基于多中心住院病历数据的岭南胃痞病中医证治规律研究

Analysis on the TCM Syndrome Diagnosis and Treatment Regularity of Stomach Stuffiness Based on the Multi-centered Medical Records

目的对多中心岭南胃痞病患者住院病历数据的证候及用药情况进行回顾性研究,总结其中医证治规律。方法选取2010年至2019年广州中医药大学第一附属医院、广东省中医院、广东省第二中医院、广州市中医院、南方医科大学珠江医院、深圳市中医院、江门五邑中医院收治的胃痞病患者的住院病历诊疗数据,回顾性搜集整理患者的年龄、性别、病程、主要症状、舌脉象、中医证型、用药情况等,并对数据进行规范化处理。计数资料采用频数及百分比进行描述性分析。采用Apriori算法对药物-药物进行三阶关联规则分析,并对统计频数较高的中药进行系统聚类分析。结果共有949例患者符合纳入标准,患者发病年龄主要在50~59岁,女性占比大于男性。岭南胃痞病患者的入院时间以惊蛰节气多见,临床主要表现为上腹部不适,中医证型以脾胃气虚证、肝郁脾虚证、脾胃湿热证为主,中药使用多为补虚类、清热类和活血祛瘀类;根据关联规则分析形成木香+茯苓+白术、砂仁+党参+白术、木香+党参+白术等主要药物组合,并聚类形成以健脾、行气、活血等为核心的新处方7个。结论岭南胃痞病具有以脾虚为本,兼夹湿热、气滞、血瘀等特点。在运用健脾药物的同时,宜适当佐以行气、清热、化湿、活血类药物,并结合发病的节气特点,做到“未病先防,既病防变”。

Objective A retrospective study of the syndrome and medication of multi-centered inpatient medical records of patients with stomach stuffiness in Lingnan area was conducted to summarize their traditional Chinese medicine(TCM)syndrome diagnosis and treatment regularity.Methods The inpatient medical records of patients with stomach stuffiness admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangdong Second Hospital of Traditional Chinese Medicine,The Affiliated TCM Hospital of Guangzhou Medical University,Zhujiang Hospital of Southern Medical University,Shenzhen Traditional Chinese Medicine Hospital and Jiangmen Wuyi Hospital of Traditional Chinese Medicine from 2010 to 2019 were selected.The data including age,gender,duration of illness,main symptoms,tongue and pulse signs,TCM syndromes and medication use were collected retrospectively,and the data was normalized processing.Enumeration data were descriptively analyzed by frequency and percentage.Apriori algorithm was used for third-order association rule analysis of drug-drugs,and the herbal medicines with high statistical frequency was analyzed by systematic clustering.Results A total of 949 patients met the inclusion criteria,with patients’age of onset mainly ranging from 50 to 59 years old,with women accounting for a larger proportion than men.Patients with Lingnan stomach stuffiness were most commonly admitted at the solar terms of‘insects awaken’,and their main clinical manifestation was upper abdominal discomfort.The TCM syndrome types were mainly qi deficiency of spleen and stomach syndrome,liver-depression and spleen deficiency syndrome,and damp-heat in spleen and stomach syndrome,while the most frequently used herbs were those for tonifying deficiency,clearing heat and activating blood to eliminate stasis.The main drug combinations were formed according to the association rule analysis,such as Radix Aucklandiae+Poria+Rhizoma Atractylodis Macrocephalae,Fructus Amomi Villosi+Radix Codonopsis+Rhizoma Atractylodis Macrocephalae,Radix Aucklandiae+Radix Codonopsis+Rhizoma Atractylodis Macrocephalae,and 7 new prescriptions with function of invigorating spleen,promoting qi and activating blood as the core were formed by clustering.Conclusion Stomach stuffiness in Lingnan area is characterised by the spleen deficiency of root cause,complicated with damp-heat,qi stagnation and blood stasis.In addition to the use of spleen-strengthening drugs,appropriate with the line of qi,heat,dampness-resolning and blood-activating drugs,and take into account the seasonal characteristics of the disease,so as to“prevent disease before it occurs,and prevent it from aggravation and pathological changes”.