基于数据挖掘法的叶海教授治疗膝骨关节炎用药规律研究

A study of medication rule of Professor YE Hai in treatment of knee osteoarthritis based on data mining approach

目的:分析叶海教授治疗膝骨关节炎(knee osteoarthritis,KOA)的用药规律。方法:收集2017年9月至2019年5月,叶海教授为首次到宁波市中医院门诊就诊的211例KOA患者开具的211首中药处方。所有患者后期均获得定期复诊,且疗效肯定。将中药处方信息录入中国中医科学院中药研究所研制的中医传承辅助系统(V2.5),由2人负责数据审核,确保数据准确。使用软件进行频次统计分析,并基于关联规则和熵聚类进行组方规律分析,最终预测新的处方。结果:叶海教授开具的211首治疗KOA的处方中,使用频次居前6位的中药分别为防风(205次)、炒谷芽(205次)、延胡索(202次)、茯苓(200次)、制川乌(167次)、桑寄生(167次),使用频次居前3位的药物组合为防风-炒谷芽(200次)、延胡索-防风(197次)、延胡索-炒谷芽(197次)。挖掘出22个核心药物组合,分别为仙茅-姜半夏-怀牛膝、鸡内金-荆芥-炒白术、鸡内金-炒白芍-炒白术、芡实-炒白芍-肉苁蓉、芡实-炒白芍-炒白术、黄芩-蝉蜕-党参、龙骨-浮小麦-牡蛎、桑寄生-苍术-重楼、甘草-桂枝-酸枣仁、荆芥-姜半夏-细辛、酸枣仁-首乌藤-钩藤、太子参-党参-巴戟天、炒白芍-肉苁蓉-薏苡仁、炒白芍-肉苁蓉-火麻仁、怀牛膝-薏苡仁-通草、柴胡-熟地黄-陈皮、黄芩-甘草-桂枝、灯心草-甘草-酸枣仁-首乌藤、黄芩-甘草-桂枝-党参、黄芩-桂枝-太子参-党参、荆芥-柴胡-细辛-熟地黄、荆芥-细辛-熟地黄-炒白术。预测出6个新处方,处方1药物组成包括仙茅、姜半夏、怀牛膝、薏苡仁、通草,处方2药物组成包括鸡内金、荆芥、炒白术、炒白芍,处方3药物组成包括芡实、炒白芍、肉苁蓉、炒白术,处方4药物组成包括甘草、桂枝、酸枣仁、黄芩,处方5药物组成包括黄芩、甘草、桂枝、党参、太子参,处方6药物组成包括荆芥、柴胡、细辛、熟地黄、炒白术。结论:叶海教授治疗KOA用药注重个体化差异和顾护中焦,常以健脾益肾、益气养血、祛风散寒、行气化湿、疏肝和胃、豁痰化瘀立法。

Objective:To analyze the medication rule of Professor YE Hai in treatment of knee osteoarthritis(KOA).Methods:Two hundred and eleven traditional Chinese medicine(TCM)prescriptions issued by Professor YE Hai for 211 outpatients with KOA who were firstly treated in Ningbo Hospital of Traditional Chinese Medicine from September 2017 to May 2019 were collected.All patients were regularly followed up in the later period,and the positive curative effects were found.The information of TCM prescriptions were input into traditional Chinese medicine inheritance support system(TCMISS)(V2.5)developed by Institute of Chinese Materia Medica of China Academy of Chinese Medical Sciences,and the data was reviewed by 2 person for ensuring their accuracy.Frequency analysis was performed by using software and the prescription rules were analyzed based on association rules and entropy clustering for predicting new prescriptions.Results:In 211 TCM prescriptions issued by Professor YE Hai for KOA,the top 6 Chinese drugs with high occurrence frequency included saposhnikovia divaricata(205 times),parched fructus setariae germinatus(205 times),rhizoma corydalis(202 times),poria cocos(200 times),radix aconiti preparata(167 times),Chinese taxillus herb(167 times);and the top 3 drug combinations with high occurrence frequency included saposhnikovia divaricata-parched fructus setariae germinatus(200 times),rhizoma corydalis-saposhnikovia divaricata(197 times)and rhizoma corydalis-parched fructus setariae germinatus(197 times).Twenty-two core TCM combinations were found out,including curculigo orchioides-ginger processed pinellia-achyranthes bidentata,endothelium corneum gigeriae galli-schizonepeta tenuifolia-parched atractylodes macrocephala,endothelium corneum gigeriae galli-parched radix paeoniae alba-parched atractylodes macrocephala,euryale ferox-parched radix paeoniae alba-cistanche deserticola,euryale ferox-parched radix paeoniae alba-parched atractylodes macrocephala,scutellaria baicalensis-periostracum cicadae-codonopsis pilosula,os draconis-fructus tritici levis-concha ostreae,taxillus chinensis-atractylodes chinensis-paris polyphylla,glycyrrhiza uralensis-ramulus cinnamomi-semen ziziphi spinosae,schizonepeta tenuifolia-ginger processed pinellia-asarum heterotropoides,semen ziziphi spinosae-caulis polygoni multiflori-ramulus uncariae cum uncis,pseudostellaria heterophylla-codonopsis pilosula-morinda officinalis,parched radix paeoniae alba-cistanche deserticola-semen coicis,parched radix paeoniae alba-cistanche deserticola-fructus cannabis,achyranthes bidentata-semen coicis-medulla tetrapanacis,bupleurum chinense-radix rehmanniae praeparata-pericarpium citrus reticulata,scutellaria baicalensis-glycyrrhiza uralensis-ramulus cinnamomi,juncus effusus-glycyrrhiza uralensis-semen ziziphi spinosae-caulis polygoni multiflori,scutellaria baicalensis-glycyrrhiza uralensis-ramulus cinnamomi-codonopsis pilosula,scutellaria baicalensis-ramulus cinnamomi-pseudostellaria heterophylla-codonopsis pilosula,schizonepeta tenuifolia-bupleurum chinense-asarum heterotropoides-radix rehmanniae praeparata and schizonepeta tenuifolia-asarum heterotropoides-radix rehmanniae praeparata-parched atractylodes macrocephala.Six new predicted TCM prescriptions were obtained,and the drug combinations of the prescriptions were(1)curculigo orchioides,ginger processed pinellia,achyranthes bidentata,semen coicis and medulla tetrapanacis,(2)endothelium corneum gigeriae galli,schizonepeta tenuifolia,parched atractylodes macrocephala and parched radix paeoniae alba,(3)euryale ferox,parched radix paeoniae alba,cistanche deserticola and parched atractylodes macrocephala,(4)glycyrrhiza uralensis,ramulus cinnamomi,semen ziziphi spinosae and scutellaria baicalensis,(5)scutellaria baicalensis,glycyrrhiza uralensis,ramulus cinnamomi,codonopsis pilosula and pseudostellaria heterophylla,(6)schizonepeta tenuifolia,bupleurum chinense,asarum heterotropoides,radix rehmanniae praeparata and parched atractylodes macrocephala respectively.Conclusion:Professor YE Hai attaches importance to individual differences and middle-jiao protection and he often takes the medication rule as the policy in treatment of KOA,including invigorating spleen and replenishing kidney,reinforcing qi and nourishing blood,expelling wind and dispersing cold,activating qi-flowing and dissipating dampness,soothing liver and harmonizing stomach and resolving stasis and eliminating phlegm.