吴煜教授治疗脾肾两虚型胃癌的用药规律研究

Medication Rules of Professor Wu Yu in the Treatment of Gastric Cancer with the Deficiency of Spleen and Kidney

目的挖掘吴煜教授治疗脾肾两虚型胃癌的用药规律。方法收集2019年8月至2020年9月经吴教授诊治且病例完整的脾肾两虚证型胃癌医案,建立医案数据库,对处方中的中药频次、四气、五味、归经、功效进行统计分析,利用中医传承计算平台V3.0进行药物关联性分析、核心药物组合分析、类方分析及k-means算法与回归模型相结合的聚类分析。结果共纳入处方314首,包含药物117种。中药使用频次超过170次者包括太子参、黄芪、半夏、陈皮、甘草、鸡血藤、女贞子、木香、黄精、砂仁。所用中药的四气以温为主(50.08%),五味以甘为主(39.63%),归经以脾(25.08%)、肺(19.20%)、肾(14.31%)经居多,功效以补虚类(42.21%)居首。药物组合频次前3位为太子参-黄芪(304次),太子参-半夏(282次),黄芪-半夏(282次)。药物关联规则中,女贞子→太子参,陈皮→太子参,半夏、陈皮→太子参,黄芪、陈皮→太子参等组合置信度均为1。药物关系中,设置支持度个数160、置信度0.9时,半夏、太子参、黄芪、陈皮、麦芽、黄精、女贞子、木香、鸡血藤、甘草关联性最强。所得7个类方中,黄芪、太子参、半夏重复程度最高,其次为陈皮、鸡血藤、木香。结论吴煜教授对脾肾两虚证型胃癌的治疗以健脾益肾、益气填精补血为主,辅以理气运脾,兼顾化痰利湿、解毒祛瘀,注重不同层次运用中药。

Objective To summarize the medication rules of professor Wu Yu in the treatment of gastric cancer with the deficiency of spleen and kidney.Methods Completed medical records of gastric cancer with spleen and kidney deficiency syndrome from August 2019 to September 2020 treated by professor Wu Yu were collected,and a medical record database was establish to analyze the frequency,four Qi,five flavors,meridian tropism and effects of medicine.Traditional Chinese medicine(TCM)inheritance support system V3.0(TCMISS V3.0)was used to carry out the medicine correlation analysis,core medicine combination analysis,prescription analysis and cluster analysis of k-means algorithm combined with regression model.Results A total of 314 prescriptions were included,including 117 kinds of medicine.The frequency of use of TCM more than 170 times including Taizishen(Pseudostellariae Radix),Huangqi(Astragali Radix),Banxia(Pinelliae Rhizoma),Chenpi(Citri Reticulatae Pericarpium),Gancao(Glycyrrhizae Radix Et Rhizoma),Jixueteng(Spatholobi Caulis),Nvzhenzi(Ligustri Lucidi Fructus),Muxiang(Aucklandiae Radix),Huangjing(Polygonati Rhizoma),Sharen(Amomi Fructus).The four Qi of TCM was mainly warm(50.08%),the five flavors was mainly sweet(39.63%),and the main meridian tropisms were spleen(25.08%),lung(19.20%)and kidney(14.31%).The effect of supplementing deficiency(42.21%)ranked first.The first three medicine combinations were Taizishen(Pseudostellariae Radix)-Huangqi(Astragali Radix)(304 times),Taizishen(Pseudostellariae Radix)-Banxia(Pinelliae Rhizoma)(282 times),Huangqi(Astragali Radix)-Banxia(Pinelliae Rhizoma)(282).In the medicine association rules,the confidence of Nvzhenzi(Ligustri Lucidi Fructus)→Taizishen(Pseudostellariae Radix),Chenpi(Citri Reticulatae Pericarpium)→Taizishen(Pseudostellariae Radix),Banxia(Pinelliae Rhizoma)and Chenpi(Citri Reticulatae Pericarpium)→Taizishen(Pseudostellariae Radix),Huangqi(Astragali Radix)and Chenpi(Citri Reticulatae Pericarpium)→Taizishen(Pseudostellariae Radix)and so on were 1.In the medicine relationship,Banxia(Pinelliae Rhizoma),Taizishen(Pseudostellariae Radix),Huangqi(Astragali Radix),Chenpi(Citri Reticulatae Pericarpium),Maiya(Hordei Fructus Germinatus),Huangjing(Polygonati Rhizoma),Nvzhenzi(Ligustri Lucidi Fructus),Muxiang(Aucklandiae Radix),Jixueteng(Spatholobi Caulis),Gancao(Glycyrrhizae Radix Et Rhizoma)had the strongest correlation.Among the 7 kinds of formula obtained,Huangqi(Astragali Radix),Taizishen(Pseudostellariae Radix)and Banxia(Pinelliae Rhizoma)had the highest repetition degree,followed by Chenpi(Citri Reticulatae Pericarpium),Jixueteng(Spatholobi Caulis)and Muxiang(Aucklandiae Radix).Conclusion Professor Wu Yu's treatment of gastric cancer with spleen and kidney deficiency is mainly focus on strengthening the spleen and benefiting the kidney,replenishing Qi,filling the essence and replenishing blood,accompanied by regulating Qi and transporting spleen,and reducing phlegm and dampness,detoxifying and removing blood stasis,and using the drugs in diffenrent levels.