基于数据挖掘分析倪青主任病证结合治疗Graves病遣方用药经验

Analysis of Professor Ni Qing's Experience in Prescription and Medication for the Combined Disease and Syndrome Treatment of Graves'Disease Based on Data Mining

目的探讨倪青主任病证结合治疗Graves病(Graves disease,GD)的遣方用药经验。方法收集就诊于倪青主任门诊的GD患者235例,结合患者临床症状和特异性理化检测指标将病情分为重度、中度、轻度和病情相对平稳的类型;中药处方235张,构建数据库,应用相关软件,分析病情与方剂及中药的关系。结果235例患者中重度7例,中度19例,轻度52例,病情平稳者157例;235张处方共涉及方剂40种,中药201味。频次统计提示重度使用最多为滋阴潜阳甲亢方;中度常用四逆散;轻度以参芪地黄汤为主;病情平稳最多用藿朴夏苓汤。201味中药中,使用频次高于10次的中药共59味,重度常用中药为夜交藤、生地黄、玄参、田基黄、栀子、牡蛎等;中度常用药为枳壳、厚朴、柴胡、香附等;轻度常用茯苓、太子参、炙甘草、生黄芪、白术、山萸肉等;病情平稳常用茯苓、泽泻、厚朴、猪苓、半夏、藿香、佩兰等。关联规则提示,支持度>10%,置信度>10%,作用度>1 h,病情与中药一项关联中与重度一起出现的为玄参、生地黄、夜交藤;中度为青皮;轻度为太子参。两项关联中与重度一起出现的为玄参、夜交藤;中度为青皮、陈皮;轻度为女贞子、旱莲草;病情平稳为牛蒡子、桔梗;仙茅、仙灵脾;荆芥、防风。三项关联中与中度一起出现的为漏芦、路路通、丝瓜络;轻度为太子参、生黄芪、生地黄;病情平稳为生薏米、苍术、田基黄;大腹皮、砂仁、莱菔子;香附、枳壳、赤芍;泽兰、泽泻、川牛膝。结论倪青主任病证结合治疗GD临床经验丰富,依据不同病情分度,分别采用滋阴潜阳、疏肝理气、益气养阴、健脾化痰、疏风利咽、利湿活血之法遣方用药。

Objective To explore director Ni Qing's experience in prescription and medication for the combined disease and syndrome treatment of Graves'disease(GD).Methods A total of 235 patients with GD treated by director Ni Qing were collected.Based on the patient's clinical symptoms and specific biochemical markers,the disease was classified into severe,moderate,mild,and relatively stable types.A database was constructed from 235 traditional Chinese medicine(TCM)prescriptions,and relevant software was used to analyze the relationship between disease severity,prescriptions,and TCM.Results Among the 235 patients,7 had severe conditions,19 had moderate,52 had mild,and 157 had relatively stale conditions.A total of 40 prescriptions and 201 TCM ingredients were involved in the 235 prescriptions.Frequency statistics showed that the most commonly used formula for severe cases was the“Nourishing Yin and Subduing Yang for Hyperthyroidism Formula”;for moderate cases,it was“Sini Powder”;for mild cases,“Shenqi Dihuang Decoction”;and for stable cases“Huopu X ialing Decoction”.Of the 201 TCMs,59 were used more than 10 times.Commonly used TCM for se-vere cases included Caulis Polygoni Multilori,raw Rehmanniae Radix.,Scrophulariae Radix,Hypericum japonicum Thunb.ex Murray,Gardeniae F ructus,and Ostreae Concha;for moderate cases,Aurantii Fructus,Magnoliae Officinalis Cortex,Bu-pleuri Radix,and Cyperi Rhi zoma;for mild cases,Poria,Pseudostellariae Radix,Glycyrhizae Radix Et Rhizoma Praeparata Cum Melle,raw Astragali Radix,Atractylodis Macrocephalae Rhizoma,and Cormi Fructus;and for stable cases,Poria,Al-ismatis Rhizoma,Magnoliae Officinalis Cortex,Polyporus,Pinelliae Rhizoma,Agastachis herba,and Eupatorii Herba.Asso-ciation rules analysis suggested that with a support value>10%,confidence>10%,and degree of action>1,the TCMs as-sociated with severe cases were Scrophulariae Radix,raw Rehmanniae Radix,and Caulis Polygoni Muliflori.For moderate cases,it was Citri Reticulatae Pericarpium V iride;for mild cases,Pseudostellariae Radix.Two TCM combinations associated with severe cases included Scrophulariae Radix and Caulis Polygoni Muliflori;for moderate cases,Citri Reticulatae Peri-carpium Viride and Citri Reticulatae Pericarpium;for mild cases,Ligustri Lucidi Fructus and Eeliptae Herba;for stable ca-ses,the TCM pairs were Arcti Fructus and Platycodonis Radix,Curculiginis Rhizoma and Epimedii Folium,Schizonepetae Herba and Saposhnikoviae Radix.Three TCM combi nations associated with moderate cases included Rhapontici Radix,Liq-uidambaris Fructus,and Luffae Fructus Retinervus;for mild cases,Pseudostellariae Radix,raw Astragali Radix,and raw Rehmanniae Radix.The stable cases incude Coicis semen,Atractylodis Rhizoma,and Hypericum japonicum Thunb.ex M urray;Arecae Pericarpium,Amomi Fructus,and Raphani Semen;Cyperi Rhizoma,Aurantii Fructus,and Paeoniae Radix Rubra;Lycopi Herba,Alismatis Rhizoma,and Cyathulae Radix.Conclusion Director Ni Qing has extensive clinical expe-rience in the combined disease and syndrome treatment of GD.Depending on the severity of the condition,different treat-ment methods were used,such as nourishing Yin and subduing Yang,soothing the liver and regulating Qi,tonifying Qi and nourishing Yin,strengthening the spleen and resolving phlegm,dispersing wind and benefiting the throat,and promoting uri-nation and activating blood circulation.