基于现代医案挖掘中医药治疗慢性阻塞性肺疾病的证治规律

Syndrome and Treatment Rules of Traditional Chinese Medicine in Treating Chronic Obstructive Pulmonary Disease Based on Modern Medical Cases

目的:基于文献医案借助中医传承辅助平台(V2.5)挖掘中医药治疗慢性阻塞性肺疾病(COPD)的证治规律,为中医药治疗COPD提供新思路。方法:检索中国知网(CNKI)、万方数据库(WanFang DATA)、维普中文科技期刊数据(VIP)等关于中医治疗COPD的医案,将符合纳入文献的医案整理在单独的Word文档中,经数据规范化后逐一录入中医传承辅助平台(V2.5),借助此软件携带的算法对所纳入COPD医案的“症状、中医证型、中药及中药性味归经”进行频数统计及对纳入医案的“组方规律”进行关联分析并挖掘出治疗COPD潜在的核心药对及新方。结果:共纳入103篇文献,共收集医案126个医案,共131次诊疗。经统计COPD常见的症状有咳嗽、咳痰、胸闷、气喘等;常见的中医证型有痰热壅肺证、痰瘀阻肺、肺脾气虚等;常见的中医治法有清热化痰、培土生金、降逆平喘等;其中治疗COPD的高频中药有半夏、苦杏仁、麻黄、陈皮等;常用药对组合有细辛-半夏、半夏-五味子-甘草等;并挖掘出12首治疗COPD的新方药。结论:中医认为COPD是由外邪、痰、瘀等病理因素相互形成的以咳、痰、喘为主要症状的肺系疾病,其主要的证候有痰热壅肺证、痰瘀阻肺、肺脾气虚等,“扶正祛邪”是其治疗的基本原则,在临床应采用祛痰化瘀,补益肺脾或肺肾的中医治法治疗COPD。

Objective To explore the syndrome and treatment rules of traditional Chinese medicine (TCM) in treating chronic obstructive pulmonary disease (COPD) based on the medical literature and cases with the help of TCM inheritance support system platform (V2.5), thus providing new ideas for TCM to treat COPD.Method The medical cases of TCM treating COPD were retrieved from China national knowledge infrastructure (CNKI), Wanfang Database, and VIP China Science and Technology Journal Database. The medical cases that met the inclusion literature were collected in a new Word document, and then input into the TCM inheritance support system platform (V2.5) after data standardization. With the help of the algorithm carried by this software, the frequency statistics of "symptoms, syndrome types of TCM, Chinese medicine, and meridians of Chinese medicine" in the included COPD medical cases were performed, and the correlation analysis of the "prescription rules" in the included medical cases was carried out, thus excavating the potential core drug pairs and new prescriptions for the treatment of COPD.Result A total of 103 articles were included with 126 medical cases and 131 diagnoses and treatments. According to statistics, the common symptoms of COPD were cough, expectoration, chest tightness, and asthma, and the common TCM syndromes included phlegm-heat obstructing lung, phlegm and blood stasis blocking lung, and lung-spleen Qi deficiency. The common TCM treatment methods included clearing heat and resolving phlegm, banking up earth to generate metal, and descending adverse and relieving dyspnea, among which the high-frequency Chinese medicines for the treatment of COPD were Pinelliae Rhizoma, Armeniacae Semen Amarum, Ephedrae Herba, Citri Reticulatae Pericarpium, and so on. The commonly used drug pairs included Asari Radix et Rhizoma-Pinelliae Rhizoma, Pinelliae Rhizoma-Schisandrae Chinensis Fructus-Glycyrrhizae Radix et Rhizoma, etc. Twelve new prescriptions for the treatment of COPD were found.Conclusion TCM believes that COPD is a lung disease formed by external evil, phlegm, blood stasis, and other pathological factors, with cough, phlegm, and asthma as the main symptoms. The main syndromes of COPD are phlegm-heat obstructing lung, phlegm and blood stasis blocking lung, and lung-spleen qi deficiency. "Strengthening the upright and dispelling evil" is the basic principle of the treatment COPD. In clinical, TCM methods with dispelling phlegm and removing blood stasis, and tonifying lung, spleen, and kidney should be adopted to treat COPD.