基于医案数据探讨明清医家及张鸣鹤辨治类风湿关节炎规律

Exploration on Regularity of Diagnosis and Treatment of Rheumatoid Arthritis by Physicians in Ming and Qing Dynasties and ZHANG Minghe Based on Medical Record Data

目的:通过对医案数据的分析,探讨明清医家及张鸣鹤教授辨治类风湿关节炎(RA)的规律。方法:运用《中华医典》电子丛书检索明清时期与RA相关的医案,对其中的病名、病因病机、证型、治则治法等进行分析;收集并整理张鸣鹤教授治疗的RA有效病例,运用SPSS 22.0软件统计分析其用药规律。结果:检索出明清时期与RA相关的医案103则,每则含患者1例、处方1首;病案中出现较多的病名有痹病(62.14%)、痛痹(15.53%)、历节病(5.83%)等;病因病机以外邪侵袭、正气亏虚、经络痹阻为主;证候分布实证居多;治法包括祛除外邪法(37.86%)、扶正祛邪法(24.27%)、化痰行瘀法(14.56%)、清热解毒法(13.59%)、温经通络法(9.71%)。张鸣鹤教授治疗RA高频用药的药味以苦、辛、甘味为主,药性以温、寒、平性为主,药类以清热药(351次)、祛风湿药(325次)、活血化瘀药(257次)为主。统计明清医案及张老验案遣方用药的特点,古今常用药物的主要药性、药味、归经及药物类别基本一致。结论:明清医家及张鸣鹤教授治疗RA的共性为均重视清热除痹法,但前者是在祛除外邪、补肾扶正基础上兼顾清热解毒,后者则结合现代患者的具体情况,更加重视清热解毒法;前者多以虫类药通络除痹,后者从用药安全性等方面考虑,多采用藤类药疏通经络。

Objective:To explore the regularity of diagnosis and treatment of rheumatoid arthritis(RA)by physicians in Ming and Qing Dynasties and Professor ZHANG Minghe through the analysis of medical records.Methods:Medical records related to RA in Ming and Qing Dynasties were searched from Chinese Medical Classic,and the name of the disease,etiology and pathogenesis,syndrome types,and treatment methods in the medical records were analyzed.Professor ZHANG Minghe’s successful cases of treating RA were collect and sorted out,then the SPSS 22.0 software was used to statistically analyze the medication regularity.Results:A total of 103 medical records related to RA in Ming and Qing Dynasties were retrieved,each containing one patient and one prescription.The most common disease names in the medical records were impediment syndrome(62.14%),painful impediment(15.53%),joint-running pain(5.83%),etc.The etiology and pathogenesis were mainly the invasion of external pathogens,deficiency of healthy qi,and obstruction of the meridians.In terms of syndrome type,it was mainly manifested as excess syndrome.The treatment methods included eliminating external pathogens(37.86%),supporting healthy qi to eliminate pathogens(24.27%),eliminating phlegm and resolving blood stasis(14.56%),clearing heat and removing toxin(13.59%),warming channels and dredging collaterals(9.71%).The medicines that Professor ZHANG Minghe often used in the treatment of RA were mainly bitter,pungent,and sweet in flavor,and the properties were mainly warm,cold and calm.The medicine categories were mainly heat-clearing medicines(used 351 times in total),wind-damp-dispelling medicines(used 325 times in total),and blood-activating and stasis-resolving medicines(used 257 times in total).According to statistics of the medical records of Ming and Qing Dynasties and the characteristics of Professor ZHANG’s prescriptions,the main properties,flavors,channel entries and categories of medicines commonly used in ancient and modern times are basically consistent.Conclusions:The commonality of physicians in Ming and Qing Dynasties and Professor ZHANG Minghe in the treatment of RA is that they both pay attention to clearing away heat and removing impediment.However,the former focuses on clearing heat and removing toxin based on eliminating external pathogens,tonifying kidney and reinforcing healthy qi,while the latter combines the specific conditions of modern patients and pays more attention to clearing heat and removing toxin.The former often used insects to dredge collaterals and remove impediment,while in the latter often used rattans to free the channels and collaterals from the perspective of drug safety.