国医大师熊继柏治疗失眠的方药规律分析

National TCM Master XIONG Jibo's formulation and medication rules for treating insomnia

目的对国医大师熊继柏教授治疗失眠的病案进行数据挖掘,分析熊继柏教授诊治失眠的用方、用药经验。方法基于中医传承辅助平台软件(V3.5),归纳和分析熊继柏教授在湖南中医药大学第一附属医院治疗失眠患者的门诊病历数据,利用该平台软件的关联规则、复杂系统熵聚类等统计方法进行数据挖掘和分析,总结药物的性味、归经、应用频次、药对组合及合方,对“证-症-方”“证-症-药”“证-方-药”进行关联,结合熊继柏教授对失眠病因病机、治则治法的认识,明确核心用药,探索其对失眠的诊治规律及遣方用药心得。结果通过总结分析,共纳入病历276份,处方中用药频次较多的有酸枣仁、龙齿、茯神、甘草,重在补虚安神;黄连、陈皮、竹茹、半夏、珍珠母、远志,重在清热化痰安神。用药性味偏甘、苦、辛,归经多为心、脾经。并归纳出虚证治疗常用合方为酸枣仁汤、枕中丹和甘麦大枣汤;因痰所致失眠治疗的主方为温胆汤及温胆汤类方(枣仁温胆汤、黄连温胆汤及十味温胆汤)。结论国医大师熊继柏治疗失眠以“补脾化痰清热,养血补肝宁心”为治疗原则,以温胆汤为基础进行加减化裁。

Objective To conduct data mining on insomnia cases treated by Professor XIONG Jibo,the National TCM Master,and analyze his formulation and medication experience.Methods Based on the Chinese Medicine Inheritance Auxiliary Platform Software(V3.5),the outpatient medical records of insomnia patients treated by Professor XIONG at the First Hospital of Hunan University of Chinese Medicine were summarized and analyzed.Statistical methods such as association rules and complex system entropy clustering of the platform software were used.The properties and flavors of Chinese medicines,their meridian affinity,application frequency,combinations of medicine pairs,and combinations of formulas were summarized,and the"pattern-symptom-formula","pattern-symptom-medication",and"pattern-formula-medication"were correlated.Combined with Professor XIONG’s understanding of the etiology,pathogenesis,and treatment principles and methods of insomnia,the core medication was clarified and the diagnosis and treatment rules as well as formulation and medication experiences for insomnia were explored.Results A total of 276 medical records were included.The most frequently used Chinese medicines were Suanzaoren(Zziziphi Spinosae Semen),Longchi(Dens Draconis),Fushen(Sclerotium Poriae Pararadicis),and Gancao(Glycyrrhizae Radix Rhizoma),which tonify deficiency and calm the mind;Huanglian(Coptidis Rhizoma),Chenpi(Citri Reticulatae Pericarpium),Zhuru(Bambusae Caulis Taenias),Banxia(Pinelliae Rhizoma),Zhenzhumu(Margaritifera Concha),and Yuanzhi(Polygalae Radix),which mainly function to clear heat,transform phlegm,and calm the mind.The frequently used Chinese medicines were sweet,bitter,and pungent in flavor,and mostly entered the heart and spleen meridians.It was concluded that the commonly used combination of formulas for treating deficiency-pattern insomnia were Suanzaoren Decoction,Zhenzong Pill and Ganmai Dazao Decoction;the main formulas for treating insomnia caused by phlegm were Wendan Decoction and the like,such as Zaoren Wendan Decoction,Huanglian Wendan Decoction,and Shiwei Wendan Decoction.Conclusion National TCM Master XIONG Jibo's treatment of insomnia follows the principle of"tonifying the spleen,transforming phlegm,clearing heat,nourishing blood,supplementing the liver,and calming the heart",with Wendan Decoction as the basic formula with modifications.