基于中医个体化诊疗平台和无尺度网络的2型糖尿病中药性味网络分布特征分析

Analysis on the distribution characteristic of the taste and nature of traditional Chinese herbs treating type 2 diabetes mellitus based on the TCM individualized diagnosis and treatment platform and Scale-Free network model

[目的]通过研究实际临床中治疗2型糖尿病的中药运用情况,以"以方(药)测证"和"以方(药)说理"的"药—证"关系理论及方法,来逆向探寻中医对2型糖尿病的证候分类。[方法]采用中医个体化诊疗平台(中医药临床信息采集系统)收集2型糖尿病住院病历信息,以"病-症-证-治-药-效"模型将其构建数据仓库,采用无尺度网络分析的方法对其治疗药物加以分类,从中找出主要治则,一方面为糖尿病的中药治疗提供参考,另一方面从中推导糖尿病的中医证候分类。[结果]共有3 247例2型糖尿病住院病历信息(起自2004年6月—2006年12月)被纳入研究,从中显现出三大网络结构,其中每个网络中常用的60种中药,其中心分别为:1)"清热凉血、养阴生津"中药,如生地、麦冬、玄参、赤芍、知母等,其中寒凉类药物为主;2)"益气养阴"中药,以生地、太子参、白术、茯苓、白芍、麦冬为主;3)"活血、行气、利水、渗湿、温阳化气"中药。这三大网络结构提示,三阶段糖尿病证型分别为阴虚热盛、气阴两虚,和阴阳两虚三大证候,同时还兼夹了瘀血、痰湿、水饮等证候因素。[结论]实际临床中2型糖尿病的中医证候分类实质为阴虚热盛、气阴两虚和阴阳两虚三大证候,并可兼夹瘀血、痰湿等邪气,为当前国内最为广泛的3型辨证理论体系提供重要的临床证据,同时,本研究结果中的药物,也将成为临床糖尿病治疗中的重要参考。

[Objective] By retrieval of the traditional Chinese herbs appled to treat type 2 diabetes mellitus（T2DM）in real world, with＂ detecting syndrome by therapeutic herbs（formulas）＂method and＂ interpreting theory by therapeutic herbs（formulas）＂philosophical idea in＂herb-syndrome＂theory and method, to reversely probe into TCM syndrome differentiation or classification on T2DM in real world. [Methods] Inpatient medical record information of T2DM collected by the TCM individualized diagnosis and treatment platform（clinical information collection system of traditional Chinese medicine）, with the ＂disease-symptom-differentiation syndrome-treatmentherb-effect＂model, was constructed into a data warehouse, by using scale-free network model, the taste and nature of these therapeutic herbs were classified, and from the classifications, the main treatment principles were find out, as on the one hand to provide reference for TCM berb choice in treating diabetes, on the other hand, to derive the TCM syndrome differentiations from these classifications. [Results] Medical record information of 3 247 cases of T2DM inpatients were included in the study, and three network structures of characteristic distribution emerged, where60 commonly used herbs in each network were shown. The centers of these network structures respectively were as follows： 1） herbs of＂eliminating heat and cooling blood, nourishing Yin and producing body fluid＂in nature, such as Sheng Di Huang（Radix Rehmanniae）, Mai Dong（Radix Ophiopogonis）, Xuan Shen（Radix Scrophulariae）, Chi Shao（Radix Paeoniae Rubra）, Zhi Mu（Rhizoma Anemarrhenae）, etc., mainly herbs of cold in nature; 2） herbs of＂the supplementing qi and nourishing Yin＂in nature, such as Sheng Di Huang（Radix Rehmanniae）, Tai Zi Shen（Radix Pseudostellariae）, Bai Zhu（Rhizoma Atractylodis Macrocephalae）, Fu Ling（Poria cocos）, Bai Shao（Radix Paeoniae Alba）, Mai Dong（Radix Ophiopogonis）, etc.; 3） herbs of＂invigorate the circulation of blood and Qi, expelling retained fluid and dampness, warming Yang to produce Qi＂in nature. Three big network structures suggested that the syndrome types of T2DM in three stages were respectively excess heat and Yin deficiency; both Qi and Yin deficiency; and Yin and Yang deficiency, often accompanied with syndromes of blood stasis, phlegm, dampness, and retained fluid, etc. [Conclusion] In real world, the clinical essence of TCM Syndromes of T2DM are three major syndromes, i.e., excess heat and Yin deficiency, both qi and Yin deficiency, and Yin and Yang deficiency, which may be accompanied with blood stasis and phlegm and/or dampness pathogens, as can provide important clinical evidence for the ＂three-typed＂syndrome differentiation theory system currently most extensively applied in domestic. Besides, the herbs found in this real-world based study may provide useful reference for TCM berb choice in treating diabetes.