清宫天花诊治经验文献研究及对猴痘诊疗的启示

Literature Research on the Diagnosis and Treatment of Smallpox in Qing Palace and Its Enlightenment on the Diagnosis and Treatment of Monkeypox

[目的]探讨清宫医案中天花的诊治经验,以期对猴痘的中医临床诊疗提供有益的参考。[方法]搜集和整理《清宫医案集成》中的天花病案,建立数据库并进行标准化处理,利用古今医案云平台WEB端的数据挖掘模块,对分期、中药、证素等进行频次统计、关联规则分析、复杂网络分析,并结合古代文献梳理和归纳。[结果]纳入的71则医案中,共涉及6个分期,其中见点、起胀、灌浆的病案最多。病案中的71首处方共涉及141种中药,高频中药有连翘、山楂、紫草、当归、生地黄等。中药属性统计发现,甘味运用最多,归经以肺经为主,寒性药使用最多。除了内服汤药之外,71则医案中共出现10种中成药。病案共涉及32个证素。将分期与中药进行关联规则分析,发掘出10组关联项。对中药进行关联规则分析,得到常用药对18组。利用复杂网络分析,得到一核心处方,共13味核心药物,分别为连翘、山楂、牛蒡子、生地黄、当归、赤芍、桔梗、甘草、荆芥穗、木通、防风、酒黄芩、紫草。[结论]对于天花诊治,清宫御医常结合全身与局部辨证,治则以透毒为第一要义,凉血散血法贯彻始终,治疗过程中尤其注重顾护正气、调畅气血。总结和归纳清宫御医的天花临证经验,对于现代猴痘的诊治有较大的参考价值,有助于补充猴痘指南的辨证和治法方药的不足。

[Objective]To discuss the diagnosis and treatment experience of smallpox in Medical Records Integration of Palace in Qing Dynasty,hoping to provide useful reference for the clinical diagnosis and treatment of monkeypox in traditional Chinese medicine(TCM).[Methods]This paper collects and collat smallpox cases in Medical Records Integration of Palace in Qing Dynasty,establishes a database and carries out standardized processing.It uses the data mining module of the WEB side of Cloud Platform of Ancient and Modern Medic Case to carry out frequency statistics,association rules and complex network analysis for staging,Chinese drug and syndrome elements,and combining literature review and data mining.[Results]Of the 71 cases included,6 stages were involved,among which the most cases were point,swelling and grout.The 71 prescriptions in the medical records involved 141 kinds of Chinese drugs,and the high frequency Chinese drugs included Forsythiae Fructus,Crataegi Fructus,Arnebiae Radix,Angelicae Sinensis Radix,Rehmanniae Radix,etc.According to the attribute statistics of Chinese drugs,sweet flavor,the channel tropism of lung meridian,and cold drugs were mainly used.In addition to internal decoction,71 medical cases appeared a total of 10 Chinese patent drugs.A total of 32 syndrome elements were involved.Association rules were analyzed between staging and TCM,and 10 groups of association items were discovered.Association rule analysis of Chinese drug was carried out,and 18 groups of commonly used drug pairs were obtained.By using complex network analysis,a core prescription was obtained,with a total of 13 core drugs,which were Forsythiae Fructus,Crataegi Fructus,Arctii Fructus,Rehmanniae Radix,Angelicae Sinensis Radix,Paeoniae Radix Rubra,Platycodonis Radix,Glycyrrhizae Radix et Rhizoma,Schizonepetae Spica,Akebiae Caulis,Saposhnikoviae Radix,Scutellariae Radix,Arnebiae Radix.[Conclusion]For the diagnosis and treatment of smallpox,the imperial doctors of the Qing Palace often combined systemic and local syndrome differentiation.The therapeutic effect was based on eruption of toxicity.The methods of cooling blood and promoting blood circulation were always implemented.In the effect process,the imperial doctors paid more attention to the protection of Qi and the harmonizing Qi and blood.Summarizing the treatment experience offers great reference value for the modern diagnosis and treatment of monkeypox and is helpful to supplementing the deficiency of syndrome differentiation and treatment methods and prescriptions in monkeypox guidelines.