基于数据挖掘分析总结沈敏鹤病证结合治疗结直肠癌用药规律

Data-based Exploration on the Regularity of Herbal Medicine Treatment to Colorectal Cancer by Professor SHEN Minhe

目的分析总结沈敏鹤病证结合辨治结直肠癌的用药规律。方法收集沈敏鹤主任中医师门诊系统2014年8月1日—2015年7月31日诊治的结直肠癌病例,将患者临床信息转化为方剂基础数据库,对药物累计频数采用描述性分析,对各大证型中频数最高的药物进行系统聚类分析。结果共收集原发性结直肠癌病例100例,处方630个,用药303种,累计用药频次6744次。通过聚类分析结合沈敏鹤主任中医师临床经验,提炼出其常用组方有:益元汤、参苓白术散、三根汤、三仁汤、小柴胡汤、天麻钩藤饮、保和丸。常用药对或组合有:柴胡和炒黄芩、太子参和生白术、生地和麦冬、炒黄连和吴茱萸、陈皮和制半夏、制半夏和厚朴、虎杖根和藤梨根和水杨梅根。结论沈敏鹤病证结合诊治结直肠癌,临证多从"虚"、"湿"、"气"、"火"、"食"五大病机论治,辨病喜用三根汤,辨证多用经方。

Objective To explore the regularity of herbal medicine treatment to colorectal cancer by Professor SHEN Minhe. Methods Patients with colorectal cancer from Chinese medicine clinic system during August 1,2014, to July 31, 2015 were collected. All the clinical information was interpreted and converted into the basic prescription database. Then, the descriptive analysis on the cumulative frequency of medicals, and the hierarchialcluster analysis on the highest frequency of medicals treated to the major syndromes were performed. Results One hundred cases of primary colorectal cancer, 630 types of prescriptions, 303 drugs, and 6744 times of cumulative treatments were recruited. Through hierarchial-clustering analysis combined with the clinical experience from Dr.Shen, the frequent formula of Shen＇s prescriptions are summarized as the following： Yiyuan decoction, Shenling baizhu powder, Sangen decoction, Three-seeds decoction, Xiao Chaihu decoction, Tianma gouteng drink, Baohe pills. The common treated combinations are Chinese thorowax root with stir-frying baical skullcap root, heterophylly falsestarwort root with raw largehead atractylodes rhizome, dried rehmannia root with dwarf lilyturf tuber, stir-frying golden thread with medicinal evodia fruit, dried tangerine peel with Processed pinellia tuber, Processed pinellia tuber with officinal magnolia bark, giant knotweed rhizome, Chinese actinidia root with Japanese avens root. Conclusion From the analysis results of Shen＇s clinical management experience on colorectal cancer, we can see that Shen＇s used to treat the disease through five basic elements of pathogenesis： deficiency, dampness, qi, fire, food stagnation. His treatment based on disease differentiation, Sangen decoction and classical prescriptions were the commonest.