固利相兼治疗2型糖尿病肾病用药规律

Medication rules in type 2 diabetic kidney disease via combination of reinforcement and elimination in combination

目的深入探析吴深涛教授“固利相兼”治疗2型糖尿病肾病的用药规律。方法收集2016年1月至2022年12月吴深涛教授诊治2型糖尿病肾病医案,建立相关数据库,运用Microsoft Office Excel 2021、SPSS Modeler 18.0和SPSS Statistics 26.0分别对处方药物进行频数统计、关联分析和聚类分析。结果共纳入832首中药处方,涉及药物228味,使用频次共计13288次。单味药物使用频率前3名的中药分别为黄芪、茯苓、石莲子。四气以寒、温、平为主,五味以甘、苦、辛为主,归经以肝、肺、脾为主,功效分类以补虚药、清热药、利水渗湿药、活血化瘀药为主。中医证型分布中,虚证以肾虚证为主,实证以浊毒内蕴证为主。高频药物关联分析得出药物组合9个,高频药物聚类分析得出核心组方3个。结论本研究借助数据挖掘技术,全面阐释了吴深涛教授“固利相兼”辨治2型糖尿病肾病的深刻内涵,即“固取精微”并非单纯地使用收涩药,更应健脾益肾以助其统摄之力。“泄利浊毒”之含义不可囿于化浊解毒,更应辨“浊毒”所处病位之异,或“清泄”,或“通利”,因势利导,予“浊毒”以出路。

Objective To analyze the medication patterns in the treatment of type 2 diabetic kidney disease with combination of reinforcement and elimination in combination.Methods Medical records of professor in diagnosis and treatment of type 2 diabetic kidney disease from January 2016 to December 2022 were collected to establish relevant database.Microsoft Office Excel 2021,SPSS Modeler 18.0 and SPSS Statistics 26.0 were used to perform frequency statistics,correlation analysis and cluster analysis.Results Totally 832 prescriptions of Chinese medicine were included,involving 228 drugs,with frequency of use 13288 times.The top three Chinese medicines with the highest frequency of single use included Astragali Radix,Poria,and Nelumbo nucifera Gaerth.The main properties coldness,warmness and neutrality.The five flavors mainly covered sweetness,bitterness and pungent.The meridians included liver,lung and the spleen mainly.The efficacy came from tonic drugs,heat-clearing drugs,water-clearing and dampness-percolating drugs,and blood-activating and stasis-removing drugs.As for the distribution of traditional Chinese medicine syndrome,the deficiency syndrome mainly referred to kidney deficiency syndrome,while the excessive syndrome was turbidity toxin syndrome.High-frequency Chinese medicine correlation analysis showed that 9 drug combinations were obtained,and 3 core prescriptions by high frequency drug cluster analysis.Conclusion For type 2 diabetic kidney disease,reinforcement not only refers to the use of astringent drugs,but also strengthen the spleen and kidney to help its regulating power.Elimination does not limit to resolving turbid toxins,but recognizing the differences in the location of turbid toxins,either by“clearing and draining”or by facilitating to discharge turbid toxins according to the position of disorders.