基于名老中医刘吉善门诊病案的数据挖掘分析

Data Mining Analysis Based on Outpatient Medical Records of Famous and Experienced TCM Doctor LIU Jishan

目的基于国家级知名中医刘吉善4年的门诊病案,分析刘吉善主任医师擅长治疗的病种、遣方用药规律及其学术思想。方法本研究以2008年至2012年间刘吉善专家门诊病案为样本,采用内容分析方法,确定分析单元,设定分析类目,建立病案数据库,对病案各类目进行频数分析,对单味中药进行聚类分析,对中医病症诊断与方药进行关联分析。结果共纳入合格病案7873例,通过频数分析统计了刘吉善专家擅长治疗的疾病:不寐(523/6.64)、眩晕(465/5.91)、感冒(380/4.83)等,常用方剂:丹温方(2232/28.35)、藿陈方(1506/19.13)等及常用药:罗汉果(5818/73.90)、炒麦芽(4868/61.83)、炒神曲(4833/61.39)、炒山楂(4833/61.37)、酸枣仁(4690/59.57)、延胡索(4690/59.57)等;聚类分析发现了常用对药:C2<6,7>:酸枣仁、延胡索;C3<11,12>:莱菔子、砂仁;C3<9,16>:葶苈子、王不留行;C3<10,13>:大枣、全蝎;C4<26,39>:凌霄花、木槿花;C4<15,20>:天麻、炒杜仲;C4<31,37>:蝉蜕、僵蚕;C4<27,25>:百合、生地黄;关联分析发现:方剂清暑益气汤与伤暑病、荆防方与粉刺病、藿陈方与咳嗽病、感冒病呈强关联(L>3):丹温方与乳癖、不寐、眩晕、月经过少、痛经、郁证关联强度较高(L>1),对药天麻、杜仲与眩晕呈强关联(L>3),酸枣仁、延胡索与不寐关联强度较高(L>1)。结论刘吉善专家擅长治疗不寐、眩晕、咳嗽、感冒等疾病,擅长运用清暑益气汤加减治疗伤暑,藿陈方加减治疗感冒病及咳嗽,荆防方治疗粉刺病;擅长运用对药天麻、杜仲治疗眩晕,酸枣仁、延胡索治疗不寐;学术思想主要体现在擅长从肝论治诸多疾病及遣方用药重视顾护脾胃。

Objective Based on the 4 years’outpatient medical record of LIU Jishan,to analyze the chief physician LIU Jishan’s specialized treatment of diseases,medication rules and academic thoughts.Methods In this study,the clinical records of LIU Jishan’s expert outpatients from 2008 to 2012 were used as samples.The content analysis method was used to determine the analysis unit.The analysis categories were set.The medical record database was established.Frequency analysis was performed on various types of medical records.Cluster analysis was performed for single Chinese materia medica,and correlation analysis was conducted to TCM diagnosis and prescription.Results A total of 7873 qualified medical records were included.Through frequency analysis,the diseases that LIU Jishan experts were good at treating(number/frequency%)were:insomnia(523/6.64),dizziness(465/5.91),cold(380/4.83),etc.Common prescriptions were Danwen Recipe(2232/28.35),Huochen Recipe(1506/19.13),etc.and commonly used herbs were Fructus Momordicae(5818/73.90),fried Fructus Hordei Germinatus(4868/61.83),fried Massa Medicata Fermentata(4833/61.39),fried Fructus Crataegi(4833/61.37),Semen Ziziphi Spinosae(4690/59.57),Rhizoma Corydalis(4690/59.57),etc.;cluster analysis found common drug pairs:C2<6,7>:Semen Ziziphi Spinosae,Rhizoma Corydalis;C3<11,12>:Semen Raphani,Fructus Amomi Villosi;C3<9,16>:Semen Descurainiae,Semen Vaccariae;C3<10,13>:Fructus Jujubae,Scorpio;C4<26,39>:Flos Campsis,Flos Hibisci L;C4<15,20>:Rhizoma Gastrodiae,fried Cortex Eucommiae;C4<31,37>:Periostracum Cicadae,Bombyx Batryticatus;C4<27,25>:Bulbus Lilii,Radix Rehmanniae Recens;Correlation analysis found that prescription Qingshu Yiqi Decoction and summerheat damage disease,Jingfang Formula and acne disease,Huochen Formula and cough disease,and cold disease were strongly associated(L>3):Danwen Formula was strongly associated with breast Bi,insomnia,dizziness,less menstruation,dysmenorrhea,and depression syndrome(L>1).Drug pair of Rhizoma Gastrodiae and Cortex Eucommiae was strongly associated with dizziness(L>3).Semen Ziziphi Spinosae and Rhizoma Corydalis had a stronger association with insomnia(L>1).Conclusion Expert LIU Jishan is good at treating diseases such as insomnia,dizziness,cough,and cold.He is good at using modified Qingshu Yiqi Decoction to treat summerheat damage,modified Huochen Formula to treat cold and cough,and Jinfang Fang to treat acne disease.He is good at treating dizziness with Rhizoma Gastrodiae and Cortex Eucommiae,and insomnia with Semen Ziziphi Spinosae and Rhizoma Corydalis.His academic thoughts are mainly reflected in his ability to treat many diseases from the liver and to take care of the spleen and stomach when giving prescription and medication.