明清时期慢性肾脏病医案辨证用药特点研究

Medication Characteristics Based on Syndrome Differentiation of Medical Cases of Chronic Kidney Disease in the Ming and Qing Dynasties

目的:借助数据统计分析技术研究明清时期慢性肾脏病(CKD)证候类型、用药特点及组方规律,以期指导临床实践。方法:通过阅读明清时期各家医案,整理CKD相关医案构建数据库。使用Microsoft Excel 2019对组方用药、症状、证素进行频次统计分析;SPSS Modeler 14.0进行关联规则及复杂网络分析;SPSS Statistics 23.0进行系统聚类及主成分因子分析。结果:符合纳入标准医案175例,涉及233味中药、115个症状、7个病位证素和16个病性证素。药物使用频次≥平均频次药物62味,其中高频药物是茯苓、泽泻、甘草、熟地黄、牡丹皮、黄柏。药物关联规则将最小支持度与最小置信度分别设置为10%、70%,得到二阶关联组合24项;最小支持度与最小置信度分别设置为10%、90%,得到三阶关联组合23项。复杂网络生成的核心组方为泽泻、茯苓、熟地黄、山药、山茱萸、甘草、白术、陈皮、牡丹皮。系统聚类得到茯苓、泽泻、熟地黄、牡丹皮等14组药物聚类组合。主成分因子分析共提取出22个公因子。频次分析CKD病位证素以肾、脾为主;病性证素以阴虚、气虚、阳虚、湿热、水停为主。结论:CKD多为本虚标实之证,病机多为脾肾虚损,变生病理产物湿热、瘀血、水饮等,治疗以补益脾肾、填精固元为基本原则,针对兼证及病理产物随证搭配。

Objective:To study the common syndrome types,medication characteristics,and prescription rules of chronic kidney disease(CKD)in Ming and Qing dynasties by using statistical analysis to guide clinical practice.Methods:The database of CKD-related medical records was constructed based on the medical records of the Ming and Qing dynasties.Microsoft Excel 2019 was used to analyze the frequency of prescriptions,symptoms,and syndrome elements.SPSS Modeler 14.0 was used for association rules and complex network analysis.SPSS Statistics 23.0 was used for system clustering and principal component analysis.Results:A total of 175 cases met the inclusion criteria,involving 233 drugs,115 symptoms,seven syndrome elements for disease location,and 16 syndrome elements for disease.There were 62 drugs with drug use frequency≥average frequency,and high-frequency drugs included Alismatis Rhizoma,Glycyrrhizae Radix et Rhizoma,Rehmanniae Radix Praeparata,Moutan Cortex,and Phellodendri Chinensis Cortex.In association rules,the minimum support and minimum confidence were set to 10%and 70%,respectively,to obtain 24 items of second-order association combinations.The minimum support and minimum confidence were set to 10%and 90%,respectively,to obtain 23 items of third-order association combinations.The core prescriptions of complex networks included Alismatis Rhizoma,Poria,Rehmanniae Radix Praeparata,Dioscoreae Rhizoma,Corni Fructus,Glycyrrhizae Radix et Rhizoma,Atractylodis Macrocephalae Rhizoma,Citri Reticulatae Pericarpium,and Moutan Cortex.System clustering yielded 14 groups of drug clustering combinations,including Poria,Alismatis Rhizoma,Rehmanniae Radix Praeparata,and Moutan Cortex.Principal component analysis extracted 22 common factors.Through frequency analysis,CKD location syndrome elements were mainly kidney and spleen;disease syndrome elements were mainly yin deficiency,qi deficiency,yang deficiency,dampness-heat,and water retention.Conclusion:CKD is dominated by the syndrome of deficiency in origin and excess in superficiality.The pathogenesis of CKD is the deficiency of the spleen and kidney,and the pathological products are dampness-heat,blood stasis,and water retention.The therapeutic principles are mainly tonifying the spleen and kidney,filling the essence,and consolidating the element,which are combined according to the concurrent syndromes and pathological products.