基于数据挖掘分析唐旭东治疗胃食管反流病重叠消化不良的临床经验

Clinical Experience of Tang Xudong in Treating Patients with Both Gastroesophageal Reflux Disease and Dyspepsia:A Study Based on Data Mining

目的探讨唐旭东教授治疗胃食管反流病(Gastroesophageal reflux disease,GERD)重叠消化不良的临床经验。方法基于真实世界门诊医案诊疗数据,采用回顾性病例系列数据挖掘结合专家访谈的研究设计,纳入唐教授诊疗GERD重叠消化不良的医案处方,建立药物数据库,分析中药使用特点;使用IBM SPSS Statistics 25.0软件进行聚类,分析其遣方用药规律。结果筛选的102张初诊处方中,共涉及中药87味,1578药次,药性寒温并用,以温行温通为主;药味以辛开苦降,甘调平衡为主;归经主要集中脾胃经;药物类别以补虚类、化湿类、理气类与清热类为主;使用频率>10%的药味31种,系统聚类显示,组方特点因疾病重叠主症表现侧重而异,关注舌苔与大便情况,紧扣八纲,通降方药有升清降浊以健脾清化助运,辛开苦降以平调脾胃,理气降胃导滞以清肝和胃之别。结论唐旭东教授临证GERD重叠消化不良立足“因滞而病”为本,问诊重视症状细节,临证思辨紧扣八纲,抓住主症,善用配伍,治疗以辨证新八纲为纲领,虚则责之脾土,实则责之肝胃,灵活延伸运用通降方法,以实现“调中复衡”的目标。

Objective To explore the clinical experience of Professor Tang Xudong in the treatment of patients with both gastroesophageal reflux disease(GERD)and dyspepsia.Methods The data of real-world outpatient medical records were used for the retrospective case series data mining,and expert interview was conducted.The medical records of the patients with GERD and dyspepsia treated by Professor Tang were collected for the establishment of a drug database,with which the use characteristics of Chinese herbal medicines were analyzed.Clustering analysis was performed in IBM SPSS Statistics 25 to reveal the compatibility rules of the prescriptions.Results A total of 102 prescriptions of initial diagnosis were screened out,involving 87 Chinese herbal medicines with the frequency of 1578.The used herbal medicines generally had cold and warm nature and were used for warming and dredging,pungent dispersing and bitter descending,and harmonizing,with the main tropism to spleen and stomach meridians.Tonifying,dampness-resolving,qi-regulating,and hear-clearing herbs were frequently used in the prescriptions.Thirty-one herbs were used with the frequency>10%,and the clustering analysis showed that the prescriptions varied according to the main symptoms.The eight-principle syndrome differentiation can be employed with attention to tongue coating and stool conditions.The prescriptions with the functions of ascending lucidity and descending turbidity can be used to invigorate spleen and promote transformation;the prescriptions with the functions of pungent dispersing and bitter descending can be used to harmonize the spleen and stomach;the prescriptions with the functions of regulate qi and descending stomach qi can be used to clear liver and harmonize stomach.Conclusion Professor Tang Xudong treated the patients with GERD and dyspepsia following the theory of disease due to stagnation.He attached importance to the detail symptoms,differentiated syndromes according to the eight principles,and well modified the prescriptions.Keeping in mind that deficiency lies in the disorder of spleen and excess lies in the disorder World Journal of Integrated Traditional and Western Medicine 2023,Vol.18,No.3 of liver and stomach,he flexibly employed the method of descending and dredging to achieve the goal of harmonizing the middle energizer to restore balance.