基于数据挖掘研究万晓刚运用柴胡类方治疗甲状腺疾病临床经验

Experience of WAN Xiaogang in Treating Thyroid Diseases with Prescriptions Containing Bupleuri Radix Based on Data Mining

目的:基于属性偏序数据挖掘方法研究万晓刚教授运用柴胡类方治疗甲状腺疾病的临床经验。方法:通过收集万晓刚教授门诊病历,将符合纳入标准的病历进行症状、舌脉、药物的规范化,将其录入Excel表格,形成数据库。将所得数据库规范格式后,制作相应形式背景图,再将形式背景图导入属性偏序结构图计算机自动生成工具,生成相应的偏序结构图。通过数据挖掘,对图像进行分析,对用药进行词频统计,总结万晓刚教授在治疗甲状腺相关疾病时的相关思路、偏好方剂、配伍规律和常用加味药物。结果:共纳入病例85例,甲状腺功能亢进症患者60例,甲状腺功能减退症患者11例,结节性甲状腺肿患者14例。甲状腺功能亢进症出现最多的症状为不寐、口干、乏力、心慌。不寐常选用柴胡桂枝干姜汤加减,口干常选用柴胡桂枝汤加减,心慌常用小柴胡汤原方加减,乏力常选柴胡桂枝汤。甲状腺功能减退症最常出现症状为口干、不寐,但该症状分布不具有代表性,选用柴胡桂枝汤较多。结节性甲状腺肿出现最多的症状为口干、颈前肿大、不寐等,柴胡桂枝汤的应用相对较多,其余多为在小柴胡汤基础上随证加减,可加用三棱、莪术、牡蛎、猫爪草等活血、软坚、散结之品。结论:万晓刚教授治疗甲状腺相关疾病,最常应用的方剂为小柴胡汤、柴胡桂枝汤、柴胡桂枝干姜汤。其中甲状腺功能亢进症患者出现不同症状时应用方剂有所不同,甲状腺功能减退症患者多用柴胡桂枝汤,结节性甲状腺肿多用小柴胡汤原方加减。

Objective: To study Prof. WAN Xiaogang’s clinical experience in treating thyroid diseases with prescriptions containing Bupleuri Radix based on attribute partial order data mining method. Methods:By collecting the medical records of Prof. WAN’s outpatient department,the records meeting the inclusion criteria were standardized for symptoms,tongue and pulse,Chinese herbs,and were input into Excel to form a database. After the standard format of the database was obtained, the corresponding formal background graph is made, which was later imported into the computer automatic generation tool of attribute partial order structure graph to generate the corresponding partial order structure graph. Through data mining,the images were analyzed;the word frequency statistics of herbs were conducted,and the relevant ideas, preferred prescriptions, compatibility rules and commonly used flavoring herbs of Prof.WAN in treating thyroid diseases were summarized. Results:A total of 85 cases were involved,including60 cases of hyperthyroidism, 11 cases of hypothyroidism and 14 cases of nodular goiter. The most common symptoms of hyperthyroidism were insomnia,dry mouth,fatigue and palpitation. The most often used prescription for insomnia was modified Chaihu Guizhi Ganjiang Tang;for dry mouth was modified Chaihu Guizhi Tang;for palpitation was modified Xiaochaihu Tang;for fatigue was Chaihu Guizhi Tang. The most common symptoms of hypothyroidism were dry mouth and insomnia, but the distribution of the symptoms was not representative,and Chaihu Guizhi Tang was more used. The most common symptoms of nodular goiter were dry mouth,neck enlargement and insomnia,and Chaihu Guizhi Tang was relatively more widely used. The treatment of other thyroid diseases was mostly modified based on Xiaochaihu Tang according to different syndromes,and the prescription was added with Chinese herbs that could invigorate blood, soften hard masses and dissipate masses like Sparganii Rhizoma, Curcumae Rhizoma, Ostreae Concha and Ranunculi Ternati Radix. Conclusion:The prescriptions most commonly used by Prof. WAN in treating thyroid diseases are Xiaochaihu Tang, Chaihu Guizhi Tang and Chaihu Guizhi Ganjiang Tang. For hyperthyroidism patients, when different symptoms appear, different prescriptions are applied;for hypothyroidism patients, Chaihu Guizhi Tang is more often used, and for nodular goiter patients,Xiaochaihu Tang is more likely used.