基于数据挖掘《赵炳南临床经验集》中辨治湿疹外用方的用药规律

Rules of external prescription in the clinical diagnosis and treatment of eczema in Zhao Bingnan’s Clinical Experience Collection based on data mining

目的:对《赵炳南临床经验集》中关于赵炳南治疗湿疹外用方的方药进行数据分析,为现代中医临床诊治湿疹病证提供参考。方法:收集《赵炳南临床经验集》中赵炳南治疗湿疹的临床病案,构建临证方药数据库,运用IBM SPSS Modeder18.0和SPSS Statistics 23.0软件对其药物的使用频次、药物功效、性味归经等进行统计分析。结果:根据纳入及排除标准进行数据清洗,最终符合条件的方剂共计24首,包含中药52味,用药总频次共计261次。数据结果显示,赵炳南治疗湿疹的高频常用药物中使用次数位于前三位的分别是黄柏(14次)、苦参(13次)和苍术(12次);药物功效使用频率较高的是清热药和攻毒杀虫止痒药,分别为23.08%(12/52)和17.31%(9/52);药性以寒性药使用频次最高(24次),药味则多选用辛味、苦味、甘味;按药物归经划分,使用频次最高的为肝经(24次),其次是脾经和肺经。通过关联分析,共得到关联数据18条(8条二项、8条三项、2条四项),核心组合为"苍术-白鲜皮-大风子-防风-薄荷"。核心药物聚类分析得到4类药组,分别是清热除湿解毒组合C1:青黛-威灵仙-白矾;收湿敛疮组合C2:麻油-五倍子-大风子;清热燥湿组合C3:苍术-大黄;清热止痒组合C4:黄柏-苦参。结论:从赵炳南辨治湿疹的外用方剂中了解到,其在治疗时善用具有发散功能的辛味药物及能够清热燥湿的苦寒类药物,旨在驱散外感风热湿邪,以黄柏、苦参、苍术为代表方药;在药物归经上多使用归肝脾二经的药物,以祛风止痒,收湿敛疮为目的;组方思路多以清热解毒,燥湿止痒的药物相配为主;外用剂型多样,有能够快速祛湿止痒的散剂;能够润滑和保护肌肤的膏剂;能够滋养润肤的油剂及能够清洁止痒的洗剂,患者可根据不同的症状来选择合适的剂型,提高治疗效果。《赵炳南临床经验集》中治疗湿疹的外用方剂的用药规律及学术思想对指导临床实践具有重要意义,值得继承和推广。

Objective: To analyze the prescriptions and drugs in the clinical diagnosis and treatment of eczema in Zhao Bingnan’s Clinical Experience Collection and to provide a reference for clinical diagnosis and treatment of eczema in modern Chinese medicine.Methods: Collecting the clinical records of treating eczema in Zhao Bingnan’s Clinical Experience Collection, and constructing the clinical prescription database. Using SPSS moder 18.0 and SPSS statistics 23.0 software to analyze the frequency of drug use, drug efficacy,property, taste and meridians. Result: According to the inclusion and exclusion criteria get on the data cleaning, there are 24 prescriptions that finally meet the requirements, including 52 traditional Chinese medicines and 261 times in total. According to the data, the top three drugs used by Zhao Bingnan in the treatment of eczema were phellodendron(14), Sophora flavescens(13) and Chinese atractylodes(12);the most frequently used drugs are heat-clearing drugs and antipruritic drugs, 23.08%(12/52) and 17.31%(9/52) respectively;the cold medicine is the most frequently used medicine(24), and the spicy, bitter, sweet taste is the most frequently used;according to the division of drug meridian, the most frequently used channel is liver channel(24), followed by spleen channel and lung channel. Through association analysis, a total of 18 associated data(8 two items, 8 three items, 2 four items) are obtained, the core combination is "Chinese atractylodes, fresh white skin, big maple seed, windbreak and alum". Cluster analysis of core drugs to get four drug groups, they are heat clearing, dehumidification and detoxification combination C1: Qingdai(青黛), Weilingxian(威灵仙) and alum;dehumidification and eliminating sores combination C2: Sesame oil, gallnut, and big maple seed;heat cleaning eliminating dampness combination C3: Chinese atractylodes and rheum officinale;heat clearing and itching relieving combination C4: phellodendron and Sophora flavescens. Conclusion:It is learned from Zhao Bingnan’s external prescriptions for the treatment of eczema that he is good at using pungent drugs with divergent function and bitter cold drugs that can clear away heat and dampness. The aim is to disperse the exogenous wind-heat and dampness, cortex phellodendri, sophora flavescens and Chinese atractylodes are the representative prescriptions. In order to dispel wind and relieve itching,to collect dampness and astringent sores, the drugs of liver and spleen channel are used more frequently. The main idea of the prescription is to clear away heat and detoxify, dry dampness and antipruritic drugs. Most of the prescriptions are mainly composed of drugs for clearing away heat and detoxification, drying dampness and relieving itching. There are various external dosage forms, such as powder which can quickly dispel dampness and relieve itching, paste that can lubricate and protect skin, oil that can nourish and moisturize skin and lotion that can clean and relieve itching, patients can choose the appropriate dosage form according to different symptoms to improve the therapeutic effect. The medication rules and academic thoughts of external prescriptions for eczema in Zhao Bingnan’s Clinical Experience Collection are of great significance for guiding clinical practice, and are worthy of inheritance and promotion.