丁氏内科严苍山流派四代传承治嗽用药分析

Drug utilization analysis of experience of four generations of doctors treating cough in YAN Cang-shan’s school of DINGs’ internal medicine

目的:通过对丁氏内科严苍山流派(简称丁氏严系)四代医家丁甘仁,严苍山,严世芸、潘华信,徐燕咳嗽病医案的收集和分析,探讨丁氏严系咳嗽病的诊疗经验及传承规律。方法:收集各医家医案,整理并制成数据库,运用R语言进行关联规则分析,总结其经验、规律。结果:揭示四代医家治咳用药的异同之处,其中苦杏仁是5位医家常用药物,前胡是除潘华信外4位医家常用药物;除丁甘仁外其他医家都贯常使用炙紫菀、枇杷叶、生甘草等药物,严世芸、潘华信和徐燕常用黄芪和黄芩;此外,严世芸善用百部、白芍、生石膏、桃仁、鱼腥草;潘华信善用炙款冬花、川贝粉、五味子;徐燕善用麦冬和生薏苡仁。结论:丁氏严系5位医家在治疗咳嗽病时注重肺燥一证,多取养阴清肺、润燥治咳之药。严世芸、潘华信深受丁甘仁、严苍山影响,结合当代气候、生活等条件的改变,六淫、五志皆可火化、燥化之现象,常取甘润养阴之药。徐燕承丁派治咳学验,不仅注重肺阴的养护,且重视脾土的健运,临床多加用健脾之药培土生金。

Objective:To explore the diagnosis and treatment experience and inheritance rules of cough in YAN Cangshan’s school of DINGs’internal medicine based on the collection and analysis of the medical records of the four generations of doctors(DING Gan-ren,YAN Cang-shan,YAN Shi-yun,PAN Hua-xin and XU Yan)of YAN Cang-shan’s school of DINGs’internal medicine.Methods:The data were extracted from the medical records of the doctors,the association rules were analyzed with R language,and their experience and rules were summarized.Results:The results reveal the similarities and differences of the four generations of doctors.Bitter apricot seed is a commonly used drug for the five doctors.Hogfennel root is a common drug used by the doctors except PAN Hua-xin.Aster,loquat leaf,raw licorice and other drugs are commonly used by the doctors except DING Gan-ren.Milkvetch root and baical skullcap root are commonly used by YAN Shi-yun,PAN Hua-xin and XU Yan.In addition,YAN Shi-yun makes good use of stemona root,debark peony root,plaster stone,peach seed,heartleaf houttuynia herb.PAN Hua-xin is good at using honey-fried coltsfoot flower,fritillary bulb powder and Chinese magnoliavine fruit.XU Yan is skilled in using dwarf lilyturf tuber and raw coix seed.Conclusion:The five doctors of YAN Cang-shan’s school of DINGs’internal medicine attached great importance to lung dryness in the treatment of cough,and they often used drugs that can nourish yin and clear lungs,moisten dryness and cure cough.YAN Shi-yun and PAN Hua-xin were deeply influenced by DING Gan-ren and YAN Cang-shan.They always took changes of contemporary climate and living conditions into consideration.Since six kinds of exogenous pathogenic factors and five kinds of emotions can convert into fire and dryness,they often use drugs that can nourish yin and moisten dryness.XU Yan inherited the experience of DINGs’School of internal medicine in treating cough.She not only focused on the maintenance of lung yin,but also on the healthy movement of spleen-earth.In clinical practice,she often used the Chinese medicine of strengthening spleen to cultivate the spleen-earth and generate lung-metal.