全国名中医治疗慢性肾炎“症-证-药”规律分析

Analysis of“Symptoms-Syndromes-Medicine”Laws of Famous Chinese Medicines in Treating Chronic Nephritis

目的基于数据挖掘技术从“症-证-药”角度探究全国名中医治疗慢性肾炎的证治用药规律,为中医药治疗慢性肾炎提供依据。方法以名老中医的姓名和“慢性肾炎”为检索词,以作者和题名为检索字段,以中国知网数据库、万方数据库、中国生物医学数据库、维普期刊上已公开发表的文献为基础,收集各位名中医大家治疗慢性肾炎的医案,建立文献数据库,运用频数统计、关联规则分析和聚类分析等数据挖掘方法分析慢性肾炎的症状、证候及用药规律。结果四诊频次统计症状以腰酸、乏力、腰痛为主;舌象多见淡舌、淡红舌、黯舌;舌苔多见腻苔、黄苔、薄白苔;脉象多见细脉、沉脉;证型以下焦湿热证、脾肾两虚证、肾阴虚证、脾气虚证、脾肾阳虚证为主,病位证素以肾、脾为主,病性证素以阳虚、气虚以及湿热为主;治法以清热利湿、益气滋阴、温补肾阳、健脾利水为主。治疗慢性肾炎涉及中药267味,用药功效以利水渗湿为最,其次为利水消肿、清热解毒、健脾等;用药频次最高的为茯苓,其次为黄芪、泽泻、白术、山药、党参、甘草、白茅根等。症状聚类以阳虚证与气虚证症状为主,药物聚类主要以补气方、补肾阴方及活血方组合为主。结论在研究纳入的143例医案症状-证型-治法-用药规律中,慢性肾炎以气虚、阳虚症状多见,但用药多以利水为主而并非补肾药,体现了从“肾主水”论治慢性肾炎的特点。

Objective Based on data mining technology from the“symptoms-syndromes-medicine”point of view to explore the national famous traditional Chinese medicine treatment of chronic nephritis medication rule,provide the basis for traditional Chinese medicine treatment of chronic nephritis.Methods With the name of famous TCM doctors and“chronic nephritis”as the search term,the author and title as the search field,and based on the published literature in CNKI database,WanFang database,Chinese biomedical database and VIP journals,the medical records of each TCM doctor in the treatment of chronic nephritis were collected,and the literature database was established.Frequency statistics,association rule analysis and cluster analysis were used to analyze the symptoms,syndromes and medication rules of chronic nephritis.Results The statistical symptoms of four diagnostic frequency were mainly lumbar acid,fatigue and low back pain.Tongue was common pale tongue,pale red tongue,dark tongue;tongue moss common greasy moss,yellow moss,thin white moss;pulse was more common fine veins,deep veins;the following syndromes were mainly syndrome of dampness-heat due to energizer,syndrome of deficiency of both spleen and kidney,syndrome of kidney Yin deficiency,syndrome of spleen Qi deficiency and syndrome of Yang deficiency of spleen and kidney.The syndrome elements of disease location were mainly kidney and spleen.The syndrome elements of disease nature were mainly syndrome of Yang deficiency,Qi deficiency and dampness-heat.The main treatment methods were clearing heat and removing dampness,tonifying Qi and nourishing Yin,warming kidney Yang,invigorating spleen and removing water.The treatment of chronic nephritis involves 267 kinds of traditional Chinese medicine,and the efficacy of water and dampness was the most,followed by water and swelling,heat and detoxification,and spleen.The highest frequency of drug use was Fulin(g Poria),followed by Huangq(i Astragali Radix),Zexi(e Alismatis Rhizoma),Baizhu(Atractylodis Macrocephalae Rhizoma),Shanyao(Dioscoreae Rhizoma),Dangshen(Codonopsis Radix),Gancao(Glycyrrhizae Radix Et Rhizoma)and Baimaogen(Imperatae Rhizoma),etc.Symptom clusters were mainly Yang deficiency syndrome and Qi deficiency syndrome,and drug clusters were mainly composed of tonifying Qi,tonifying kidney Yin and activating blood.Conclusion In the 143 cases included in this study,the symptoms of chronic nephritis are mainly Qi deficiency and Yang deficiency,but the medication is mainly based on diuresis rather than tonifying kidney medicine,which reflects the characteristics of treating chronic nephritis from“kidney controls water metabolism”.