古代医籍胃癌医案用药规律的发掘研究

Research on Medication Rule of Gastric Adenocarcinoma in Ancient Medical Books

目的:挖掘整理古代医籍中治疗胃癌的医案,探析其用药规律,为临床治疗胃癌提供借鉴。方法:查阅1911年以前以“噎膈”“反胃”为主症的医案,基于中医传承辅助平台软件建立处方数据库,挖掘高频药物,分析高频药物的四气、五味、归经、功效等,对统计结果进行分析。结果:共收入23本医案的154张处方,涉及中药376味,药物使用总频数1300次。高频药物前30味分别为制半夏、茯苓、白茯苓、半夏、代赭石、陈皮、当归身、枇杷叶、干姜、杏仁、瓜蒌皮、淡吴萸、橘红、淡干姜、白芍、吴茱萸、川黄连、淮山药、生姜、炙甘草、竹茹、枳壳、白蜜、泽泻、丁香、薤白头、白术、桃仁、麦冬等。高频药物按功效分类主要为理气药、温里药、平肝熄风药、利水渗湿、温化寒痰药;药性以温性药为主,其次为寒性药;五味以甘味为主,继之辛味;药物归经前5位分别是胃经、脾经、大肠经、肺经、心经等。结论:古代医籍中胃癌医案的用药有一定规律性,治疗以温阳开浊为主。

Objective:To excavate and sort out the medical records of treating gastric cancer in ancient medical books and analyze the medication rule,in order to provide references for treatment of gastric cancer in clinical practice.Methods:Representative medical works of gastric cancer written by medical experts of the past dynasties prior to the late Qing Dynasty(1911)were reviewed and a data of prescriptions of gastric cancer was established through the Traditional Chinese Medicine Inheritance Assistant Platform Software(V2.5)to find high-frequency drugs,then we analyzed the four qi,five tastes,meridian and efficacy of high-frequency drugs,and the statistical results.Results:A total of 154 prescriptions were collected,involving 376 kinds of Chinese medicinal,with a total frequency of 1300 times.The top 30 frequently used drugs were Rhizoma Pinelliae,Poria,white Poria,Rhizoma Pinelliae,Daizheshi,Pericarpium Citri Reticulatae,Dangguishen,Folium Eriobotryae,Rhizoma Zingiberis,Semen Armeniacae Amarum,Pericarpium Trichosanthis,Danwuyu,Exocarpium Citri Rubrum,Dan Rhizoma Zingiberis(Radix Paeoniae Alba,Fructus Evodiae,Chuanlian,Huai Rhizoma Dioscoreae,Rhizoma Zingiberis Recens,roasted Radix Glycyrrhizae,Zhu Caulis Bambusae in Taenia,Fructus Aurantii,Baimi,Rhizoma Alismatis,Flos Caryophylli,Xie Baitou,Rhizoma Atractylodis Macrocephalae,Semen Persicae,Radix Ophiopogonis.The high frequency drugs were classified according to their efficacy into regulating qi-flowing medicine,warming interior medicine,diuresis and diffusing dampness medicine,warmly resolving cold-phlegm medicine.The main property of drug was warming,followed by cold.The medicinal flavor was mostly sweet,followed by acrid.The top 5 channel tropism of drugs were stomach meridian,spleen meridian,large intestine meridian and lung heart meridian respectively.Conclusion:In ancient medical books,the drug use of gastric cancer medical cases has certain regularity,and the treatment is mainly to warm yang and open turbidness.