基于临床医案的国医大师唐由之用药规律分析

An analysis on the law of Tang Youzhi's medication based on clinical medical cases

目的分析国医大师唐由之教授治疗眼科疾病的用药规律,以期为经验传承及临床治疗提供参考。方法检索、收集、整理出2012—2014年国医大师唐由之门诊病历中中药处方231张,对获取的处方中药数据进行规范化处理,利用古今医案云平台v1.5集成数据挖掘功能对中药数据进行频次统计、聚类分析、关联分析,得到唐由之教授治疗眼科疾病的常用药物及其属性、分类,常用药对,核心方药组成。结果唐由之教授常用治疗眼病中药有生黄芪、炙黄芪、丹参、枸杞子、当归、覆盆子、白蒺藜等。四气五味方面常用温性药物、平性药物,甘味药物频次明显高于其他。聚类分析显示以欧式距离为12可分为三组:第一组为生黄芪、炙黄芪等;第二组为白蒺藜、沙苑子、车前子等。中药关联分析显示常用药物组合为生黄芪-炙黄芪;丹参-生黄芪;当归-丹参等。中药功效显示唐由之教授治疗此类疾病多用具有固精缩尿、明目、养肝明目、益气补中、补益肝肾等功效的药物。结论唐由之教授在临床治疗眼科疾病中坚持“气血理论”为指导,注重益气补中、补益肝肾。善于使用生、炙黄芪联用等方法发挥药对的作用。在治则治法和药物选用上互为作用。

OBJECTIVE To analyze the medication rule of Tang Youzhi, National Master of Chinese Medicine, in the treatment of ophthalmic diseases, in order to provide references for experience inheritance and clinical treatment. METHODS From 2012 to 2014, 231 Traditional Chinese Medicine prescriptions by Tang Youzhi in the outpatient medical records were retrieved, collected and sorted out. And the integrated data mining function of medical record cloud platform v1.5 were used to carry out frequency statistics, cluster analysis and correlation analysis on the data of Traditional Chinese Medicine, so as to obtain the commonly used herbs and their attributes, classifications, commonly used drug pairs, and core prescription composition of Tang Youzhi in the treatment of ophthalmic diseases. RESULTS Prescriptions for eye diseases of Professor Tang Youzhi, common includes raw astragalus, roasted astragalus, rooted salvia, wolfberry, angelica,raspberry, tribulus terrestris, etc. Analysis based on four qi and five flavors showed that the herbs with warm and plain nature were most frequently used, and the frequency of sweet herbs was significantly higher than other drugs. Cluster analysis showed that according to the European distance of 12 the herbs were divided into three groups: raw Astragalus, roasted Astragalus, etc;Tribulus terrestris, semen astragali complanati, plantain seed, etc;Poria, Kochia, etc. Traditional Chinese Medicine association analysis showed that the commonly used drug combinations were roasted astragalus, raw astragalus, rooted salvia,astragalus, angelica, rooted salvia, etc. The efficacy of Traditional Chinese Medicine showed that Professor Tang Youzhi often used herbs with the functions of consolidating essence, reducing urine, brightening eyes, nourishing liver, brightening eyes, supplementing qi and tonifying middle,etc. CONCLUSIONS In the clinical treatment of ophthalmic diseases, Professor Tang Youzhi insists on the theory of qi and blood as the guidance and pays attention to the invigoration of qi and kidney. He is skilled at using the combination of raw and roasted astragalus and other paired herbs to exert their combined effects. The treatment principles, methods and drug selection are delicately selected to be mutual promoting.