基于隐结构辨证规则的9323例中医古籍咳嗽病案的方-证分析

Prescriptions and Syndromes of 9323 Cough Cases in Ancient Chinese Medical Books Based on Rules of Latent Structure Differentiation

目的:探索基于隐结构辨证规则的中医古籍咳嗽医案以方测证规律。方法:提取古籍中医肺病数据库内咳嗽病案9323例,先用Lantern5.0(孔明灯)软件构建频次>100的前120味中药隐结构模型,再对获得的隐变量进行综合聚类和隐类诠释,最后通过综合聚类的辨证规则分析咳嗽的证候分布规律。结果:对120味中药建模得到46个隐变量,114个隐类,按照贝叶斯信息测度(BIC)评分,模型分数为-161242.92,模型图形成以Y0,Y5,Y7,Y13,Y35,Y38为核心,且Y36,Y38,Y24,Y19,Y17涉及4个隐类。根据隐结构流线图汇总出10个综合聚类模型,其中Z5外寒内饮证的分值8.4最高,提示Z5的辨证规则结果支持度较高,中药半夏的互信息0.31和信息覆盖度63%最高;Z2肺气阴两虚证的分值-2最低,五味子的分值-15最低,提示Z2的辨证规则支持度较低;Z6风热犯肺证和Z10痰瘀阻肺证中连翘、羌活的分值均为19.1最高,提示这2味中药对其贡献度较大。以方测证得出咳嗽的常见证候有凉燥袭肺、肾阴虚、肺肾阴虚、外寒内饮、风热犯肺、肝火犯肺、肺热炽盛、痰湿阻肺、痰瘀阻肺9种,新发现的咳嗽证型有外寒内饮证和痰瘀阻肺证。结论:基于隐结构辨证规则的以方测证完善了咳嗽的证候分型,为中医隐性知识的显性化提供思路,同时为其他疾病的证候完善也提供方法参考,并有利于开发有价值的新处方。

Objective:To explore cough cases recorded in ancient traditional Chinese medicine(TCM)books based on the Rules of Latent Structure Differentiation.Method:The 9323 cough cases in the database of ancient TCM books and pulmonary diseases were extracted.At first,Lantern 5.0 software was used to construct the top 120 TCM hidden structure model with the frequency>100.Then,the obtained hidden variables were comprehensively clustered and interpreted.Result:The 46 hidden variables and 114 hidden classes were obtained through the modeling of 120 traditional Chinese medicines.According to the bayesian information measure(BIC)score,the model score was-161242.92.The model diagram was formed with Y0,Y5,Y7,Y13,Y35 and Y38 as the cores,and Y36,Y38,Y24,Y19 and Y17 involved 4 hidden classes.Ten comprehensive clustering models were summarized according to the hidden structure flow chart,among which the highest score of Z5 external cold and internal decoction syndrome was 8.4,indicating that the result of syndrome differentiation rules of Z5 had a high degree of support,and the highest mutual information degree and information coverage of Pinellia sinensis were 0.31 and 63%.Z2 had a low score for the syndrome of deficiency of lung qi and Yin,which was-2,and Schisandra had the lowest score of-15,indicating that the syndrome differentiation rules of Z2 was less supportive.Forsythia and Notopterygium both had the highest score of Z6 wind-heat attack lung syndrome and Z10 phlegm and blood-stasis pulmonary syndrome,which was 19.1,indicating that these two TCMs had a great contribution to it.According to the test,the common syndromes of cough were cold and dryness attacking the lung,kidney-Yin deficiency,kidney-Yin deficiency of the lung,cold and internal decoction,wind heat invading the lung,liver fire invading the lung,lung heat burning,phlegmdampness blocking the lung,phlegm-stasis blocking the lung.The newly discovered cough syndromes were external cold and internal rheum syndrome and phlegm-stasis blocking the lung syndrome.Conclusion:Based on the syndrome differentiation rules of hidden structure,the improved classification of cough syndromes provides ideas for the demonstration of tacit knowledge of TCM and methodological reference for the improvement of syndromes of other diseases,and is conducive to the development of valuable new prescriptions.