基于《古今名医临证金鉴》的历代名医论治胸痹心痛的用药规律研究

Medication Rules of Famous Doctors in Past Dynasties for Xiongbi (胸痹) and Xintong (心痛)Recorded in Gujin Mingyi Linzheng Jinjian (古今名医临证金鉴)

目的:探讨古今名医论治胸痹心痛的用药规律,为临床用药提供借鉴。方法:整理《古今名医临证金鉴·胸痹心痛卷》中历代名医论治胸痹心痛的有效经验方,将复方录入Excel2010建立数据库,采用古今医案云平台(V2.3)进行频次分析、关联规则和聚类分析,采用SPSS Modeler18.0进行因子分析。结果:共纳入74位医家的333首经验方,涉及中药289味,以甘草、丹参、茯苓、半夏、当归、郁金、桂枝、薤白、麦冬、瓜蒌、红花、五味子、党参、白芍、陈皮为核心中药。药性以温、平为主,药味以甘、辛、苦为主。归经以心经为主,与肺、肝、脾、胃经密切相关。功效以燥湿化痰和活血化瘀为主,辅以补脾益气,养阴生津。关联规则获得茯苓-甘草、五味子-麦冬、瓜蒌-薤白、半夏-茯苓、等17个核心药对。因子分析将药物分为6个公因子,涵盖生脉散、瓜蒌薤白半夏汤、橘红汤、桂枝汤、等方,累计贡献度64.68%。聚类分析将药物分为4个组合,共奏豁痰宽胸、健脾利湿、活血化瘀、益气养阴、气血阴阳并调之效。结论:本研究通过数据挖掘总结了历代名医论治胸痹心痛的临证经验,为临床用药提供借鉴。

Objective:To explore the medication rules of famous doctors in past dynasties for the treatment of Xiongbi(胸痹)and Xintong(心痛),so as to provide reference for clinical medication.Methods:The related empirical prescriptions in Gujin Mingyi Linzheng Jinjian·Xiongbi Xintong Juan(古今名医临证金鉴·胸痹心痛卷)were sorted out and input into Excel 2010 for establishing a database,based on which the frequency,association rule,and clustering analysis was conducted using the Ancient and Modern Medical Record Cloud Platform(V2.3).SPSS Modeler18.0 was employed for factor analysis.Results:A total of 333 empirical prescriptions of 74 doctors were included,involving 289 Chinese herbs,with Gancao(甘草),Danshen(丹参),Fuling(茯苓),Banxia(半夏),Danggui(当归),Yujin(郁金),Guizhi(桂枝),Xiebai(薤白),Maidong(麦冬),Gualou(瓜蒌),Honghua(红花),Wuweizi(五味子),Dangshen(党参),Baishao(白芍),and Chenpi(陈皮)as the core herbs.They,mainly Wen(温)and Ping(平)in Xing(性)and Gan(甘),Xin(辛),and Ku(苦)in Wei(味),act on Xinjing(心经)and are closely related to Feijing(肺经),Ganjing(肝经),Pijing(脾经),and Weijing(胃经).Most of the herds were selected for Zaoshi(燥湿),Huatan(化痰),Huoxue(活血),and Huayu(化瘀),supplemented by those capable of Buqi(补脾),Yiqi(益气),Yangyin(养阴)and Shengjin(生津).17 core herbal pairs were yielded by the association rule analysis,such as Fuling(茯苓)-Gancao(甘草),Wuweizi(五味子)-Maidong(麦冬),Gualou(瓜蒌)-Xiebai(薤白),Banxia(半夏)-Fuling(茯苓).As revealed by factor analysis,six common factors were extracted for these herbs,covering Shengmaisan(生脉散),Gualou Xiebai Banxiatang(瓜蒌薤白半夏汤),Juhongtang(橘红汤),and Guizhitang(桂枝汤),with a cumulative contribution of 64.68%.According to the clustering analysis,the herbs could be classified into four clusters,and their combination contributed to Huotan(豁痰),Kuanxiong(宽胸),Jianpi(健脾),Lishi(利湿),Huoxue(活血),Huayu(化瘀),Yiqi(益气),Yangyin(养阴),Tiaoqixue(调气血)and Tiaoyinyang(调阴阳).Conclusion:Through data mining,this study has summarized the clinical experience of famous doctors in past dynasties for the treatment of Xiongbi(胸痹)and Xintong(心痛),which will provide reference for future clinical medication.