国医大师诊治胃脘胀痛用药规律探析

Analysis of the Regularity of Diagnosis,Treatment and Medication of Epigastric Distention and Pain Treated by the Masters of Traditional Chinese Medicine

收集《国医大师验案良方·脾胃卷》中关于国医大师治疗胃脘胀痛的医案,建立医案数据库,采用古今医案云平台V2.2.3进行数据挖掘和分析。结果共纳入胃脘胀痛医案70个,涉及184味中药。四诊资料统计分析结果显示,胃脘胀痛的基本病机可分为肝胃失和及脾虚挟湿两类,治法以养胃阴、补益脾气、活血化瘀、理气、疏肝为主。治疗胃脘胀痛的高频药物为白芍、炙甘草、黄连、延胡索、半夏、甘草、白术、香附、厚朴、太子参等,性味以甘、温为主,主要入脾、胃、肝经。关联规则分析结果显示国医大师论治胃脘胀痛,虚则补之,采用养胃阴、补益脾气以治其本;实则泻之,采用活血化瘀、疏肝理气治其标。复杂网络分析得出核心方药组成为半夏、白术、黄连、白芍、延胡索、香附、甘草(炙甘草)。分析结果提示国医大师治疗胃脘胀痛多用入脾、胃二经之甘温药,采用养胃阴、补益脾气治法的同时不忘疏肝理气、活血化瘀,虚实兼顾,标本同调。

The medical cases of epigastric distention and pain treated by traditional Chinese medicine(TCM)masters recorded in the Proven Cases and Effective Prescriptions of Traditional Chinese Medicine Masters-Spleen and Stomach Volume were collected,and then the medical case database was established. The data mining and analysis were conducted on the Ancient and Modern Medical Cases Cloud Platform V2.2.3. The results showed that a total of70 cases of epigastric distention and pain involving 184 Chinese medicines were included. Statistical analysis of the data collected by the four diagnostic methods showed that the basic pathogenesis of epigastric distention and pain could be classified into two categories,namely disharmony of liver and stomach,and spleen deficiency blended with dampness. The treatment focuses on nourishing stomach yin, tonifying spleen qi, activating blood and removing stasis,regulating qi and soothing liver. The high-frequency herbs used for the treatment of epigastric distention and pain are Radix Paeoniae Alba, Radix Glycyrrhizae Preparata, Rhizoma Coptidis, Rhizoma Corydalis, Rhizoma Pinelliae, Radix Glycyrrhizae, Rhizoma Atractylodis Macrocephalae, Rhizoma Cyperi,Cortex Magnoliae Officinalis, Radix Pseudostellariae, etc., which are mainly sweet and warm in nature and mainly have the meridian tropism of the spleen,stomach and liver meridians. The results of the association rule analysis showed that during the diagnosis and treatment of epigastric distention and pain, the TCM masters follow the principle of treating deficiency with replenishment by adopting the methods of nourishing stomach yin and tonifying spleen qi to treat the root cause,and follow the principle of treating excess with purgation by adopting the methods of activating blood and resolving stasis, and soothing liver and regulating qi to treat the symptoms.Complex network analysis showed that the core formulae consist of Rhizoma Pinelliae, Rhizoma Atractylodis Macrocephalae, Rhizoma Coptidis, Radix Paeoniae Alba, Rhizoma Corydalis, Rhizoma Cyperi, Radix Glycyrrhizae or Radix Glycyrrhizae Preparata. The analysis results suggest that TCM masters treat epigastric distention and pain usually using the sweet and warm herbs with the meridian tropism of the spleen and stomach meridians,and they also utilize the methods of soothing liver and regulating qi,activating blood and removing stasis when focusing on nourishing stomach yin and tonifying spleen qi, so as to treat both of the deficiency syndrome and excess syndrome,and treat the symptoms and root cause simultaneously.