数据挖掘《伤寒杂病论》中方剂治疗心律失常的规律研究

Study on the law of treating arrhythmia with data mining “Shanghan Zabing Lun”

目的运用数据挖掘方法探索《伤寒杂病论》中方剂及其加减方治疗心律失常的规律。方法以1979-01-01—2016-12-31公开发表的运用《伤寒杂病论》中方剂治疗心律失常的临床文献为研究对象,根据《国际疾病分类标准编码(ICD-10)》和《中医病证分类与代码》将纳入数据进行病名规范后录入Excel 2010,并进行频数分析。参照第8版《内科学》中相关内容并根据数据挖掘关联规则要求将部分病名进行合并及病名简称处理,并按照纳入原则选取有具体疾病诊断的数据进行方剂与心律失常疾病之间的关联规则数据挖掘,运用Apriori算法及Python语言处理,以SQL Server 2008 R2统计分析软件作为数据挖掘工具,以"概率"和"重要性"2个指标结合频次、临床实际等对方剂与具体心律失常疾病之间的关联进行多角度分析。结果应用《伤寒杂病论》中方剂治疗快速性心律失常的文献共479篇,涉及方剂57首(包括合方),其中炙甘草汤应用频次最高(212次);治疗缓慢性心律失常的文献共408篇,涉及方剂47首(包括合方),其中麻黄细辛附子汤应用频次最高(153次);麻黄细辛附子汤与慢房颤、病窦综合征之间可能存在有意义关联。结论快速性心律失常多符合气血阴阳俱虚的炙甘草汤证,缓慢性心律失常则以阳气虚衰的麻黄细辛附子汤证研究居多,且慢房颤与病窦综合征的病因病机及表现更符合麻黄细辛附子汤证,临床对这2种疾病的诊疗思考可从麻黄细辛附子汤证入手。

Objective Through data mining method to explore the ＂Shanghan Zabing Lun＂ prescription and its addition and subtraction guidelines for the treatment of arrhythmia law.Methods The clinical literature on the treatment of arrhythmia with Zhang Zhongjing＇s ＂Shanghan Zabing Lun＂ was published between 1979-01-01-2016-12-31. The included data were standardized according to the International Classification of Diseases Standards （ICD-10） and the Classification and Code of TCM Syndrome, and then entered into Excel 2010, and frequency analysis was performed. Referring to the relevant contents of the 8th edition of Internal Medicine, according to the requirement of data mining association rules, the disease names are merged and abbreviated. According to the inclusion principle, the association rules between prescriptions and arrhythmia diseases are selected for data mining, and Apriori algorithm and Python language are used for data mining. Using SQL Server 2008 R2 statistical analysis software as a data mining tool, the association between specific arrhythmias and prescriptions was analyzed from multiple perspectives by combining ＂probability＂ and ＂importance＂ with frequency and clinical practice. Results There were 479 papers on the treatment of tachyarrhythmia with Chinese prescriptions in ＂Shanghan Zabing Lun＂, involving 57 prescriptions （including compound prescriptions）, of which Zhigancao decoction was the most frequently used （212 times）. A total of 408 papers dealing with bradyarrhythmia included 47 prescriptions （including compound prescriptions）, of which Mahuang Xixin Fuzi decction were the most frequently used （153 times）. Mahuang Xixin Fuzi decoction may be associated with chronic atrial fibrillation and sick sinus syndrome. Conclusion Rapid arrhythmia is more consistent with Zhigancao decoction of qi and blood and Yin and Yang deficiency. Slow arrhythmia is more consistent with Mahuang Xixin Fuzi decoction of Yang deficiency. And the etiology, pathogenesis and performance of slow atrial fibrillation and sick sinus syndrome are more in line with Mahuang Xixin Fuzi decoction syndrome. Clinical considerations for the diagnosis and treatment of these two diseases can be started from the Mahuang Xixin Fuzi decoction syndrome.