基于明清医案的耳鸣用药规律研究

Study on the Medication Law for Tinnitus Based on Medical Cases of Ming and Qing Dynasties

目的探讨明清医案中治疗耳鸣的用药规律。方法检索《中华医典》中文数据库中有关耳鸣治疗的明清医案,采集医案中处方药物等信息建立数据库,统计药物分类及功效、性味、归经情况,对高频药物进行聚类及关联规则分析。结果共纳入耳鸣治疗医案98篇,涉及方剂209首、药物160味。使用频次前5位的药物分别为茯苓(114)、甘草(73)、党参(48)、当归(47)、半夏(45);使用频次前3位的药物分类分别为清热类(336)、健脾类(200)、祛湿类(148);药性以寒性(729)和温性(506)为主,药味以甘味(901)、苦味(745)、辛味(276)为主。对使用频次> 20的29种高频药物进行聚类分析,得到5类核心药物聚类组,当相对距离为1时,得到4组4味核心药物聚类组。通过关联规则分析,共得22条药对及药组关联规则。结论明清医案中治疗耳鸣的用药以清热、健脾、祛湿等为主,临床不应局限从肝肾角度用药,还应注意调理脾胃及心经用药。

Objective To explore the rule of medication for treating tinnitus in medical cases in Ming and Qing Dynasty. Methods The Ming and Qing dynasty medical records related to tinnitus treatment in the Chinese Medical Dictionary were collected. The information on prescription drugs in medical records was collected to establish a database. The drug classification and efficacy,property,taste and channel tropism were recorded. The clustering and association rule analysis were performed for the high frequency drugs. Results Totally 98 cases of tinnitus treatment were included,involving 209 prescriptions and 160 herbs. The top five herbs used were Fuling( Poria,114),Gancao( Radix Glycyrrhizae,73),Dangshen( Radix Codonopsis,48),Danggui( Radix Angelicae Sinensis,47),and Banxia( Rhizoma Pinelliae,45). The top three drugs used were classified as clearing heat( 336),and invigorating spleen( 200) and removing dampness( 148);the herbs were mainly cold( 729) and warm( 506) in property,and the taste were mainly sweet( 901),bitter( 745),and pungent( 276). Cluster analysis was performed on 29 high-frequency drugs with frequency larger than 20,and 5 groups of core drug clusters were obtained. When the relative distance was 1,4 groups of 4 drug core clusters were obtained. Through the analysis of association rules,a total of 22 drug pairs and drug group association rules were obtained. Conclusion In the Ming and Qing Dynasties,the treatment of tinnitus is mainly for clearing heat,invigorating spleen and removing dampness. The clinical practice should not be limited to the use of liver and kidney. Attention should also be paid to conditioning the spleen and stomach and heart channel medicine.