基于数据挖掘探讨李庆生治疗干眼用药规律

Investigation on the medication rules of LI Qingsheng in the treatment of dry eye based on data mining

目的通过数据挖掘李庆生主任医师治疗干眼的用药规律,将名老中医临证经验数据化以便更好地传承其学术思想。方法选取2013年11月4日—2018年11月6日李庆生治疗干眼的病历资料共计79份。将患者姓名、年龄、性别及处方用药信息输入Excel建立数据库,统一中药名称后,对药物的属性、用药频次和功效进行分析,采用Ward联结聚类算法进行聚类分析。结果(1)一般状况:79份医案共涉及中药102味。其中四气以寒性(40味,39.22%)最多,五味以甘味(47味,46.08%)最多,归经以肝经(29味,28.43%)最多。(2)辨证分型:共涉及4个证型,分别为肝肾亏虚、阴血不足证(40次,50.63%),邪热留恋证(27次,34.18%),肺阴不足证(10次,12.66%),脾胃湿热证(2次,2.53%)。(3)用药频率:用药频率>20%的药物(核心药物)共有21味,用药频率排在前6位的分别是甘草(75次,94.94%)、麦冬(70次,88.61%)、北沙参和山药(各62次,78.48%)、菊花和枸杞子(各61次,77.22%)。(4)核心药物功效分类:21味核心药物中,以补虚药(10味,47.62%)最多,其次为清热药(6味,28.57%),解表药(2味,9.52%)。(5)聚类分析:得到3类组方,功效分别是为益气补阴、清热解表;清热解表、凉血泻火;养阴补血、清热泻火、引药上行。同时又得到5个药对:甘草-麦冬;密蒙花-白芷;玉竹-熟地黄;桔梗-黄芩;阿胶-石斛。结论李庆生对干眼的主要治疗原则为补虚、清热、解表,用药主要从肝肾、肺、脾胃的调治入手,有3类组方分别用于肺阴不足证,邪热留恋证,肝肾亏虚、阴血不足证。

OBJECTIVEThrough data mining, LI Qingsheng’s medication rules for treating dry eye were digitized, so as to better inherit his academic ideas.METHODSA total of seventynine medical records of dry eye treated by LI Qingsheng from November 4,2013 to November 6,2018 were selected. Patients’ name, age, gender and prescription medication information were input into Excel to establish a database. After unifying the name of Chinese medicines, their attribute, medication frequency and efficacy were analyzed, and Ward connection clustering algorithm was used for cluster analysis.RESULTS(1) General information: In these seventy-nine medical records, 102 kinds of Chinese medicines were used. Among them, the cold property (fourty drugs, 46.08%) was the most common in the four properties, the sweet flavor(forty-seven drugs, 46.08%)was the most common in the five flavors, and the liver meridian(twentynine drugs, 28.43%) was the most common in the channel tropisms.(2) Syndrome differentiation: There were four syndrome typesinvolved, which were liver and kidney deficiency, Yin and blood deficiency syndrome(forty times,50.63%), pathogenic heat lingering syndrome(twenty-seven times, 34.18%), lung Yin deficiencysyndrome(ten times, 12.66%), damp heat in the spleen and the stomach syndrome(two times,2.53%).(3) Medication frequency: There were twenty-one core Chinese medicines(frequency ofutilization>20%). The top six Chinese medicines were licorice(seventy-five times, 94.94%), radix ophiopogonis(seventy times, 88.61%), radix glehniae(sixty-two times, 78.48%), Chinese yam(sixty-two times, 78.48%), chrysanthemum(sixty-one times, 77.22%), and Chinese wolfberry(sixtyone times, 77.22%).(4) Efficacy classification of core Chinese medicines: Among the twenty-onecore Chinese medicines, the deficiency-nourishing medicines(ten drugs, 47.62%) were the most,followed by heat-clearing medicines(six drugs, 28.57%), and exterior-relieving medicines(twodrugs, 9.52%).(5) Cluster analysis: Three medicine combinations were obtained, with the effectsof benefiting Qi and Yin, clearing heat and resolving exterior symptoms, clearing heat andresolving exterior symptoms, cooling blood and clearing fire, nourishing Yin and blood, clearingheat and purging fire, and inducing medicine to move upward. At the same time, five drug pairswere obtained: Licorice-radix ophiopogonis, butterflybush flower-radix angelicae, radix polygonati officinalis-prepared rehmannia root, Platycodon grandiflorum-Scutellaria baicalensis georgi,donkey hide gelatin-Caulis dendrobii.CONCLUSIONSThe investigation indicated that DoctorLI Qingsheng’s main treatmnet principles for treating dry eye were tonifying deficiency, clearingheat and resolving exterior symptoms. The Chinese medicines were mainly used to regulate liver,kidney, lung, spleen and stomach. There were three medicine combinations for lung Yin deficiencysyndrome, pathogenic heat lingering syndrome, liver and kidney deficiency syndrome, Yin andblood deficiency syndrome.