新安医家孙一奎辨治痞满用药规律及特色探析

Research of medication rules and characteristics of Xin′an physician Sun Yikui in treating distention and fullness

目的:通过数据挖掘技术探索新安医家孙一奎辨治痞满的用药规律及其特色,以期拓宽现代医家诊治痞满的思路和视野。方法:收集并整理《赤水玄珠》《孙文垣医案》中辨治痞满的处方,建立方药数据库,采用WPS Office软件对录入中药的频次、种类和属性进行分析,使用SPSS Modeler 18.0和SPSS Statistics 26.0软件对高频药物进行关联规则分析及聚类分析,并制作用药规律网络图。结果:31首处方涉及中药69味,归26类,其中理气药、补气药、清热燥湿药、温化寒痰药使用居多,高频使用药物为枳实、半夏、甘草、陈皮、黄连、白术、黄芩、人参等;药性以温性居多,药味以辛味、苦味为主,归经以脾经、胃经、肺经多见。关联规则分析得到核心药物组合20种,半夏、甘草、陈皮和枳实之间关系最密切。聚类分析共得到7组药物组合,C1药组为泽泻、猪苓、姜黄,是中满分消丸的核心药物,泽泻、猪苓利水渗湿、行痰饮,姜黄化瘀血、消食积,三药合用开疏经络,则痰湿可下,痞自消;C2药组为黄连、黄芩,两药合用共奏清热燥湿、泻火解毒之功;C3药组为半夏、甘草、干姜,3味药物组成半夏干姜汤,温中助阳、和胃降逆;C4药组为人参、厚朴,两药益气行气,气行则湿化,气行则血行;C5药组为当归、红花、柴胡,此组药物活血行气,气血调和则脾胃安;C6药组为陈皮、木香,两药合用共奏健脾消食之功;C7药组为槟榔、大腹皮,两药上下分消、破气消积。结论:新安医家孙一奎辨治痞满,首重明证,其用药特色为辛开、苦降、甘补并用,攻补兼施,标本兼治,实则理气化痰,虚则温中补气。

Objective:To explore the medication rules and characteristics of Sun Yikui,a Xin′an physician,in the diagno-sis and treatment of distention and fullness through data mining techniques in order to broaden the thinking and vision of modern physicians.Methods:The prescriptions for the treatment of distention and fullness in Chi Shui Xuan Zhu and Sun Wenyuan′s Medical Records were collected and sorted,and the prescription database was established.WPS Office software was used to analyze the frequency,type and properties of the recorded Chinese medicines.SPSS Modeler 18.0 and SPSS Statistics 26.0 software were used to analyze association rules and cluster of high-frequency drugs,and the medication rules network diagram was made.Results:The 31 prescriptions involved 69 Chinese medicines,grouped into 26 categories,among which the majority were qi-regulating drugs,qi-tonifying drugs,heat and dampness clearing drugs,warming cold phlegm drugs,and high frequency drugs were Zhishi,Banxia,Gancao,Chenpi,Huanglian,Baizhu,Huangqin,and Renshen.The medicinal property was mainly warm,the medicinal flavor was mainly pungent and bitter,and the channel tropism was mainly the spleen meridian,the stomach meridian and the lung meridian.Association rule analysis showed 20 core drug combinations,and Banxia,Gancao,Chenpi and Zhishi were the most closely related.A total of 7 groups of drug cluster combinations were obtained by cluster analysis.The C1 drug group included Zexie,Zhuling and Jianghuang,which were the core drugs of Zhongman Fenxiao Pills.Zexie and Zhuling could clear dampness and promote diuresis,and remove phlegm and retained fluid,while Jianghuang could remove blood stasis and eliminate food accumulation.The combination of three medicines could dredge the meridians and collaterals,therefore the phlegm-dampness would dissipate and the distention would be relieved;the C2 drug group included Huanglian and Huangqin.The two drugs were used together to play the function of clearing heat and drying dampness,purging fire for removing toxin;the C3 drug group included Banxia,Gancao and Ganjiang,and the three drugs were composed of Banxia Ganjiang Decoction,which warmed the middle energizer and helped the Yang-qi,and normalized the stomach by descending the adverse qi;the C4 drug group consisted of Renshen and Houpo.The two drugs were used to tonify qi and promote qi.Normal flow qi ensured normal resolution of dampness and flow of blood;the C5 drug group was Danggui,Honghua and Chaihu.This group of drugs could promote blood circulation and qi circulation,harmonize qi and blood harmony and soothe the spleen and the stomach;the C6 drug group consisted of Chenpi and Muxiang.The two drugs were used together to play the function of invigorating spleen to promote digestion;the C7 drug group was Binglang and Dafupi,and the two drugs were used to eliminate pathogens by phlegm elimination and purgation respectively,and relieve stagnant qi and remove food retention.Conclusion:When Sun Yikui,a Xin′an physician,differentiates and treats distention and fullness,he gives priority to the syndrome.The pungent drugs to promote qi circulation,the bitter drugs to dredge intestines and the tonic drugs are used simultaneously,which can achieve the purpose of combination of tonification and purgation,as well as both symptoms and root cause.The excess syndrome is treated by regulating qi-flowing and eliminating phlegm,while the deficiency syndrome is treated by warming the middle energizer and tonifying qi.