胃食管反流病中医药临床用药配伍规律研究

The Study on the Compatibility Rule of Clinical Medication of Gastroesophageal Reflux Disease in Traditional Chinese Medicine

目的:总结分析中医药治疗胃食管反流病的临床用药规律,归纳辨证配伍规律,指导临床运用。方法:通过收集湖南中医药大学第一附属医院消化内科胃食管反流病患者病例资料,建立数据库;使用古今医案云平台进行中药频次和性味归经分析;使用SPSS Modeler 14.0、SPSS Statistics 23.0进行关联规则分析、复杂网络分析以及系统聚类分析。结果:共收集50例胃食管反流病患者,涉及50首处方、80味中药、17个症状以及5个证型。用药频次≥平均频次的中药32味,高频中药为瓦楞子、柴胡、甘草、延胡索、郁金等。设置最小支持度为50%,最小置信度为90%,分别得到药对二阶关联组合11项,三阶关联组合36项。系统聚类得到瓦楞子、白及、合欢皮、酸枣仁、甘草、柴胡等6组药物聚类组合。复杂网络生成核心组方为瓦楞子、延胡索、旋覆花、甘草、白及、郁金、丹参、麦芽。临床治疗胃食管反流病多为平性药,且寒温并用;药味多甘、苦、辛,归肺、脾、胃、肝经为主,功效主要以燥湿化痰、行气解郁、清热解毒、补脾益气为主。结论:中医临床治疗胃食管反流病多采用标本兼治,其中以疏肝理肺健脾治本,以调气血、化痰瘀、制胃酸治标,用药上以寒温并用为主,且重在平调。

Objective:To summarize and analyze the clinical use of Chinese medicine in the treatment of gastroesophageal reflux disease,to summarize the rules of identification and dispensing,and to guide clinical application.Methods:By collecting case data of patients with gastroesophageal reflux disease in the Department of Gastroenterology,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,a database was established;the frequency and flavor attribution of Chinese medicine was analyzed using the ancient and modern medical case cloud platform;SPSS Modeler 14.0and SPSS Statistics 23.0were used for association rule analysis,complex network analysis and systematic clustering analysis.Results:A total of 50patients with GERD were collected,involving 50prescriptions,80herbal medicines,17symptoms and 5evidence types.There were 32herbal medicines with frequency of use≥the average frequency,and the high-frequency herbal medicines were corrugated seeds,Chai Hu,licorice,Yan Hu Suo,and Yu Jin.The minimum support level was set at 50%and the minimum confidence level at 90%,and 11second-order association combinations and 36third-order association combinations were obtained for the drug pairs,respectively.The systematic clustering yielded six groups of drug clustering combinations,including corrugated seeds,Bai He,Acacia bark,sour date palm,licorice,and Chai Hu.The complex network generated core group formulas of corrugated seeds,Yanhuosuo,Radix et Rhizoma,Glycyrrhiza glabra,Baihe,Yujin,Danshen,and Malt.The clinical treatment of gastroesophageal reflux disease mostly consists of plain medicines,and cold and warm are used together;the taste of the medicines is mostly sweet,bitter and pungent,and they mainly belong to the lung,spleen,stomach and liver meridians,and their effects mainly focus on drying dampness and resolving phlegm,moving qi and relieving depression,clearing heat and detoxifying toxins,and tonifying the spleen and benefiting qi.Conclusion:The clinical treatment of GERD in Chinese medicine is mainly based on both the symptoms and the root cause,including treating the root cause by draining the liver,regulating the lung and strengthening the spleen,and treating the root cause by regulating qi and blood,resolving phlegm and stasis,and controlling gastric acid.