基于多中心临床医案和“方剂-药性-功效-疾病”的藏族医治疗高血压用药规律研究

Study on regularity of drug use in Tibetan medicine treating hypertension based on multi-center clinical medical records and "prescription-property-efficacy-disease"

探索藏族医临床治疗高血压(查隆堆仓)的用药规律,分析其方剂药性特点。收集藏族医治疗高血压的137例临床医案,采用数据挖掘,Gephi,Cytoscape等方法和软件,并结合藏族药药性理论分析。结果发现临床医案中隆型高血压有44例,查型高血压有57例;治疗所用方剂共有103首,其中频次依次为二十五味余甘子丸(96次)、七十味珍珠丸(80次)、八味沉香丸(75次)、三味甘露散(62次),且前4位关联很强,置信度≥95%。方剂涉及的组方药物共有332种,为体现核心组方药物,该研究首次提出了藏族药方剂组方药物的相对用量分析法,并分析得到诃子、余甘子、木香、沉香等相对用量最多,组方药物关联分析发现,草果为首的红花、肉豆蔻、天竺黄、丁香、豆蔻等的关联较高,置信度≥75%,该6种药物是藏族医联合用药时保护脏腑和调节三胃火的关键药物。方剂药性以凉、钝、稀、糙等为主,功效集中在热、锐、臭、粘等特性引起的血热、血液黏稠、脉络堵塞等病机,主要治疗查隆病、查培病(多血症)等疾病。提出藏族医治疗高血压具有'清血热-通脉络-调胃火'三位一体的治疗原则,主治高血压的同时兼顾心血管功能和胃肠代谢功能,这可能是其治疗高血压疗效显著而持久的隐性知识。

This study aimed to explore the rule of Tibetan medicine in clinical treatment of hypertension(k Hrag-rLung-stod-vtshangs)and analyze the characteristics of its prescriptions.One hundred and thirty-seven cases of hypertension treated Tibetan medicine were collected.Data mining,Gephi,Cytoscape and other methods and software were used to analyze the characteristics of Tibetan medicine.The results showed that there were 44 cases of r Lung-type hypertension in clinical medical records,while 57 cases of k Hrag-type hypertension.There were 103 treatment prescriptions.The frequency of these prescriptions covered Twenty-five Yuganzi Pills(96 times),Seventy Pearl Pills(80 times),Eight Chenxiang Pills(75 times),and Sanwei Ganlu Powder(62 times),and they were highly correlated,with confidence greater than 95%.There were 332 prescriptions involved in the prescriptions which is core prescription medicines.This study first proposed the dosage analysis method of Tibetan medicine prescription medicines,and obtained the more dosage of Chebulae Fructus,Phyllanthi Fructus,Aucklandiae Radix,Aquilariae Lignum Resinatum and so on.The correlation analysis of the prescription medicines found that Carthami Flos,Myristicae Semen,Bambusae Concretio Silicea,Caryophylli Flos,Amomi Fructus Rotundus led by Tsaoko Fructus had a high correlation and a confidence greater than 75%.These herbs were guaranteed when Tibetan medicine was used in combination.The key drugs for protecting viscera and regulating the three gastric fires.The prescription is mainly cold,blunt,sparse and rough.Its efficacy focuses on the pathogenesis of blood fever,blood stickiness and venous blockage caused by heat,sharpness,odor and stickiness.It mainly treats Tibetan medicine diseases such as k Hrag-r Lung-stod-vtshangs and k Hrag-vpel(polyemia).It is suggested that Tibetan medicine has a three-in-one invisible treatment principle of'clearing blood-heat,opening vessel and regulating stomach-fire'in the treatment of hypertension,which attributed to both cardiovascular function and gastrointestinal metabolic function.This may be a significant and invisible knowledge of Tibetan medicine in the treatment of hypertension.