基于古今医案云平台的中医治疗失眠证治规律研究

Research on the rules of Traditional Chinese Medicine treatments of insomnia based on Ancient and Modern Medical Records Cloud Platform

目的挖掘中医辨证论治失眠的组方用药规律。方法筛选纳入古今医案云平台(V 1.5.7)古代医案、现代医案、名医医案及共享医案数据库中所收录的符合本研究要求的有关失眠的医案,应用平台软件中的频次分析、关联分析、药对分析等方法进行数据挖掘。结果共收集失眠医案664个,主要症状为入睡困难、早醒、睡眠表浅、睡中易醒、多梦等;出现频次排名前5位的证型包括痰热内扰证、心肾不交证、肝郁化火证、心脾两虚证、心神不宁证;共涉及处方664首,药物414味,出现频次排名前5位的药物依次为甘草、茯苓、生地黄、酸枣仁、当归,高频药物多以养心安神、清热化痰、疏肝解郁、滋阴降火药为主,所用药物多为平性、甘味,多归心经;使用频次前5位的药物组合包括牡蛎-龙骨、茯苓甘草、陈皮-茯苓、当归-生地黄、柴胡-甘草等。结论中医辨证失眠多从心论治,用药多以养心安神为主,辅以清化痰热、补益心脾、疏肝解郁、滋阴养血等药物,从而标本兼治,改善患者症状。

Objective To explore the rules of prescription and medication of Traditional Chinese Medicine(TCM)syndrome differentiation treatment for insomnia.Methods We screened the medical records related to insomnia from the ancient medical cases,modern medical cases,famous medical cases and shared medical record database,and then we put data into the Ancient and Modern Medical Case Cloud Platform(V 1.5.7).The platform software Data mining was applied and performed by frequency analysis,correlation analysis,and drug pair analysis.Results This study collected 664 cases related to insomnia,like difficulty in falling sleep,early waking up,easy to wake up,dreaminess.The top 5 syndromes included internal phlegm-heat,imbalance between heart-yang and kidney-yin,liver stagnation transforming into fire,heart and spleen deficiency,restless mind.There were 664 prescriptions,414 TCM medications,where the top 5 medications included Glycyrrhizae Radix et Rhizoma,Poria,Rehmanniae Radix,Ziziphi Spinosae Semen,Angelicae Sinensis Radix.The effect of high-frequency medications were nourishing the heart and calming the mind,clearing heat and dissipating phlegm,soothing the liver and relieving depression,and nourishing yin and yang.The top five drug-combinations included Ostreae Concha-Longgu,Poria-Glycyrrhizae Radix et Rhizoma,Citri Reticulatae Pericarpium-Poria,Angelicae Sinensis Radix-Rehmanniae Radix,Bupleuri Radix-Glycyrrhizae Radix et Rhizoma.Conclusions TCM syndrome differentiation for insomnia focus on the heart.The medications are mainly to nourish the heart and calm the mind,supplemented by clearing heat,replenishing heart and spleen,soothing the liver and relieving stagnation,nourishing yin and blood for the symptoms relief,with treatment priciple of seeking both temporary and permanent solutions.