基于八纲与邪毒理论探讨名老中医治疗高血压病用药规律

Based on the Bagang and Evil Poison Theory to Explore the Rule of Famous Old Chinese Medicine Doctors in the Treatment of Hypertension

目的:探讨基于八纲与邪毒理论的名老中医辨治高血压病用药规律。方法:以十五国家科技攻关计划(2004BA721A01H10)名老中医治疗高血压病的247例医案为研究对象,提取医案的主症、证型、中药等信息,主症和中药进行术语规范,证型与八纲邪毒进行对应,证-药关系采用关联规则分析计算置信度,以置信度>30%作为相关性标准。数据管理采用Access软件,数据分析采用SAS 9.4平台。结果:①247例医案中高血压病主症分为头部症状、胸部症状、全身及肢体症状,以头晕、胸闷、头痛、心悸、乏力等症状为主。②高血压病的证型较复杂,多数证型阴阳兼具、虚实夹杂,也涉及多个脏腑(肝、肾、脾等)和多种邪毒(痰、瘀、湿等)。③41位名老中医治疗247例高血压病的中药总数高达270种,用药频数3268次,常用药为天麻(44.53%)、丹参(40.49%)、钩藤(36.84%)、菊花(35.22%)、茯苓(34.41%)、川芎/牛膝(29.55%)。按中药功效分类则以息风止痉、活血调经、清热、化痰、利水、理气、补气血阴阳为主。④头部症状以头痛、头晕为主,代表性用药是天麻、钩藤和菊花。胸部症状以胸闷为主,代表性用药是丹参和川芎;心悸的代表性用药是甘草和丹参;心前区疼痛的代表性用药是丹参和延胡索。⑤高血压病多属于半表半里证,故一般不明言表里分类;按阴阳划分,阴证71例,阳证176例,以阳证为主;按寒热划分,非寒非热69例,热证168例,寒证10例;按虚实划分,其中虚证191例,非虚非实证56例。高血压病八纲辨证分型以阳证、热证、虚证为主,用药以天麻、钩藤、菊花平肝潜阳、息风止痉,丹参、牛膝活血化瘀,茯苓利水祛湿为主。结论:八纲与邪毒理论对高血压病医案分类具有较好的普适性,可归纳不同名老中医辨证用药的共性规律,起到执简御繁的效果,有利于临床推广应用。

Objective:To explore the rule of prescription and treatment of hypertension by well-known old Chinese doctors based on the Bagang andevil poison theory.Method:Taking the 247 medical records of famous TCM doctors in the treatment of hypertension in the Tenth National Science and Technology Project(2004BA721A01H10)as the research object,extract the main symptoms,syndrome types,Chinese medicine and other information of the medical records.The main symptoms and traditional Chinese medicine are standardized.The syndrome type corresponds to the Bagang evil poison.The relationship between syndrome and Chinese medicine is analyzed by association rules to calculate the confidence level,and the confidence level is greater than 30%as the correlation standard.Data management adopts Access software,and data analysis adopts SAS 9.4 platform.Results:①The main symptoms of hypertension in 247 medical records were divided into head symptoms,chest symptoms,systemic and limb symptoms,with dizziness,chest tightness,headache,palpitations,fatigue and other symptoms.②Most syndrome types have both Yin and Yang,mixed with deficiency and excess,and also involve multiple viscera(liver,kidney,spleen,etc.)and a variety of evil toxins(phlegm,blood stasis,dampness,etc.).③41 famous TCM doctors treated 247 cases of hypertension The total number of Chinese medicines is as high as 270,and the frequency of medication is 3268.Commonly used medicines are Gastrodia(44.53%),Salvia(40.49%),Uncaria(36.84%),Chrysanthemum(35.22%),Poria(34.41%),Chuanxiong/Achyranthes(29.55%).According to the classification of traditional Chinese medicine,it is mainly based on dispelling wind and relieving spasm,promoting blood circulation,regulating menstruation,clearing heat,eliminating phlegm,diuresis,regulating qi,and replenishing yin and yang.④Head symptoms are mainly headache and dizziness.Representative medications are Gastrodia,Uncaria and Chrysanthemum.Chest symptoms are mainly chest tightness,and the representative drugs are Danshen and Ligusticum chuanxiong;the representative drugs for palpitation are licorice and Danshen;the representative drugs for precordial pain are Danshen and Corydalis.⑤Hypertension is mostly half-outside and half-inside syndromes,so it is generally not clear to classify the outside and inside;according to yin and yang,71 cases of yin syndrome,176 cases of yang syndrome,mainly Yang syndrome;according to cold and heat,69 cases of non-cold and non-heat There were 168 cases of heat syndrome and 10 cases of cold syndrome.According to the classification of deficiency and excess,there were 191 cases of deficiency syndrome and 56 cases of non-deficiency and non-experience.The eight types of hypertension are mainly based on Yang syndrome,heat syndrome,and deficiency syndrome.The medications include gastrodia elata,Uncaria,chrysanthemum for calming the liver and suppressing Yang,relieving wind and relieving spasm,Danshen,Achyranthes bidentata,promoting blood circulation and removing blood stasis,Poria diuresis and dampness Mainly.Conclusion:The Bagang andevil poison theoryhas good universality for the classification of hypertension medical records.It can summarize the medication rules of different famous traditional Chinese medicine doctors in the diagnosis and treatment of hypertension,which has a simplified effect and is beneficial to clinical application.