基于古今医案云平台系统探析慢性糜烂性胃炎临床症状-证候-用药规律

An analysis of the clinical symptom-syndrome-medication rule of chronic erosive gastritis based on the ancient and modern medical case cloud platform system

目的用数据挖掘技术分析慢性糜烂性胃炎的临床症状、常见证候及用药规律,形成理法方药融合统一的辨证论治思路。方法检索中国知网(China National Knowledge Infrastructure,CNKI)、维普中文期刊服务平台维普中文期刊数据库(Chongqing VIP Information Company Limited,VIP)、万方数据知识服务平台(Wanfang Database)建库至2022年6月1日相关期刊文献中慢性糜烂性胃炎的症状与证型及治疗处方,利用古今医案云平台(V2.5)对慢性糜烂性胃炎的临床症状包括舌象、脉象、常见证候、证素特点及用药规律进行分析。结果收集慢性糜烂性胃炎的医案207例,经过规范化处理后,高频出现的前五种症状依次为嗳气、口苦、纳差、口干、乏力;病性证素主要为湿和热;病位证素主要在于脾和胃;常见的中医证型为脾胃湿热证、脾胃气虚证、肝胃不和证、胃阴虚证4个类型,占所有证型的50%以上。通过证型与用药社团分析,脾胃湿热证用黄芩、黄连、半边莲等;脾胃气虚证用党参、白术、木香等;肝胃不和证用陈皮、郁金、枳实;胃阴虚证用天花粉、白芍、玉竹等。结论慢性糜烂性胃炎以脾胃湿热为主要病机,病性以实证为主;清化湿热,调理气机可作为治疗本病的重要方法。临床上应根据症状进行辨证分型,根据分型结果进行处方用药,疗效最佳。

Objective To form the thinking of syndrome differentiation and treatment based on the integration of theory,law and medicine,data mining techniques are used to analyze the clinical symptoms,common syndromes and medication rules of chronic erosive gastritis.Methods The symptoms and syndromes as well as prescriptions of chronic erosive gastritis in traditional Chinese medicine(TCM)were retrieved from China National Knowledge Infrastructure(CNKI),Chongqing VIP Information Company Limited(VIP)and Wanfang Database to June 2022.The symptoms of chronic erosive gastritis including picture of the tongue,pulse condition,common syndromes,elements of syndrome and medication rules were analyzed by using the ancient and modern medical records cloud platform(V2.5).Results Totally 207 medical cases of chronic erosive gastritis were collected and standardized,the top five frequency symptoms were belching,mouth bitter,poor appetite,dry mouth,and fatigue.The major properties of the disease were dampness and heat;the pathological lesions of the disease were mainly in the spleen and stomach;the common pattern of TCM were spleen-stomach damp-heat syndrome,spleen-stomach qi deficiency syndrome,liver-stomach disharmony syndrome and deficiency of stomach yin syndrome.These four evidence types accounted for more than 50%of all evidence types.Through the analysis of the syndrome type and medication associations,Radix Scutellariae,Rhizoma Coptidis and Herba Lobeliae Chinensis were used for the spleen-stomach damp-heat syndrome.Radix Codonopsis,Rhizoma Atractylodis Macrocephalae and Radix Aucklandiae were used for the spleen-stomach Qi deficiency syndrome.Pericarpium Citri Reticulatae,Radix Curcumae and Fructus Aurantii Immaturus were used for the liver stomach disharmony syndrome,and Radix Trichosanthis,Radix Paeoniae Alba and Rhizoma Polygonati Odorati were used for the deficiency of stomach Yin.Conclusion The main pathogenesis of chronic erosive gastritis is dampness-heat of spleen and stomach,and the nature of the disease is excess syndrome;clearing away damp-heat and regulating Qi movement can be an important treatment method of this disease.Clinical syndrome differentiation should be based on symptoms and treatment should be prescribed according to the results of syndrome differentiation in order to obtain the best efficacy.