痰瘀同治方治疗心绞痛现代医案用药规律的关联规则分析

Exploration on Medication Law of Medical Records of Angina Pectoris of Coronary Heart Disease Treated by Dissolving Phlegm and Activating Blood Stasis Prescription based on Association Rules

目的:分析痰瘀同治方治疗冠心病心绞痛的用药规律。方法:检索中国生物医学文献数据库,中国知网、万方数据库、维普数据库所收录的痰瘀同治方治疗心绞痛医案,建立数据库,运用频数统计与关联规则(apriori算法、复杂系统熵聚类)分析痰瘀同治方中常用药物配伍、组方与证治规律。结果:共选取符合标准的医案115首,所用中药共132味。瓜蒌、丹参、薤白、川芎、半夏、黄芪、茯苓、当归、陈皮是治疗冠心病心绞痛医案痰瘀同治方中出现频次较高的药物;其药物四气以温、平、寒药为主,五味以苦、甘(淡)、辛为主,药物归经以归心经、肝经、脾经为主;痰瘀同治方治疗心绞痛频次较多的药对为瓜蒌与薤白或半夏、瓜蒌与丹参、丹参与川芎或黄芪及半夏与茯苓或陈皮;出现频率最多的3味药物组合为瓜蒌、薤白与半夏或枳壳;核心组方为瓜蒌薤白半夏汤、川芎当归散、茯苓川芎汤与黄芪丹参汤等化裁而成。结论:现代临床医者应用痰瘀同治方治疗冠心病心绞痛的配伍用药规律为化痰药、活血化瘀药与补益气血药、理气药、祛湿药的结合为主;治法治则为活血化瘀,理气化痰,养心通脉。

Objective： To analyze the laws of medication for the modern medical cases of Angina pectoris of coronary heart disease treated by dissolving phlegm and activating blood stasis prescription. Methods： By retrieving the medical records related to Angina pectoris of Coronary Heart Disease treated by dissolving phlegm and activating blood stasis prescription by Sino Med, CNKI,WANFANG and VIP Database from January 1994 to November 2017, and then we set up a medical records database. The commonly used drug compatibility and formula composition laws were analyzed with frequency statistics and association on rules. Results： A total of115 standard medical cases were included, with 132 Chinese medicine used. The frequently-used medicinals were Gualou（Trichosanthes kirilowii）, Danshen（Salvia miltiorrhiza）, Xiebai（macrostem onion）, Chuanxiong（Ligusticum wallichii）, Banxia（Pinellia ternata）, Huangqi（Astragalus）, Fuling（Poria cocos）, Danggui（Angelica sinensis）,Chenpi（dried tangerine）. The mainly nature of drugs was warm, plain and cold, mainly taste of drugs was bitter,sweet（tasteless）, and pungent, and the channel tropism of drugs distributed to heart, spleen, and liver. The high frequent couplet medicines in dissolving phlegm and activating blood stasis prescription in treating angina pectoris were Trichosanthes kirilowii and macrostem onion or Pinellia ternata, Trichosanthes kirilowii and Salvia miltiorrhiza, Salvia miltiorrhiza and Ligusticum wallichii or Astragalus membranaceus, and Astragalus and Pinellia ternata and poria or tangerine peel; the most frequent three kinds of combination of drugs were Trichosanthes kirilowii, macrostem onion and Pinellia ternate or Fructus aurantii. The core prescriptions were Gualou Xieba iBanxia Decoction（瓜蒌薤白半夏汤） and Chuanxiong Danggui powder（川芎当归散）, Fuling Chuanxiong Decoction（茯苓川芎汤） and Huangqi Danshen decoction. Conclusion： The Chinese medicine category used with high frequency of modern physicians clinical treatment in Angina pectoris of Coronary Heart Disease by dissolving phlegm and activating blood stasis prescription were dissolving phlegm herbs, activating blood stasis herbs, Tonic-qi herbs, qi-regulating Herbs and Invigorating spleen herbs, seasoned with Drying wetness herbs. The treating principles and therapeutic methods is activating blood and dissolving stasis, regulating the flow of qi to eliminate phlegm and nourishing heart unclogged arteries.