《医案类聚》中明清医案治疗癥瘕积聚的用药规律研究

Analysis of medication rule for abdominal mass accumulation in medical records in Ming and Qing dynasties in the Collection of Medical Cases

目的通过整理明清时期医案治疗癥瘕积聚的处方,借助中医传承计算平台V3.0探究明清时期医家治疗癥瘕积聚的用药、组方规律及其学术思想。方法依据《医案类聚》中所载明清时期医家治疗癥瘕积聚的医案,提取其中处方信息,利用Excel 2016将处方信息规范化整理成数据库,基于中医传承计算平台V3.0对处方进行分析。结果通过纳排标准筛选整理出203首方剂,284味中药;分析用药规律可知所用中药的四气以温、寒、平为主,五味以苦、辛、甘为主,归经以脾、肝、胃三经为主;药物功效以理气类、补虚类、活血化瘀类为主;在药物使用频次上,最高频使用5味药物是茯苓、当归、陈皮、半夏、香附。通过关联规则分析得出,使用频次最高的对药为茯苓-半夏;使用频次最高的角药为茯苓-陈皮-半夏。通过k均值聚类算法可将处方分为3个聚类,并得出核心处方药物。结论明清医家治疗癥瘕积聚的处方具有鲜明的用药规律,用药围绕着“理气化痰、活血化瘀、益气养血、清热解毒”为原则,用药上注重气血同调、寒温相配、气机升降、攻补兼施;为现今中医临床诊治癥瘕积聚相关疾病提供了理论依据和遣方用药的参考。

Objective To explore the rules of medication,formulae and the academic thoughts of medical practitioners for the treatment of abdominal mass accumulation during the Ming and Qing dynasties with Traditional Chinese Medicine Inheritance Computing System V3.0 by sorting out the prescriptions for abdominal mass accumulation in the medical records in Ming and Qing dynasties.Methods Prescriptions were extracted from the medical records in the Ming and Qing dynasties in the Collection of Medical Cases for the treatment of abdominal mass accumulation,and these prescriptions were normalized and organized into a database by Excel 2016,and were analyzed based on the Traditional Chinese Medicine Inheritance Computing System V3.0.Results A total of 203 prescriptions with 284 Chinese materia medicas(CMMs)were screened according to the inclusion and exclusion criteria.Analysis of the medication rule showed that the CMMs used were mainly warm,cool,and neutral in nature,bitter,pungent and sweet in flavor,and belonged to the spleen,liver,and stomach meridians.CMMs with Qi regulating,deficiency tonifying,and blood circulation activating and blood stasis removing effects were frequently used.The five most frequently used CMMs were poria cocos,Chinese angelica root,dried old orange peel,pinellia,and rhizoma cyperi.The association rule analysis revealed that the most frequently used drug pair was poria cocos-pinellia,and the most frequently used angle medicine was poria cocos-dried old orange peel-pinellia.Three clusters of prescriptions and core CMMs in prescriptions were derived based on the k-means clustering algorithm.Conclusion Distinctive medication rule is seen in the prescriptions of Ming and Qing dynasties for the treatment of abdominal mass accumulation,which is based on the principles of"regulating Qi and resolving phlegm,activating blood circulation and removing blood stasis,nourishing Qi and blood,and clearing heat and detoxification",and pays attention to the common treatment of Qi and blood,matching of cool and warm medicines,ascending and descending of Qi activities,and simultaneous application of purging-tonifying therapy.This rule provides a theoretical basis and a reference for the use of medicines in the clinical treatment of abdominal mass accumulation related diseases.