基于数据挖掘探析名老中医余国友治疗胃肠功能衰竭用药规律

Prescription regularity of famous veteran traditional Chinese medicine Doctor Yu Guoyou for treating gastrointestinal failure based ondata mining

胃肠功能衰竭是一种严重的全身性炎症反应,常并发多脏器功能不全综合征,中西医结合治疗具有较好的疗效。该研究收集名老中医余国友主任医师中医药治疗89例胃肠功能衰竭的175张处方,通过数据挖掘探析、统计其中药及中药类别频数、频率,采用系统聚类方法分析其用药规律,总结余老的常用药物及处方。研究结果显示药物使用频次前3位的是厚朴、枳实、大黄,均为小承气汤的组成成分;使用中药中以补虚药、理气药、清热药、化痰药、化湿药为最常用类别,补虚药里又以占比达2/3的补气药为主;同时挖掘出新处方和新的药物组合,可作为临床用药参考。研究结果表明,余老临床辨证胃肠功能衰竭多以脾胃气虚为本,以热毒、血瘀、气滞、湿阻为标,论治胃肠功能衰竭常以健脾、理气、泻下通腑为主,依证配合化瘀解毒、化湿利浊、清热化痰等方药,辨证施治,随症加减,在治疗过程中重视"胃气"的调养和胃肠功能的恢复。

Gastrointestinal failure is a kind of severe systemic inflammatory response,and often complicated with multiple organ dysfunction syndrome. Integrated traditional Chinese and Western medicine have a better curative effect in treating it. This study collected the famous veteran TCM physician Yu Guoyou＇s 175 prescriptions for treating 89 cases of gastrointestinal failure,calculated the frequency of traditional Chinese medicines and their categories,and analyzed the medication regularity with system clustering method,so as to summarize Yu＇s frequently used drugs and prescriptions. The results showed the top three most frequently used drugs aremagnolia bark,bitter orange,andrhubarb,which are components of Xiaochengqi decoction; Among the traditional Chinese medicines,medicines of tonifying deficiency,regulating qi,clearing heat,eliminating phlegm and dissipating dampness are most commonly used. Among thetonic medicines,those for tonifying Qi accounted for 2/3,which was the largest proportion; At the same time,some new prescriptions and new drug combinations were excavated and could be used as thereference for clinical medication. According to the findings,when differentiating syndromes of gastrointestinal failure,Yu regards the spleen and stomach Qi deficiency as theroot cause and the heat toxin,blood stasis,Qi stagnation and dampness as the symptoms. In the treatment of gastrointestinal function failure,Yu gives priority to strengthening spleen,regulating Qi and purgation,prescribes medicines fordissolving blood stasis and detoxication,dissipating dampness,clearing heat and eliminating phlegmaccording to syndrome types. In other words,the treatment is based on syndrome differentiation,and the prescription is modified according to symptoms. In particular,Yu attaches importance to stomach-Qi recuperation and gastrointestinal function recovery in the process of treatment.