基于医案及数据挖掘的叶天士治疗崩漏用药规律研究

Research of YE Tianshi’s Herb-using Regulation in Metrorrhagia and Metrostaxis Based on Date Mining

目的：探索叶天士治疗崩漏用药规律及特点。方法：整理《临证指南医案》《未刻本叶氏医案》中关于崩漏的医案。采用EXCEL 2010、SPSS Clementine 11.1、SPSS 22.0、Liquorice软件对医案中的药物进行频数分析、关联规则分析、聚类分析和复杂网络分析。结果：（1）药物频数分析、药性特点分析：崩漏医案中常见的高频药物有：人参（0.66）、阿胶（0.51）、白芍（0.40）、茯神（0.34）、生地（0.31）、当归（0.29）、海螵蛸（0.23）、甘草（0.20）、茜草（0.20）等;温性、寒性药物使用较多且比重相当。（2）关联规则分析得出常用药组：两种药物的组合有4组,分别为：生地、阿胶;茜草、海螵蛸;茜草、鲍鱼;人参、甘草。3种药物的组合有4组：生地、阿胶、白芍;生地、人参、阿胶;茯神、白芍、阿胶;茜草、海螵蛸、鲍鱼。（3）聚类分析将频次≥5的高频药物分为5组,分别为：茜草、海螵蛸、鲍鱼;龟甲、牡蛎、柏子仁;女贞子、墨旱莲、白芍、生地、阿胶、天冬、茯神;艾叶、当归、甘草;茯苓、人参。（4）复杂网络分析得出核心处方药物为：人参、阿胶、白芍、生地、当归、茯神、墨旱莲、女贞子、海螵蛸。结论：叶天士治疗崩漏时,根据病情特点,灵活选择寒热之药、通涩并用之法;止血养血同时兼用安神潜阳以宁血海、生阴血;注重月经与奇经八脉、阳明经的关系,善用参苓阖阳明以固冲脉,而达止崩之效。

Objective：To research the herb-using regulation in metrorrhagia and metrostaxis of YE Tianshi. Methods：Collect the cases in clinical guide medical case and unpublished YE＇s medical records. Extract the herbs from those cases and process them with data mining methods,including correlation rule analysis,cluster analysis and complex network analysis,with EXCEL 2010,SPSS Clementine 11.1,SPSS 22.0,Liquorice software. Results：（1）The high frequency herbs in cases of metrorrhagia and metrostaxis are：ginseng（0.66）,donkey-hide gelatin（0.51）,Radix Paeoniae Alba（0.40）,Poria cocos（0.34）,Radix Rehmanniae（0.31）,Angelica Sinensis（0.29）,cuttlefish bone（0.23）,licorice（0.20）,Radix Rubiae（0.20）. Warm herbs and cold herbs are commoner used.（2）There are four 2-herb-groups through correlation rule analysis：Radix Rehmanniae donkey-hide gelatin,Radix Rubiae cuttlefish bone,Radix Rubiae abalone,ginseng licorice. And there are four 3-herb-groups through correlation rule analysis：Radix Rehmanniae donkey-hide gelatin Radix Paeoniae Alba,Radix Rehmanniae ginseng donkey-hide gelatin,Poria cocos Radix Paeoniae Alba sonkey-hide gelatin,Radix Rubiae abalone cuttlefish bone.（3）Based on the cluster analysis,high-frequency herbs can be divided into five groups：Radix Rubiae,abalone,cuttlefish bone;tortoise plastron,ostrea,platycladi seed;glossy privet fruit,eclipta,Radix Paeoniae Alba,Radix Rehmanniae,donkey-hide gelatin,asparagus,Poria cocos;folium artemisiae argyi,Angelica sinensis,licorice;poria,ginseng.（4）The core prescription according to complex network analysis are：ginseng,donkey-hide gelatin,Radix Paeoniae Alba,Radix Rehmanniae,Angelica sinensis,Poria cocos,eclipta,glossy privet fruit,cuttlefish bone. Conclusion：YE chose cold or warm herbs and nourishing or reducing methords by the characteristics of pathogenic condition when treating metrorrhagia and metrostaxis. Using tranquillizing herbs and Yang-subduing herbs with blood-nourishing herbs and hemostatic herbs to tonify blood and Yin. Attaching importance to the relationship of menstruation and eight extra meridians,Yangming meridian,from the angle of which using ginseng and poria to treat metrorrhagia and metrostaxis.