《临证指南医案》中治疗淋浊的用药规律

Pharmaceutical Rules for the Treatment of Linzhuo in Medical Records of Clinical Guidelines

目的:通过分析《临证指南医案》中治疗淋浊的医案,探讨叶天士治疗淋浊的用药特色。方法:选取符合纳入标准的医案建立数据库,采用频数、聚类、关联规则等方法分析叶天士治疗淋浊的用药规律。结果:本研究共纳入44首方剂药物105味,用药总频次是295次,平均每方用药少于7味,高频使用药物共18味占47. 8%。药性最高频为寒性,药味最高频为甘味,药效最高频为补虚,归经最高频为肾经,聚类分析得到4组多味药物聚合组和7组药对聚合组。关联规则得到6组药对关联组和1组多味药关联组。结论:叶天士认为淋属肝胆、浊属心肾,并提出了奇脉病的概念以治疗淋浊,数据挖掘中得出的高频用药、药对及药物组合为其基础用药。

Objective:To analyze the regularity of applying TCM in treatment of stranguria with turbid discharge disease in A Guide to Clinical Practice with Medical Record.Methods:To select medical cases that meet the inclusion criteria,and input into database trimmed after unified standard,Medication laws of stranguria with turbid discharge by YE Tian-shi of TCM were analyzed using frequency analysis,cluster analysis,and so on.Results:forty-four compound prescriptions for stranguria with turbid discharge disease were selected including 105 herbs with less than 7 herbs in every prescription.The total frequency of herb usage was 295.The accumulated usage frequency of 18 commonly used traditional Chinese medicines accounted for 47.5%.The four natures of herbs used commonly was cold herbs.The five flavours of herbs used commonly was sweet herbs.The categories of herbs used commonly was herbs for restoring vital energy.The channel tropism of herbs used commonly was kidney channel.Four highly frequent cluster prescriptions and eight highly frequent cluster herb pair were summarized based on the cluster analysis.The rules in pair of herbs were 6,and rules in group of herbs was 1 by association analysis.Conclusion:According to YE Tian-shi,stranguria belongs to liver and gallbladder,turbidity belong to heart and kidney,and the concept of Qi meridian disease is put forward to treat stranguria with turbid discharge.