张声生教授辨治溃疡性结肠炎中医临证经验

Professor Zhang Shengsheng′s TCM Clinical Experience in Syndrome Differentiation and Treatment of Ulcerative Colitis

目的:深度挖掘并系统总结张声生教授治疗消化科疑难性疾病溃疡性结肠炎(UC)的临床经验,分析张教授的组方用药规律,临证策略与思路。方法:本研究收集张教授门诊治疗UC病例资料97例,总计289诊次,并运用我团队与中国中医科学院中医药信息研究所共同合作开发的“病案一体化数据挖掘系统”进行分析处理。结果:通过数据分析得到张教授治疗UC核心处方:炙黄芪、炒白术、薏苡仁、黄连、木香、白扁豆、三七粉、地榆炭。常用药对有:1)炒白术、炙黄芪、地榆炭;2)薏苡仁、白扁豆、山药;3)黄芩、黄连、木香、白芍;4)延胡索、仙鹤草、三七粉;5)当归、香附;6)防风、葛根。药物随证加减规律为::1)腹胀伴有肠鸣时,多用槟榔、木香、焦神曲;2)腹痛伴大便脓血时,多用延胡索、地榆炭、仙鹤草;3)里急后重时多用黄连、儿茶、三七粉;4)畏寒时多用炮姜、肉桂;5)口苦时多用黄连、连翘。结论:运用“病案一体化数据挖掘系统”分析了UC的症状和证候规律,总结了张声生教授中医临证策略与思路。

Objective:To explore the traditional Chinese medicine(TCM)clinical experience of Professor Zhang Shengsheng in the treatment of ulcerative colitis(UC)in the gastroenterology department and analyze his medication regularity and clinical strategies.Methods:This study collected the Data of 97 UC patients treated by Professor Zhang in the outpatient clinic,with 289 visits in total.The data were analyzed and processed by Integrated Medical Record Data Mining System co-built by this research team and Institute of Information on Traditional Chinese Medicine,China Academy of Chinese Medical Sciences.Results:Data analysis revealed that the core prescriptions formulated by Professor Zhang in the treatment of UC contained Astragali Radix Praeparata cum Melle,fried Atractylodis Macrocephalae Rhizoma,Coicis Semen,Coptidis Rhizoma,Aucklandiae Radix,Lablab Semen Album,Notoginseng Radix et Rhizoma powder,and processed Sanguisorbae Radix.The commonly used drug combinations were:1)fried Atractylodis Macrocephalae Rhizoma-Astragali Radix Praeparata cum Melle-processed Sanguisorbae Radix,2)Coicis Semen-Lablab Semen Album-Dioscoreae Rhizoma,3)Scutellariae Radix-Coptidis Rhizoma-Aucklandiae Radix-Paeoniae Radix Alba,4)Corydalis Rhizoma-Agrimoniae Herba-Notoginseng Radix et Rhizoma powder,5)Angelicae Sinensis Radix-Cyperi Rhizoma,and 6)Saposhnikoviae Radix-Puerariae Lobatae Radix.The modification principles of prescriptions are listed below.1)Arecae Semen,Aucklandiae Radix,and Massa Medicata Fermentata were added in the context of abdominal distension accompanied by borborygmus.2)Corydalis Rhizoma,processed Sanguisorbae Radix,and Agrimoniae Herba were added in the context of abdominal pain accompanied by purulent and bloody stool.3)Coptidis Rhizoma,Catechu,and Notoginseng Radix et Rhizoma powder were added in the context of tenesmus.4)Zingiberis Rhizoma Praeparatum and Cinnamomi Cortex were added in the context of aversion to cold.5)Coptidis Rhizoma and Forsythiae Fructus were added in the context of bitter taste in mouth.Conclusion:The present study analyzed the symptoms and syndrome rules of UC by the Integrated Medical Record Data Mining System and summarized the TCM clinical strategies and ideas of Professor Zhang.