梁德治疗退变性腰椎管狭窄症用药规律的数据挖掘

Data Mining of Medication Rules for Degenerative Lumbar Spinal Stenosis Treated by LIANG De

【目的】采用数据挖掘方法探讨梁德教授治疗退变性腰椎管狭窄症(DLSS)的用药规律。【方法】收集梁德教授有效诊治DLSS患者的门诊处方,基于中医传承辅助平台软件(TCMISS V2.5),统计梁德教授治疗DLSS处方中各药物的使用频次、药物之间的关联规则等,挖掘潜在的新方组合。【结果】共纳入133首处方和73味药物。使用频次在20次以上的药物有26味,主要可分为补肝肾强筋骨类、祛湿类、活血止痛类、补气健脾类、滋阴疏肝类、行气理气类等。药物组合及核心药物组合分析结果显示梁德教授治疗DLSS用药以补益肝肾或健脾运湿为基础,随症加减。基于核心组合筛选得到3首潜在新方,其中新方1的组成为党参、苍术、生地黄、甘草、炙甘草、白术,新方2的组成为山药、枸杞子、泽泻、桃仁、酒山茱萸肉,新方3的组成为续断、杜仲、独活、金银花。【结论】梁德教授诊治DLSS用药以补益肝肾为主,常辅以健脾行气、清热除湿、活血化瘀等药,提示其诊治DLSS多从肝、脾、肾三脏入手,重视祛湿除热的临证经验和“筋骨并重”的治疗原则。

Objective To explore the medication rules for degenerative lumbar spinal stenosis(DLSS)treated by Professor LIANG De with data mining methods. Methods The outpatient prescriptions issued by Professor LIANG De for DLSS patients were collected. Based on the Traditional Chinese Medicine(TCM)Inheritance Support Platform(TCMISS V2.5),the medication frequency and the herbal association rules of the herbs in the outpatient prescriptions issued by Professor LIANG De for DLSS were analyzed, and then the potential new candidate prescriptions were mined out. Results A total of 133 prescriptions and 73 herbs were included for the analysis.There were 26 herbs with the medication frequency over 26 times, and the herbs can be classified into the categories of herbs for tonifying liver and kidney to strengthen bones and muscles,herbs for dispelling dampness,herbs for activating blood and relieving pain, herbs for replenishing qi and strengthening spleen, herbs for nourishing liver and soothing liver,and herbs for activating qi and regulating qi. The analysis results for herbal combinations and core herbal combinations showed that Professor LIANG De focused on tonifying liver and kidney or strengthening spleen to remove dampness by modified treatment according to the symptoms of DLSS. A total of3 new candidate prescriptions were derived from the core herbal combinations. The new prescription 1 was composed of Radix Codonopsis, Rhizoma Atractylodis, Radix Rehmanniae, Radix Glycirrhizae, Radix Glycirrhizae Preparata, and Rhizoma Atractylodis Macrocephalae. The new prescription 2 was composed of Rhizoma Dioscoreae,Fructus Lycii,Rhizoma Alismatis,Semen Persicae,and wine-prepared Fructus Corni.The new prescription 3 was composed of Radix Dipsaci,Cortex Eucommiae,Radix Angelicae Pubescentis,and Flos Lonicerae. Conclusion For the treatment of DLSS,Professor LIANG De usually adopts the herbs for tonifying liver and kidney, and uses the herbs of strengthening spleen and activating qi, clearing heat and removing dampness, and activating blood and resolving stasis for adjuvant therapy, which embodies the thoughts of Professor LIANG De in differentiating and treating DLSS from the liver, spleen and kidney, addresses the importance of dispelling dampness and clearing heat,and paying equal attention to sinew and bone.