郁证证型分布及用药规律的病例回顾研究

Distribution of the Syndrome Patterns and Medication Rules of Depression Syndrome:A Retrospective Case Study

【目的】分析郁证患者性别、年龄、中医证型分布特点及用药规律,为郁证临床诊疗规范的制定提供参考。【方法】收集2018年至2022年深圳市中医院门诊治疗郁证的初诊病例,分别对纳入病例的性别、年龄、中医证型、用药情况等进行统计;结合系统聚类、关联规则等数据挖掘方法分析其用药规律,并对结果进行网络可视化展示。【结果】(1)共纳入病例2612例,其中男性883例(33.81%),女性1729例(66.19%);年龄方面,以20~49岁的青中年为主,其中又以30~39岁年龄段患者为最多。不同性别、不同年龄段发病情况比较,差异均有统计学意义(P<0.05)。(2)中医证型方面,分布频次居前3位的证型为肝气郁结、心神失养、肝郁化火,其他为心脾两虚、心肾阴虚、阴虚内热、痰气郁结、痰热扰神、血瘀证、心胆气虚。不同性别、不同年龄段的中医证型分布比较,差异均有统计学意义(P<0.05)。(3)用药方面,涉及中药272味,频次较高的依次为酸枣仁(1909次)、白芍(1900次)、郁金(1708次)、远志(1565次)、珍珠母(1562次)等;核心药对有龙齿-珍珠母、香附-白芍、龙齿-郁金等。【结论】肝气郁结为郁证的核心病机贯穿始终,同时易夹杂血瘀、痰结、阴虚等复杂病机;治疗上应以疏肝解郁、养心安神为主要原则,并根据不同证型或清肝泻热,或痰瘀并治,或气血同调,综合施治。

Objective To analyze the distribution of gender,age,traditional Chinese medicine(TCM)syndrome patterns and the medication rules for the patients with depression syndrome,so as to provide reference for the establishment of clinical norms for the diagnosis and treatment of depression syndrome.Methods The initial-visit outpatient cases of depression syndrome in Shenzhen Traditional Chinese Medicine Hospital from 2018 to 2022 were collected,and the statistical analysis was made for the gender,age,TCM syndrome types and medication frequency for the patients.Data mining methods of hierarchical clustering and association rule analysis were adopted for investigating the medication rules,and the results were presented by network graph.Results(1)A total of 2612 cases were included,of which 883(33.81%)were male and 1729(66.19%)were female.The cases were predominated by the young and middle-aged group with 20-49 years old,and the age group of 30-39 years accounted for the largest percentage.Statistically significant difference of the incidence of depression syndrome was shown in various genders and in various age groups(P<0.05).(2)The top 3 syndrome types with high frequency were liver-qi stagnation syndrome,inadequate nourishment of heart syndrome,and stagnated liver-qitransforming into fire syndrome,and then came the heart and spleen deficiency syndrome,heart-kidney yin deficiency syndrome,yin deficiency with internal heat syndrome,phlegm qi stagnation syndrome,phlegm-heat disturbing the mind syndrome,blood stasis syndrome,and heart and gallbladder qi deficiency syndrome.The differences of the distribution of TCM syndrome types were statistically significant in various genders and in various age groups(P<0.05).(3)A total of 272 herbal medicines were involved,and the herbs with high frequency in descending order were Ziziphi Spinosae Semen(1909 times),Paeoniae Radix Alba(1900 times),Curcumae Radix(1708 times),Polygalae Radix(1565 times)and Margaritifera Concha(1562 times).The core herbal pairs were Draconis Dens-Margaritifera Concha,Cyperi Rhizoma-Paeoniae Radix Alba,and Draconis Dens-Curcumae Radix.Conclusion Liver-qi stagnation is the core pathogenic mechanism of depression syndrome throughout the course of disease,and the pathogenesis is easily complicated with blood stasis,phlegm stagnation and yin deficiency.The therapeutic principles for depression syndrome are to sooth liver and relieve depression,and to nourish heart and calm mind.And the comprehensive treatment of clearing the liver and removing heat,eliminating both phlegm and blood stasis,or simultaneous regulation of qi and blood should be performed responding to various syndrome types.