高思华治疗甲状腺结节用药规律分析

Analysis of Professor GAO Sihua’s Medication Regularity for Treatment of Thyroid Nodules

目的:总结高思华教授治疗甲状腺结节的遣方用药经验与规律。方法:选择高思华教授2013年6月至2018年12月在北京中医药大学国医堂治疗甲状腺结节的门诊病例数据,建立标准化医案数据库。使用“古今医案云平台(V2.2.3)”软件中描述分析、聚类分析、关联规则分析及复杂网络分析模块,对中医证候、中药频次及性味归经、组方规律、核心中药组成进行挖掘。结果:共纳入446诊次,其中中医证候多见为血瘀证、气滞证、气阴两虚证、痰湿证,舌象多呈现瘀色,脉象多沉细。涉及中药132味,使用频次居前5位的分别为柴胡、赤芍、当归、枳实、甘草;药性以微寒、平、温为主,药味以苦、辛、甘为主,归经以肝、脾、心、肺、肾为主。关联规则及聚类分析得到4种组方规律,分别为血府逐瘀汤、柴胡疏肝散、四君子汤、六味地黄汤加减。复杂网络分析得到核心用药共22味,其中柴胡为网络最核心药。结论:高思华教授治疗甲状腺结节注重标本兼顾,以肝、脾、肾同调治其本,行气活血、化痰消瘿、清热利湿治其标,以恢复肝的疏泄、脾的运化、肾的藏精功能为首要任务。遣方用药刚柔并济,整体调治,扶正祛邪。

Objective:To summarize Professor GAO Sihua’s experience and regularity of prescription in the treatment of thyroid nodules.Methods:Collect the outpatient cases data for thyroid nodules of Professor GAO Sihua in the Traditional Chinese Medicine Hall of Beijing University of Chinese Medicine from June 2013 to December 2018 to establish a standardized medical record database.Trsditional Chinese medicine(TCM)syndromes,TCM frequency,nature and taste,prescription regularity,and core medicine were analyzed by frequency analysis,association rule analysis,cluster analysis and complex network analysis modules in the“Ancient and Modern Medical Case Cloud Platform(V2.2.3)”software.Results:A total of 446 cases were included.Among them,the TCM syndrome is mostly blood stasis,qi stagnation,qi and yin deficiency,phlegm dampness,the most of tongue is stasis,and the most of pulse is heavy and thin.A total of 132 Chinese herbs were included.The top 5 Chinese herbs were Chaihu(Bupleuri Radix),Chishao(Paeoniae Radix Rubra),Danggui(Angelicae Sinensis Radix),Zhishi(Aurantii Fructus Immaturus),and Gancao(Glycyrrhizae Radix et Rhizoma).The medicinal properties were mainly slightly cold,calm,and warm,the medicinal taste was mainly bitter,pungent and sweet,and the main meridians were liver,spleen,heart,lung and kidney meridian.Four prescriptions were found by association rule analysis and cluster analysis,which were Xuefu Zhuyu Decoction(血府逐瘀汤),Chaihu Shugan Powder(柴胡疏肝散),Sijunzi Decoction(四君子汤)and Liuwei Dihuang Decoction(六味地黄汤).Total 22 core herbs were found,among which Chaihu was key herb.Conclusions:In the treatment of thyroid nodules,Professor GAO Shihua pays attention to both the incidental and fundamental aspects.Regulating liver,spleen and kidney at the same time are for fundamental aspects.Promoting qi and blood circulation,resolving phlegm to eliminate simple goiter,clearing heat and dampness are for incidental factors.The most important is to recover dispersion function of the liver,the transport function of the spleen and the store essence function of the kidney.Prescriptions of medicine are both rigid and soft,overall treatment to strengthen the body resistance to eliminate pathogenic factors.