石强教授“泻实调气”思想治疗咳嗽用药规律探析

Exploring the rules of medication in treating cough based on Professor SHI Qiang’s thought of reducing excess and regulating Qi

目的:探讨石强教授治疗咳嗽的用药规律,为咳嗽的临床诊疗提供有益参考。方法:收集石强教授治疗咳嗽的有效处方275首,药物经标准化后,运用Excel 2021对药物频数、四气、五味、归经、毒性和功效进行分类统计。使用IBM SPSS Statistics 26.0对高频中药(频率>10%)进行系统R聚类,并结合专业知识选择预测分类。采用SPSS Statistics 26.0中的因子分析(主成分分析)对高频药物(频率>10%)进行Kaiser-Meyer-Olkin(KMO)和Bartlett球形检验,根据结果提取出公因子的分布。结果:275首处方共使用中药245味,累计用药频次3388次。频数分析显示使用频率>10%的中药共38味,分别为川贝母、蝉蜕、石膏、苦杏仁、乌梢蛇等;药性以寒、温为主,药味以甘、苦、辛味为多,归经主入肺经、胃经、脾经、肝经;功效分类按频次高低依次为化痰止咳平喘药、清热药、解表药、化饮药等。高频药物(频率>10%)经聚类分析分为10类,通过因子分析得出14个公因子。结论:从临床咳嗽效方分析出的阳明风热表证、上焦(腑)湿痰痹阻、升降失宜、营分风热等证型下不同的核心药物体现石强教授基于“泻实调气”思想,运用“肺与大肠相表里”理论、痰饮分治学说、气机升降学说和风邪的发生机制治疗咳嗽的用药思路,对于当前咳嗽诊疗具有一定价值。

Objective:To explore the medication rule of Professor SHI Qiang in treating cough,so as to provide useful reference for the clinical diagnosis and treatment of cough.Methods:A total of 275 effective prescriptions for the treatment of cough by Professor SHI Qiang were collected.After drug standardization,Excel 2021 was used to classify the frequency,four Qi(气),five flavors,meridian tropism,toxicity and efficacy of the traditional Chinese medicines.IBM SPSS Statistics 26.0 was used to carry out systematic R clustering of high-frequency traditional Chinese medicines(frequency>10%),and combined with professional knowledge to select predictive classification.The factor analysis(principal component analysis)of SPSS Statistics 26.0 was used to carry out KaiserMeyer-Olkin(KMO)and Bartlett spherical test for high frequency traditional Chinese medicines(frequency>10%),and the distribution of common factors was extracted according to the results.Results:A total of 245 traditional Chinese medicines were used in 275 prescriptions,with a cumulative frequency of 3388 times.Frequency analysis shows a total of 38 traditional Chinese medicines with frequency>10%,including Chuanbeimu(Bulbus Fritillariae Cirrhosae),Chantui(Periostracum Cicadae),Shigao(Gypsum Fibrosum),Kuxingren(Semen armeniacae amarum),Wushaoshe(Zaocys),etc..The medicinal properties are mainly cold and warm,the flavors are mostly sweet,bitter and pungent,and the kinds of meridian tropism are mainly lung,stomach,spleen and liver meridians.The efficacy classifications in descending order of relieving phlegm cough and asthma medicines,heat-clearing medicines,relieving superficies medicines and dissolving retained fluid medicines,etc..The high-frequency drugs(frequency>10%)is divided into 10 categories by cluster analysis,and the factor analysis yields 14 common factors.Conclusion:Different core drugs under the Yangming(阳明)wind-heat superficies syndrome,upper energizer(Fu-organ)dampness-phlegm obstruction,improper ascending and descending,and Yingfen(营分)wind-heat syndrome were analyzed from the clinical cough effective prescriptions.It reflects Professor SHI Qiang’s medication ideas of using the theory of mutual exterior-interior relation between lung and large intestine,the theory of separate treatment of phlegm and drink,the theory of ascending and descending of Qi movement,and the mechanism of wind evil based on the thought of reducing excess and regulating Qi,which have value for the current cough diagnosis and treatment.