《临证指南医案》治疗温热病的组方用药规律研究

Study on Prescription Rules of Linzheng Zhinan Yian in Treatment of Febrile Diseases

目的探究《临证指南医案》中温热病篇组方用药规律。方法以《临证指南医案》卷五温热篇所载医案建立数据库,采用SPSS Statistics 26.0及SPSS Modeler Version 18.0作为数据挖掘平台,运用频次统计、关联规则Apriori算法及聚类分析进行统计分析。结果《临证指南医案》温热病篇共收录医案60则,共102味中药,总用药频次达427次,其中高频药物有7味(用药频次>15),分别为地黄、甘草、麦冬、人参、犀角、阿胶、玄参;药物类别以清热药与补虚药为主;药性方面以寒性为主,温性次之;药味分析来看,以甘、苦、辛类药物居多;药物常归肺经、心经及胃经;关联分析得出阿胶—生地黄、阿胶—麦冬、石膏—甘草等核心药对;聚类分析整理出五组核心药物组合。结论叶天士辨治温热病时根据卫气营血传变规律,多以清热凉血药配伍滋阴润燥药,同时补益正气,注重清热与补虚同治。

Objective To explore the prescription rules of febrile diseases in Linzheng Zhinan Yian.Methods The database was established based on the medical records in the fifth chapter of Linzheng Zhinan Yian.SPSS Statistics 26.0 and SPSS Modeler Version 18.0 were used as data mining platforms.Frequency statistics,association rule Apriori algorithm and cluster analysis were used for statistical analysis.Results A total of 60 medical records were collected,including 102 kinds of traditional Chinese medicine,and the total medication frequency was 427 times.Among them,7 kinds of high frequency drugs(medication frequency>15)were Dihuang(Rehmanniae Radix),Gancao(Glycyrrhizae Radix Et Rhizoma),Maidong(Ophiopogonis Radix),Renshen(Ginseng Radix Et Rhizoma),Xijiao(Rhinoceros Horn),Ajiao(Asini Corii Colla)and Xuanshen(Scrophulariae Radix).The drug categories were mainly heat-clearing drugs and tonifying drugs.The medicinal properties were mainly cold,followed by warm.The tastes were sweet,bitter and pungent in the majority.The drugs often belong to lung,heart and stomach meridians.The correlation analysis showed that the core drug pairs were Ajiao(Asini Corii Colla)-Shengdidihuang(Rehmanniae Radix),Ajiao(Asini Corii Colla)-Maidong(Ophiopogonis Radix),Shigao(Gypsum Fibrosum)-Gancao(Glycyrrhizae Radix Et Rhizoma),etc.Cluster analysis sorted out five core drug combinations.Conclusion According to the law of Wei-Qi-Ying-blood transmission,YE Tianshi used heat-clearing and blood-cooling drugs combined with nourishing Yin and moistening dryness drugs,at the same time,he replenished healthy Qi,and paid attention to clearing heat and tonifying deficiency.