基于数据挖掘探讨清代医家治疗便秘的用药规律

Exploration of the medication rules of physicians in the Qing Dynasty for constipation based on data mining

目的:应用数据挖掘的方法,探索清代医家治疗便秘的用药规律。方法:筛选《景岳全书》《类证治裁》《临证指南医案》中治疗便秘的方剂,提取信息、规范名称后使用Microsoft Excel软件建立数据库,应用IBM SPSS Statistics 26和Modeler 18.0软件对处方中药物、性味归经及类别进行频次统计,并对高频药物进行聚类分析、关联规则分析。结果:《景岳全书》《类证治裁》《临证指南医案》中所载治疗便秘的方剂共116个,涉及148味中药,药性以温、寒、微寒为主,药味以苦、甘、辛居多,主入脾、肝二经,使用频次≥9次的药物有28味,频次最高的前5味分别为当归、甘草、大黄、茯苓、熟地黄。聚类分析将药物分为4类,1类为牛膝、山茱萸、山药、熟地黄、枸杞子、肉桂、车前子、泽泻、猪苓、茯苓,温肾利水;2类为火麻仁、苦杏仁、桃仁、郁李仁、柏子仁、肉苁蓉、当归、生地黄、枳壳,润肠通便;3类为人参、白术、甘草、厚朴、枳实、陈皮,疏肝补脾;4类为大黄、栀子、滑石,泻火通便。当归-桃仁是二阶关联规则中支持度最高的药对,人参+甘草-白术、山药+山茱萸-熟地黄是药物三阶关联规则中支持度最高的药物组合。结论:清代医家治疗便秘多以补脾疏肝为基本治则,从肝脾同调入手,善用补虚药与理气药相结合,为便秘的临床治疗提供思路。

Objective:To explore the medication rules of physicians in the Qing Dynasty for constipation based on data mining.Methods:The prescriptions for constipation in Jingyue Quanshu,Leizheng Zhicai and Linzheng Zhinan Yi′an were screened,and the information was extracted and the names were standardized to establish a database using Microsoft Excel software.IBM SPSS Statistics 26 and Modeler 18.0 software were used to calculate the frequency of drugs in the prescription,their properties,flavors,channel tropism and categories.Cluster analysis and association rule analysis were performed on high-frequency drugs.Results:A total of 116 prescriptions for constipation were recorded in Jingyue Quanshu,Leizheng Zhicai and Linzheng Zhinan Yi′an,involving 148 Chinese herbs.The medicinal properties were mainly warm,cold and slightly cold,the medicinal flavors were mostly bitter,sweet and pungent,and the channel tropism was mainly the spleen and liver channels.There were 28 drugs used more than 9 times,and the top 5 drugs were Danggui,Gancao,Dahuang,Fuling and Shudihuang.By cluster analysis,the drugs were divided into 4 categories.The first category was Niuxi,Shanzhuyu,Shanyao,Shudihuang,Gouqizi,Rougui,Cheqianzi,Zexie,Zhuling and Fuling,which were used for warming kidney and eliminating dampness;the second category was Huomaren,Kuxingren,Taoren,Yuliren,Baiziren,Roucongrong,Danggui,Shengdihuang and Zhiqiao,which were used for moistening the bowel and promoting purgation;the third category was Renshen,Baizhu,Gancao,Houpo,Zhishi and Chenpi,which were used for soothing liver and tonifying spleen;the fourth category was Dahuang,Zhizi,Huashi,which were used for reducing fire and promoting purgation.Danggui and Taoren were the drug pair with the highest support in the second-order association rule,while Renshen+Gancao-Baizhu and Shanyao+Shanzhuyu-Shudihuang were the drug combination with the highest support in the third-order association rule.Conclusion:In the Qing Dynasty,the basic treatment of constipation is tonifying spleen and soothing liver.Starting from the coordination of liver and spleen,the combination of deficiency-tonifying drugs and Qi-regulating drugs is used to provide ideas for the clinical treatment of constipation.