基于数据挖掘技术分析卢秉久教授治疗慢性乙型肝炎肝硬化代偿期瘀血阻络证用药规律

Medication rules of Professor Lu Bingjiu in the treatment of chronic hepatitis B cirrhosis with blood stasis blocking collaterals syndrome in the compensatory stage based on data mining technology

目的:通过数据挖掘技术探讨卢秉久教授治疗慢性乙型肝炎(CHB)肝硬化代偿期瘀血阻络证的用药规律。方法:收集2017年5月—2023年2月卢秉久教授治疗瘀血阻络型慢性乙型肝炎肝硬化代偿期患者的门诊病历,选取符合纳入标准的91张首诊处方进行规范化处理,借助Microsoft Office Excel 2020对所涉及药物的使用频次、性味、归经进行统计分析,运用SPSS 25.0软件对使用频率≥23%的药物进行相关性分析和聚类分析,应用SPSS Modeler 18.0软件构建关联规则网络图。结果:卢秉久教授治疗慢性乙型肝炎肝硬化代偿期瘀血阻络证的91张首诊处方中,共使用药物124味,药物主要归脾、肝、肺经,药性以寒性、温性为主,药味主要为甘、苦味。核心药对8对,分别为海螵蛸-鸡内金、陈皮-大腹皮、炙甘草-苍术、炙甘草-厚朴、茯苓-太子参、三七-大腹皮、莪术-牡蛎、莪术-大黄。聚类分析得到聚类组合4组,聚类组合1为海螵蛸、鸡内金、莪术、牡蛎、大黄;聚类组合2为陈皮、大腹皮、三七;聚类组合3为炙甘草、苍术、厚朴、木香;聚类组合4为茯苓、太子参、白术、当归。构建核心处方1首,药物组成为鸡内金、海螵蛸、大黄、三七、大腹皮、苍术、莪术、白术、牡蛎、木香、当归。结论:卢秉久教授治疗慢性乙型肝炎肝硬化代偿期瘀血阻络证寒温并用,以苦软坚的同时兼以甘补虚;遣方中活血散瘀的同时注重调畅中焦气机及顾护脾胃之气,防攻伐之品过于峻烈而伤正,“既病防变,未病先防”,达到“正气复,脾气旺,瘀则消”的治疗目的。

Objective:To explore the medication rules of Professor Lu Bingjiu in the treatment of chronic hepatitis B and cirrhosis with blood stasis blocking collaterals syndrome in the compensatory stage by data mining technology.Methods:The outpatient medical records of Prof.Lu Bingjiu in the treatment of chronic hepatitis B and cirrhosis with blood stasis blocking collaterals syndrome in the compensatory stage from May 2017 to February 2023 were collected,and 91 first-diagnosis prescriptions that met the inclusion criteria were selected for standardized treatment.Microsoft Office Excel 2020 was used to conduct statistical analysis of the frequency of use,nature and flavor,and meridian tropism of the involved drugs.SPSS 25.0 software was used to conduct correlation analysis and cluster analysis of drugs with use frequency≥23%.SPSS Modeler 18.0 software was used to construct the association rule network diagram.Results:Prof.Lu Bingjiu used a total of 124 drugs in 91 first-diagnosis prescriptions for the treatment of chronic hepatitis B and cirrhosis with blood stasis blocking collaterals syndrome in the compensatory stage.The meridian tropism was mainly spleen channel,liver channel and lung channel.The drug property was mainly cold and warm.The drug flavor was mainly sweet and bitter.There were 8 pairs of core medicine,including Haipiaoxiao-Jineijin,Chenpi-Dafupi,Zhigancao-Cangzhu,Zhigancao-Houpo,Fuling-Taizishen,Sanqi-Dafupi,Ezhu-Muli,and Ezhu-Dahuang.Four cluster combinations were obtained by cluster analysis.The first cluster combination was Haipiaoxiao,Jineijin,Ezhu,Muli and Dahuang.The second cluster combination was Chenpi,Dafupi and Sanqi.The third cluster combination was Zhigancao,Cangzhu,Houpo and Muxiang.The fourth cluster combination was Fuling,Taizishen,Baizhu and Danggui.A core prescription was constructed,which consisted of Jineijin,Haipiaoxiao,Dahuang,Sanqi,Dafupi,Cangzhu,Ezhu,Baizhu,Muli,Muxiang and Danggui.Conclusion:Prof.Lu Bingjiu treats chronic hepatitis B and cirrhosis with blood stasis blocking collaterals syndrome in the compensatory stage with the combination of cold and warm therapy,as well as softening the hard mass with bitter herbs and supplementing the deficiency with sweet herbs.While activating blood circulation and dissipating blood stasis in the administration of prescriptions,attention should be paid to regulating the Qi activity of middle energizer and protecting the Qi of the spleen and stomach,so as to prevent the severe herbs from damaging the healthy Qi.The disease should be prevented from spreading,and the disease should be prevented before it is produced,which can achieve the therapeutic purpose of“the restoration of healthy Qi,the prosperity of spleen Qi,and the elimination of blood stasis”.