基于古今医案云平台的名老中医治疗慢性胃炎用药规律研究

Analysis on the Medication Law of Famous TCM Doctors for the Treatment of Chronic Gastritis Based on the Ancient and Modern Medical Record Cloud Platform

目的利用古今医案云平台(V2.3.2)整理并挖掘名老中医治疗慢性胃炎的用药规律。方法收集古今医案云平台(V2.3.2)名医医案库中75位名老中医及其书籍中的医案数据,以古今医案云平台(V2.3.2)进行用药频次统计分析、聚类分析、复杂网络分析。结果共纳入医案423个,涉及中药269味,主要有陈皮、柴胡、茯苓、法半夏、白术、白芍、黄连、黄芩、甘草、党参、砂仁、木香;药性以温、平、微寒为主;药味多属辛、苦、甘;归经主归脾、胃、肺、肝经。高频中药系统聚类分析聚为4组,C1:柴胡、黄芩、法半夏、黄连;C2:陈皮、茯苓、党参、白术、甘草、白芍、砂仁、木香。C2可进一步分为C3与C4,C3:党参、白术、甘草、白芍、砂仁、木香;C4:陈皮、茯苓。复杂网络分析得到4组中医证候及其核心处方,痰热中阻证常用法半夏、枳实、黄连、瓜蒌、吴茱萸、海螵鞘、郁金、延胡索、柴胡、茯苓;肝胃不和证常用柴胡、黄芩、白芍、桂枝、木香、陈皮、茯苓;脾胃气虚证常用陈皮、白术、茯苓、党参、木香;寒热错杂证常用黄连、半夏、黄芩、党参、干姜。结论名老中医治疗慢性胃炎以行气健脾、清热燥湿、疏肝降逆、滋补胃气为诊疗思路,从虚实、气血、寒热、脏腑4个方面进行辨证。

Objective To use the ancient and modern medical record cloud platform(V2.3.2)to sort out and excavate the medication law of famous and veteran TCM doctors in the treatment of chronic gastritis.Methods The medical record data of 75 national famous TCM doctors were collected in the the ancient and modern medical record cloud platform(V2.3.2)and their books.The statistical analysis,clustering analysis and complex network mining methods in the software were used to analyze the medication law of the famous and veteran TCM doctors in the treatment of chronic gastritis.Results 423 medical cases were included,involving 269 kinds of Chinese materia medica,mainly including Citri Reticulatae Pericarpium,Bupleuri Radix,Poria,Pinelliae Rhizoma,Atractylodis Macrocephalae Rhizoma,Paeoniae Radix Alba,Coptidis Rhizoma,Scutellariae Radix,Glycyrrhizae Radix et Rhizoma,Codonopsis Radix,Amomi Fructus,and Aucklandiae Radix;the medicinal properties were mainly warm,mild and slightly cold,and the tastes were mostly acrid,bitter,and sweet,and mainly belong to the spleen,stomach,lung,and liver meridians.The application of systematic clustering analysis was clustered into 4 groups of Chinese materia medica:C1:Bupleuri Radix,Scutellariae Radix,Pinelliae Rhizoma,Coptidis Rhizoma;C2:Citri Reticulatae Pericarpium,Poria,Codonopsis Radix,Atractylodis Macrocephalae Rhizoma,Glycyrrhizae Radix et Rhizoma,Paeoniae Radix Alba,Amomi Fructus,Aucklandiae Radix.C2 can be further divided into C3 and C4.C3:Codonopsis Radix,Atractylodis Macrocephalae Rhizoma,Glycyrrhizae Radix et Rhizoma,Paeoniae Radix Alba,Amomi Fructus,Aucklandiae Radix;C4:Citri Reticulatae Pericarpium,Poria.4 groups of TCM syndromes and their core prescriptions were obtained by complex network analysis.Phlegm-heat middle resistance syndrome was mainly treated by Pinelliae Rhizoma,Aurantii Fructus Immaturus,Coptidis Rhizoma,Trichosanthis Fructus,Euodiae Fructus,Sepiae Endoconcha,Curcumae Radix,Corydalis Rhizoma,Bupleuri Radix,and Poria;liver and stomach disharmony syndrome was mainly treated by Bupleuri Radix,Scutellariae Radix,Paeoniae Radix Alba,Cinnamomi Ramulus,Aucklandiae Radix,Citri Reticulatae Pericarpium,and Poria;spleen and stomach qi deficiency was mainly treated by Citri Reticulatae Pericarpium,Atractylodis Macrocephalae Rhizoma,Poria,Codonopsis Radix,and Aucklandiae Radix;cold and heat mixed syndrome was mainly treated by Coptidis Rhizoma,Pinelliae Rhizoma,Scutellariae Radix,Codonopsis Radix,and Zingiberis Rhizoma.Conclusion The treatment of famous and veteran TCM doctors for chronic gastritis takes invigorating qi and strengthening spleen,clearing heat and drying dampness,soothing liver and reducing inversion,nourishing stomach qi as the diagnosis and treatment idea,conducting differentiation of symptoms and signs from four aspects:deficiency and excess,qi and blood,cold and heat,and viscera.