基于数据挖掘技术对徐燕主任治疗胸痹用药规律探微

Investigation on Medication Rule of Xu Yan in Treatment of Thoracic Obstruction Based on Data Mining

目的采用数据挖掘方法研究徐燕主任临床治疗胸痹的用药经验。方法收集2007—2019年徐燕主任门诊及病房治疗胸痹的有效医案,通过R语言arules包实现关联规则算法,确定医案中药物的使用频次、药物归经与药物组合的关联规则,分析医案中诊治胸痹病的用药经验。结果对筛选出的260例有效医案进行分析,得到使用频次>100的有16味药,包括白术、水蛭、山楂、黄芪等补气健脾、活血化瘀逐痹类药物为主;药物归经主要涉及心、脾、胃、肝、肾等经;常用药物组合共有19对(置信度>0.8),包括牡丹皮-丹参、白术-山楂-黄芪、黄芪-白术、当归-白术、山楂-白术等,常以补气健脾类药与活血祛瘀逐痹类药相配伍;挖掘核心药物组合共5对,分别为黄芪-山楂-水蛭、山药-山楂-水蛭、牡丹皮-丹参、白术-水蛭、白术-丹参-当归,擅用健脾养心、散瘀化结之法以治胸痹。结论由分析结果可以得出徐燕主任治疗胸痹过程中多以健脾补中与活血祛瘀逐痹之法相结合,攻补兼施,在继承“丁氏内科疗法”的基础上,形成了自身的临床用药特色,体现了以培土补心治疗胸痹的诊疗思路,为临床治疗胸痹提供了参考。

Objective To explore the experience of Director Xu Yan in the treatment of thoracic obstruction.Methods The cases of thoracic obstruction syndrome in the outpatient and ward of Xu Yan from 2007 to 2009 were collected,then we computed the frequency of each herb,the meridian distribution of each herb and association rules among the herbs by the algorithm of association rules using the R language rules package,we analyzed the medication experience and rule in prescription for thoracic obstruction.Results The selected 260 cases of thoracic obstruction syndrome were dealt with statistics,16 medicines with frequency of drug use(confidence>100)were obtained,including Atractylodes Macrocephala Koidz,Leech,Hawthorn,Astragalus and other drugs for invigorating qi and spleen,promoting blood circulation,removing stasis and eliminating arthralgia;drug meridian mainly involves heart,spleen,stomach,liver,kidney,etc;19 pairs of commonly used drug combinations(confidence>0.8)were mined from the database,such as Cortex Moutan and Salvia Miltiorrhiza,Atractylodes Macrocephala Koidz and Hawthorn and Astragalus,Astragalus and Atractylodes Macrocephala Koidz,Angelica Sinensis and Atractylodes Macrocephala Koidz,Hawthorn and Atractylodes Macrocephala Koidz,edc,the drugs of invigorating qi and spleen were often combined with those of promoting blood circulation and removing blood stasis and eliminating arthralgia.5 core combinations were excavated,they were Astragalus and Hawthorn and Leech,Rhizoma Dioscoreae and Hawthorn and Leech,Cortex Moutan and Salvia Miltiorrhiza,Atractylodes Macrocephala Koidz and Leech,Atractylodes Macrocephala Koidz and Salvia Miltiorrhiza and Angelica Sinensis,good at using the method of invigorating the spleen and nourishing the heart,,dispersing blood stasis and resolving stasis to treat thoracic obstruction.Conclusion From the analysis results,it can been seen that the thought for diagnosis and treatment of Director Xu Yan was to combine of invigorating the spleen and tonifying the middle part of the body with the method of promoting blood circulation,removing stasis and eliminating arthralgia,both attacking and supplementing.On the basis of inheriting“Ding’s internal medicine therapy”,she formed her own clinical medication characteristics which reflected the diagnosis and treatment thoracic obstruction by cultivating soil and nourishing heart,it provided a reference for clinical treatment of thoracic obstruction.