCM are Flos Magnoliae,Fructus Xanthii,Radix Angelicae Dahuricae,Herba Asari,Rhizoma Atractylodis Macrocephalae,Radix Saposhnikoviae,Radix Astragali seu Hedysari,Rhizoma Dioscoreae,Radix Rehmanniae Recens,Radix Paeoniae Rubra,Fructus Forsythiae.The core prescriptions are Xanthium Powder,Buzhong Yiqi Decoction,Wendan Decoction(Huodan Pills),Simiao Powder(Simiao Yongan Decoction),Mahuang Xixin Fuzi Decoction(Wenfei Zhiliu Pills).Conclusion:This study has certain reference value for clinical research on the law of medication for sinusitis.