国医大师周仲瑛辨治甲状腺癌医案集内关联解析研究

Intra-set correlation analysis of medical records of thyroid cancer treated by traditional Chinese medicine Master ZHOU Zhongying

目的 基于集内关联分析对国医大师周仲瑛辨治甲状腺癌中医临床医案进行解构,分析国医大师周仲瑛对于甲状腺癌的“机-证-药-方”经验。方法 通过Medcase数据处理平台,基于频繁模式增长(FP-Growth)加强关联分析算法,对2001年6月1日至2015年2月28日国医大师周仲瑛辨治甲状腺癌医案进行集内关联分析。结果 本次研究涉及医案43则,共43位患者,167诊次。集内关联运算处理后,选取高关联症状28组,高关联舌象21组,高关联脉象10组,高关联病机28组,高关联药物34组,高关联西医诊断26组。国医大师周仲瑛辨证治疗甲状腺癌,产生关联规则较多的症状有颈部肿胀、颈部疼痛、咳嗽、口干;产生关联规则较多的舌象有质隐紫、质暗红、有裂纹;产生关联规则较多的脉象有弦、细、小、滑;产生关联规则较多的病机有痰瘀互结、湿热内蕴、气阴两伤;产生关联规则较多的药物有柴胡、泽漆、天冬;产生关联规则较多的西医诊断有甲状腺癌、失眠、慢性胃炎。结论 甲状腺癌多属本虚标实,基本病机为痰瘀互结、湿热内蕴、气阴两伤,与肝、肾、脾关系密切。国医大师周仲瑛以攻补兼施为总原则,强调理气解郁、化痰散结、化湿泄浊、清火败毒、润燥软坚、益气养阴,重视滋养肝肾、补益脾胃,兼顾心肺。

Objective Based on intra-set correlation analysis, this paper deconstructs the clinical medical records of traditional Chinese medicine(TCM) Master ZHOU Zhongying in treating thyroid cancer, and analyzes the experience in “mechanism-syndrome-medicine-prescription” for thyroid cancer.Methods Through Medcase data processing platform, based on Frequent Pattern(FP)-Growth enhanced correlation analysis algorithm, the medical records of Professor ZHOU Zhongying for the treatment of thyroid cancer from June 1, 2001 to February 28, 2015 were analyzed within the set.Results This study involved 43 medical records, 43 patients, and 167 visits. After processing intra-set correlations, 28 groups of highly correlated symptoms, 21 groups of highly correlated tongue images, 10 groups of highly correlated pulse conditions, 28 groups of highly correlated pathogenesis, 34 groups of highly correlated herbs, and 26 groups of highly correlated western medicine diagnosis were selected. Professor ZHOU Zhongying treats thyroid cancer according to syndrome differentiation. Symptoms with more association rules included neck swelling, neck pain, cough, and dry mouth;tongue images with more association rules included dark purple tongue, dark red tongue, and fissured tongue;pulse conditions with more association rules were wiry pulse, thready pulse, small pulse, and slippery pulse;the pathogenesis with more association rules was phlegm and blood stasis, damp-heat accumulation,and impairment of both Qi and Yin;herbs with more association rules were Chaihu(Bupleuri Radix), Zeqi(Sun Euphoribiae Herb), and Tiandong(Asparagi Radix);western medicine diagnosis with more association rules included thyroid cancer, insomnia, and chronic gastritis.Conclusion Thyroid cancer mostly presents as deficiency in origin and excess in manifestations. The basic pathogenesis is phlegm and blood stasis, damp-heat accumulation, and impairment of both Qi and Yin, which are closely related to liver, kidney, and spleen. Professor ZHOU Zhongying adopts both attack and supplement approaches as the general treatment principle, with a strong emphasis on regulating Qi and relieving depression, eliminating phlegm and resolving stagnation, eliminating dampness and turbidity, clearing fire and destroying poison, moistening dryness and softening hard mass, invigorating Qi and nourishing Yin, and paying attention to nourishing liver and kidney, invigorating spleen and stomach,while protecting the heart and lungs.