基于数据挖掘探讨蜀地伤寒田曾流派临证辨治模式

Pattern of syndrome differentiation-based treatment of typhoid fever in Sichuan Province of China by Tian-Zeng Academic School: A study based on data mining

目的:通过串联审视田曾流派治案之药、方证与诊法联系规律,明晰其脉法体系与临证辨治模式。方法:以田曾流派存世医案为基础,建立田曾流派“脉象-方证-症状-处方-药物”数据库。采用IBM SPSS Modeler 18.0软件中的Apriori算法对脉-方证、脉-症、症-方及症-药进行关联规则分析,并运用Cytoscape 3.7.2软件对关联结果进行可视化展示。结果:共纳入田曾流派医案275个,其中脉-方证关联规则中置信度最高的是脉沉有力→调胃承气汤(100.00%);脉-症规则中置信度最高的是脉弦长→肠鸣辘辘(100.00%)、脉浮缓→纳呆(100.00%)及脉沉弦→头晕(100.00%);置信度较高的症-方规则主要集中于半夏泻心汤证;症-药关联中置信度最高的为小便灼热→滑石(100.00%)、心悸→甘草(100.00%)及心悸+头晕→甘草(100.00%)。结论:田曾流派以脉象定方药,以脉象联症状,将“脉-方证-药”体系及“脉-症-方药”体系有机融入临床实践中,形成“脉象-方证-症状-处方-药物”五位一体之独特辨治模式,对经方之临床实践具有指导意义。

Objective: To investigate the pulse manifestation system and pattern of syndrome differentiation-based treatment in clinical practice by examining the association between medicine, syndrome, and diagnostic method used by Tian-Zeng Academic School.Methods: A “pulse manifestation-syndrome-symptom-prescription-drug” database was established for Tian-Zeng Academic School based on the existing medical records of Tian-Zeng Academic School.The Apriori algorithm in IBM SPSS Modeler 18.0 software was used to perform an association rule analysis of pulse manifestation-syndrome, pulse manifestation-symptom, symptom-prescription, and symptom-drug, and the results were visualized using Cytoscape 3.7.2 software.Results: A total of 275 medical records of Tian-Zeng Academic School were included.As for the pulse manifestation-syndrome association rule, strong sunken pulse→Tiaowei Chengqi decoction had the highest confidence of 100.00%;for the pulse manifestation-symptom association rule, long and wiry pulse→borborygmus, floating moderate pulse→poor appetite, and deep wiry pulse→dizziness had the highest confidence of 100.00%;for the symptom-prescription association rule, Banxia Xiexin decoction and related syndromes had a relatively high confidence;for the symptom-drug association rule, burning sensation during urination→talc, palpitation→Radix Glycyrrhizae, and palpitation+dizziness→Radix Glycyrrhizae the highest confidence of 100.00%.Conclusion: Tian-Zeng Academic School determines prescriptions and drugs based on pulse manifestation, associates pulse manifestation with symptoms, and integrates the “pulse manifestation-syndrome-drug” system and the “pulse manifestation-symptom-prescription” system into clinical practice, to form the unique “pulse manifestation-syndrome-symptom-prescription-drug” pattern for syndrome differentiation-based treatment, which has certain guiding significance for the clinical application of classical prescriptions.