Traditional Chinese medicine Master XIONG Jibo’s medication experience in treating arthralgia syndrome through data mining

Objective This study aimed to examine and propagate the medication experience and group formula of traditional Chinese medicine(TCM)Master XIONG Jibo in diagnosing and treat-ing arthralgia syndrome(AS)through data mining.Methods Data of outpatient cases of Professor XIONG Jibo were collected from January 1,2014 to December 31,2018,along with cases recorded in A Real Famous Traditional Chinese Medicine Doctor:XIONG Jibo's Clinical Medical Record 1,which was published in December 2019.The five variables collected from the patients’data were TCM diagnostic information,TCM and western medicine diagnoses,syndrome,treatment,and prescription.A database was established for the collected data with Excel.Using the Python environment,a custom-ized modified natural language processing(NLP)model for the diagnosis and treatment of AS by Professor XIONG Jibo was established to preprocess the data and to analyze the word cloud.Frequency analysis,association rule analysis,cluster analysis,and visual analysis of AS cases were performed based on the Traditional Chinese Medicine Inheritance Computing Platform(V3.0)and RStudio(V4.0.3).Results A total of 610 medical records of Professor XIONG Jibo were collected from the case database.A total of 103 medical records were included after data screening criteria,which comprised 187 times(45 kinds)of prescriptions and 1506 times(125 kinds)of Chinese herbs.The main related meridians were the liver,spleen,and kidney meridians.The properties of Chinese herbs used most were mainly warm,flat,and cold,while the flavors of herbs were mainly bitter,pungent,and sweet.The main patterns of AS included the damp heat,phlegm stasis,and neck arthralgia.The most commonly used herbs for AS were Chuanniuxi(Cyathu-lae Radix),Huangbo(Phellodendri Chinensis Cortex),Cangzhu(Atractylodis Rhizoma),Qinjiao(Gentianae Macrophyllae Radix),Gancao(Glycyrrhizae Radix et Rhizoma),Huangqi(Astragali Radix),and Chuanxiong(Chuanxiong Rhizoma).The most common effect of the herbs was“promoting blood circulation and removing blood stasis”,followed by“supple-menting deficiency(Qi supplementing,blood supplementing,and Yang supplementing)”,and“dispelling wind and dampness”.The data were analyzed with the support≥15%and con-fidence=100%,and after de-duplication,five second-order association rules,39 third-order association rules,39 fourth-order association rules,and two fifth-order association rules were identified.The top-ranking association rules of each were“Cangzhu(Atractylodis Rhizoma)→Huangbo(Phellodendri Chinensis Cortex)”“Cangzhu(Atractylodis Rhizoma)+Chuanniuxi(Cyathulae Radix)→Huangbo(Phellodendri Chinensis Cortex)”“Chuanniuxi(Cyathulae Radix)+Danggui(Angelicae Sinensis Radix)+Gancao(Glycyrrhizae Radix et Rhizoma)→Qinjiao(Gentianae Macrophyllae Radix)”and“Chuanniuxi(Cyathulae Radix)+Danggui(Angelicae Sinensis Radix)+Gancao(Glycyrrhizae Radix et Rhizoma)+Huangbo(Phello-dendri Chinensis Cortex)→Qinjiao(Gentianae Macrophyllae Radix)”,respectively.Five clusters were obtained using cluster analysis of the top 30 herbs.The herbs were mainly dry-ing dampness,supplementing Qi,and promoting blood circulation.The main prescriptions of AS were Ermiao San(二妙散),Gegen Jianghuang San(葛根姜黄散),and Huangqi Chongteng Yin(黄芪虫藤饮).The herbs of core prescription included Cangzhu(Atractylodis Rhizoma),Chuanniuxi(Cyathulae Radix),Gancao(Glycyrrhizae Radix et Rhizoma),Huangbo(Phellodendri Chinensis Cortex),Mugua(Chaenomelis Fructus),Qinjiao(Gentianae Macro-phyllae Radix),Danggui(Angelicae Sinensis Radix),and Yiyiren(Coicis Semen).Conclusion Clearing heat and dampness,relieving collaterals and pain,and invigorating Qi and blood are the most commonly used therapies for the treatment of AS by Professor XIONG Jibo.Additionally,customized NLP model could improve the efficiency of data mining in TCM.

Retrospection and Reflection on the Role of Henry C.Lu as a Traditional Chinese Medicine Writer,Educator,and Translator

This paper respectfully commemorates the life of Dr.Henry C.Lu(1936-2022),who was the founding president of International College of Traditional Chinese Medicine of Vancouver.Dr.Lu was an active educator,a prolific writer and translator of traditional Chinese medicine(TCM)in the West and an influential figure during the initial stage of the international dissemination of TCM.By comprehensively searching,referencing,and cross-validating the literature,this article reviewed Dr.Lu’s major life events,bibliography,and,most importantly,his contribution to TCM education and translation.Dr.Lu should be given more credit for his achievements,and further studies are needed in future.

Historical Legacy of Traditional Chinese Medicine Education in Canada:The Case of Henry C.Lu

This article begins with a review of the publications by Dr.Henry C.Lu,a Canadian-Chinese traditional Chinese medicine(TCM)scholar,educator and writer,and founder of a Vancouver-based TCM college.Dr.Lu has translated many TCM classics and written books extensively on TCM education,TCM clinical practice and Mandarin-Chinese grammar.Aside from his widespread prominence as one of the representative English translators of Huangdi Neijing(The Yellow Emperor’s Inner Classic),Dr.Lu is also noted for his pioneering role in the promotion of TCM education in British Columbia,where he lived and worked for more than half of his life.By making references to and drawing lessons from Dr.Lu’s four-decade-long efforts to help TCM gain legal status and to promote wider application of TCM in Canada,this article also puts forth suggestions for overseas TCM education and international TCM standards for building a global community with a shared future.

Intra-set correlation analysis of medical records of thyroid cancer treated by traditional Chinese medicine Master ZHOU Zhongying

Objective Based on intra-set correlation analysis, this paper deconstructs the clinical medical records of traditional Chinese medicine(TCM) Master ZHOU Zhongying in treating thyroid cancer, and analyzes the experience in “mechanism-syndrome-medicine-prescription” for thyroid cancer.Methods Through Medcase data processing platform, based on Frequent Pattern(FP)-Growth enhanced correlation analysis algorithm, the medical records of Professor ZHOU Zhongying for the treatment of thyroid cancer from June 1, 2001 to February 28, 2015 were analyzed within the set.Results This study involved 43 medical records, 43 patients, and 167 visits. After processing intra-set correlations, 28 groups of highly correlated symptoms, 21 groups of highly correlated tongue images, 10 groups of highly correlated pulse conditions, 28 groups of highly correlated pathogenesis, 34 groups of highly correlated herbs, and 26 groups of highly correlated western medicine diagnosis were selected. Professor ZHOU Zhongying treats thyroid cancer according to syndrome differentiation. Symptoms with more association rules included neck swelling, neck pain, cough, and dry mouth;tongue images with more association rules included dark purple tongue, dark red tongue, and fissured tongue;pulse conditions with more association rules were wiry pulse, thready pulse, small pulse, and slippery pulse;the pathogenesis with more association rules was phlegm and blood stasis, damp-heat accumulation,and impairment of both Qi and Yin;herbs with more association rules were Chaihu(Bupleuri Radix), Zeqi(Sun Euphoribiae Herb), and Tiandong(Asparagi Radix);western medicine diagnosis with more association rules included thyroid cancer, insomnia, and chronic gastritis.Conclusion Thyroid cancer mostly presents as deficiency in origin and excess in manifestations. The basic pathogenesis is phlegm and blood stasis, damp-heat accumulation, and impairment of both Qi and Yin, which are closely related to liver, kidney, and spleen. Professor ZHOU Zhongying adopts both attack and supplement approaches as the general treatment principle, with a strong emphasis on regulating Qi and relieving depression, eliminating phlegm and resolving stagnation, eliminating dampness and turbidity, clearing fire and destroying poison, moistening dryness and softening hard mass, invigorating Qi and nourishing Yin, and paying attention to nourishing liver and kidney, invigorating spleen and stomach,while protecting the heart and lungs.

An analysis of the national TCM master Lu Zhizheng’s academic thought

Lu Zhizheng as one of the first national TCM masters in China, has gradually formed an academic thought of his own after longterm clinical practice of TCM. Such as development of spleen and stomach theory,18-character guideline——holding central area, operating also, taking good care of emotional activities, soothing liver, moistening dryness, improving digestion, and while his conclusions have been used for clinical practice flexibly. He suggested that the key of pathogenesis may be excessive fluid together with phlegm dampness and proposed the treatment rules of diseases caused by dampness. And he attempted to expound the methods and results of the research of rheumatism diseases. If conditions of diseases change,Professor Lu Zhizheng would be agile and adjust according to the conditions. The method of herbs is principled,and King Way therapy used by TCM treatment should be promoted.

从“气化”浅述国医大师葛琳仪运用风药治疗脾胃病之学术思想

[目的]介绍国医大师葛琳仪教授(以下简称葛教授)分层次施用风药辨治脾胃病的临床特色及其临证经验。[方法]通过理论溯源,跟师随诊,整理并分析葛教授基于气化理论运用风药治疗脾胃系疾病的临床医案,总结葛教授巧施风药辨治脾胃病的思路、心得和用药特色,并附医案一则加以佐证。[结果]气化是生命的基本活动,气化异常是疾病产生的重要原因。葛教授指出,脾胃病的基本病机是“气化异常”,常从“气化”切入,巧施风药以调畅气机,恢复脾升胃降功能,维稳五脏气机,具体分为四个层次:以风药疏肝和脾、壮气运脾、燥湿健脾以及搜风通络养脾。常用的风药有柴胡、防风、黄芪、升麻、佛手、紫苏梗、苍术、娑罗子、桑叶、藿香、草果、厚朴、佩兰、徐长卿、炒僵蚕等及其组成的药对、药串。[结论]葛教授临证精于辨证,从“气”切入,按不同层次巧施风药治疗脾胃病,特色鲜明,疗效显著,其学术思想值得临床借鉴和推广。

国医大师熊继柏治疗泄泻用药规律探究

对国医大师熊继柏治疗泄泻病案进行数据挖掘,分析熊继柏教授诊治泄泻的用药经验。基于中医传承辅助平台软件(V3.0),归纳和分析熊继柏教授在湖南中医药大学第一附属医院治疗泄泻患者的门诊病历数据,利用该平台软件的关联规则、复杂系统熵聚类等统计方法进行数据挖掘和分析,总结药物的性味、归经、应用频次、舌脉象频次及药对组合,通过结合熊继柏教授对泄泻病因病机、治则治法的认识,明确核心用药,探索国医大师的诊治规律及用药规律;且以验案举例说明。通过总结分析,共纳入病历168份,处方中用药频次较多的有砂仁、厚朴、黄连、木香、甘草、茯苓、白术、陈皮、半夏、西洋参,药性以温、平、寒为主,药味偏苦、辛、甘,归经多为脾胃经,归纳出治疗泄泻的主方为香砂六君子汤和连朴饮。国医大师熊继柏治疗泄泻以“健脾理气,清热燥湿”为治疗原则,在香砂六君子汤和连朴饮的基础上进行辨证论治,加减化裁。

中医风湿病学专业硕士学位研究生培养模式探究

为进一步提升中医风湿病学专业硕士学位研究生的传承和创新能力,根据中国当前中医风湿病学专硕研究生的培养现状,提出了一个以“传承+创新”为导向的中医风湿病学培养体系.该体系主要包括:强化中医“经典”学习,传承中医药文化;深化科研创新能力培养;加强中西医结合知识体系构建;发挥导师引导作用;合理规划科室轮转时间.多管齐下,与时俱进,培养高校人才.研究结果可为相关院校优化及创新中医风湿病学专业硕士学位研究生培养模式提供参考.

乳腺癌“应激治乳”新理论的构建与临床应用探讨

应激是生物体对内、外源性刺激的一种非特异的适应性反应,有助于维持机体内环境稳态。然而当应激反应的程度超过机体适应阈值,即可诱发多种疾病。乳腺癌发病率和死亡率高居女性恶性肿瘤前列,乳腺病领域首位国医大师林毅教授创立“六郁治乳”理论,认为六郁是乳腺癌发生发展的核心病机,而六郁与机体应激反应系统密切相关,中医药在调整应激稳态平衡领域有特色优势。该文基于中医经典理论、“六郁治乳”理论及现代应激理论,提出“应激治乳”学说,阐释应激因素介导乳腺癌发生发展的病机特性、致病特点、分子机制,提出基于应激稳态调控的核心思想和辨治原则,总结“应激治乳”理论指导下的遣方用药。“应激治乳”理论的构建丰富了中医乳腺癌理论体系,有望为改善乳腺癌患者的临床预后提供新路径。

借鉴师承教育模式探索闽医萧氏学术流派的生存与发展

闽医萧氏学术流派是福建省萧氏在长期临床实践历程中形成的,拥有独特的学术理论和临床经验,具有区域性特色的中医外科流派。中医师承教育在中医学术流派传承过程中发挥了很大作用,文章分别从闽医萧氏学术流派传承发展情况、存在的主要问题及发展建议等方面报告了研究结果,拟通过借鉴师承教育模式的优势探索出一条更适合闽医萧氏学术流派的生存与发展之道,以期发扬传承闽医学术流派优势特色理论与临床经验。

张伯礼教授治疗慢性心力衰竭经验

心力衰竭是大多数心血管疾病的终末阶段,也是主要的死亡原因。张伯礼教授临证数十载,对于治疗慢性心力衰竭具有丰富的临床经验。本文整理张伯礼教授治疗慢性心力衰竭经验,浅析该病的病因病机、遣方用药,以期体悟张伯礼教授在诊疗此病时的中医临床思维。

国医大师王晞星基于阴火理论辨治癌性发热经验

癌性发热是恶性肿瘤在发病过程中出现的与肿瘤直接相关或因肿瘤治疗而引起的非感染性发热。国医大师王晞星教授从“阴火理论”出发,认为脾胃气虚、阴火上冲为癌性发热之关键病机,病变脏腑涉及肝、脾、肾三脏,当以甘温益气、健脾升阳、清泻阴火为首要治则;同时应重视“土木关系”,通过养血解郁、疏肝散火之法以调和肝脾;并通过滋阴清热、引火归元之法阻断阴火的传变。王晞星教授根据多年临床经验,在补中益气汤基础上化裁创制补中调肝汤(药物组成包括黄芪、党参、白术、升麻、柴胡、当归、白芍、麦冬、五味子、陈皮、蜈蚣、石见穿、八月札、炙甘草等),通过益中气、补肝血、调肝气、消癥散结,以调和人体寒热阴阳,可有效改善肿瘤患者癌性发热症状。

国医大师韩明向辨治郁证的经验研究

目的:运用数据挖掘技术探究并总结韩明向教授辨治郁证的用药经验。方法:收集韩明向门诊郁证患者的病例,运用 Excel软件建立数据库,对病人年龄、性别、辨证证型、以及高频药物进行统计学分析,并用SPSS软件进行关联规则分析、频数项集分析、聚类分析。结果:共收录处方108例,好发人群为绝经期前后的女性和中青年及中年男性,证型最多的为气郁化火证。涉及药物189味,高频药物包括柴胡、当归、白芍、甘草、牡丹皮、栀子等;常用药对有茯神-合欢皮、酸枣仁-合欢皮、栀子-牡丹皮等;常用药物组合有酸枣仁、柴胡-合欢皮,茯神、夏枯草-合欢皮,茯神、栀子-合欢皮等。聚类分析得出栀子-牡丹皮-当归-白芍-柴胡、合欢皮-茯神-夏枯草等4个药物聚类组合。结论:韩明向教授秉承“治病必求于本”的学术思想,抓住郁证中气郁之关键,结合当代好发人群的生理及外在特点,从郁、气、火三方面形成行气解郁,疏肝泻火为主要治疗准则的临床经验。

中医专业学位研究生岗位胜任力的研究现状

中医专业学位研究生,是为满足中国中医事业发展对中医专门人才的迫切需求而培养的具有中医临床能力的更高层次医疗人才,其临床思维与能力主要通过中医住院医师规范化培训进行提升,其培训成果可以通过岗位胜任力进行评估。本文通过整理目前国内外医师岗位胜任力模型研究,梳理国内中医专业学位研究生岗位胜任力研究进展,以及对比现有临床医师岗位胜任力模型内容,进行综述,旨在基于现有岗位胜任力模型研究现况,融汇中医特色,探索适合中医专业学位研究生规范化培训体系,更好地提升中医专业学位研究生整体水平,为我国中医事业发展输送更多高质量的人才。

国医大师李佃贵基于“医道同源”理论运用对药和角药论治脾胃病经验介绍

医、道结合的思想极为玄妙,正所谓“道可道,非常道”,世间万事万物都处于“道”中,中医学也不例外。国医大师李佃贵教授在其临证之时,亦有“岐黄源于道”“医道同源”“医道同理”等行医理念。千百年来,中医学与道学交融并进,两者有诸多理念不谋而合。李师认为道家思想和中医理念在某种程度上是相通的。脾胃内损、脾虚不运、中焦气机升降失常是脾胃病的主要病机,肝郁是关键的病理因素,治疗时应以补脾胃、固后天之本为主,疏肝郁、调气机为辅,兼以除外邪等。李师临证之时,在“医道同源”理论的基础上,尊重配伍规律,探索理解药物配伍中“道”的内涵,为“道”学思想和中医理法方药结合来防治脾胃病提供一条新思路、新方法。该文基于“医道同源”理论从“一生二,二生三,三生万物”的角度来探讨李师如何运用对药和角药论治脾胃病进行分析总结,如仙鹤草-酒萸肉补虚止泻,砂仁-厚朴醒脾理气,合欢皮-合欢花解郁安神;黄芪-党参-太子参补中益气,白扁豆-薏苡仁-白蔻仁祛湿化邪,焦麦芽-焦山楂-焦神曲消食化积。

国医大师刘柏龄运用补肾祛瘀法治疗膝骨性关节炎经验

介绍国医大师刘柏龄教授运用补肾祛瘀法治疗膝骨性关节炎的经验。刘柏龄主张“治肾亦即治骨”,认为膝骨性关节炎以肝肾亏虚为根本原因,瘀血痹阻为标实,病位在肝肾,治疗上应抓住主要矛盾,以补肾壮骨为主,祛瘀通络为辅,补肾祛瘀法贯穿膝骨性关节炎整个疗程的始终。临证常选用膝痛1号方化裁治疗膝骨性关节炎,善用海螵蛸、藤类药、虫类药,内外兼治,临床疗效显著。

间者并行,甚者独行——国医大师皮持衡辨治慢性肾衰临证思路发微

慢性肾衰病机复杂,症候繁多,混淆疑惑,辨证难明,此为“疑”;多脏腑虚损,气血阴阳不调,津液输布失常,病理产物相兼为病,处方不定,此为“难”。因其病情复杂性和多变性,且单一治法容易顾此失彼,故临床不可简单的扶正或祛邪,应有计划有层次多角度多途径施治。皮持衡教授从事肾病研究四十余年,认为慢性肾衰为本虚标实之证,治疗需紧扣病机、标本兼顾、病证结合、中西合参,以调阴阳平衡。皮持衡教授认为“间者并行、甚者独行”理论可有效指导临床,根据该理论采取扶正与祛邪交替给药的治疗方法,使药物既各自独行,又并行其治,既用药精专,又无犯虚虚实实之弊,取效颇佳,值得借鉴。现将皮老临证思路稍作探析,并结合医案进一步佐证,以飨同道。

基于TabNet的周仲瑛教授辨治甲状腺功能亢进病机预测模型及用药规律研究

目的以周仲瑛教授治疗甲状腺功能亢进(甲亢)的临床病案为研究对象,探索运用基于神经网络的TabNet模型发现甲亢的诊疗规律,为传承名老中医学术思想、辅助临床诊疗提供方法参考。方法基于周仲瑛教授及其团队的临床甲亢诊疗医案,构建标准化、结构化训练数据,研究基于注意力机制和稀疏特征选择机制的算法,通过输入标准化临床表现,标准化舌象、脉象构建病机预测模型,分析核心症状、病机和药物以及三者之间的联系。结果通过训练好的预测模型对肝郁、肝火、痰饮、肾虚、阴虚、瘀血6个病机进行预测,与决策树、随机森林等经典算法构建的多标签分类模型相比,本模型分类和预测指标均较好。通过决策树算法进行挖掘,总结6个核心病机对应中药社团:醋柴胡、夏枯草、牡蛎、炙鳖甲、玄参、天冬、麦冬等。结论在临床医案数据上运用TabNet算法,构建基于临床表现、舌象和脉象的病机预测模型,可有效地预测核心病机,进而发现“症-机-药”之间的联系,为名老中医学术思想的传承和临床辅助诊疗决策提供方法学参考。

基于数据挖掘总结国医大师段富津“散邪清补,肺脾同调”法治疗小儿咳嗽经验

目的 基于中医传承计算平台(V3.0)建立数据库,对数据进行频数分析、关联规则、聚类分析,总结段富津教授治疗小儿咳嗽的用药规律及特点,提炼核心处方,以为临床治疗小儿咳嗽提供宝贵经验及依据。方法 选取1991—2008年经导师诊治的小儿咳嗽患者共416例,502诊次,录入中医传承计算平台(V3.0),建立数据库,分析证型分布规律、中药使用频数、聚类分析、常用药对关联频数和核心处方。结果 416例咳嗽患儿中证型以风热证为首,兼见痰湿证。药物频次使用居多的药味有桔梗、甘草、枇杷叶、陈皮、紫菀、牛蒡子,常见药对组合有桔梗-甘草,桔梗-枇杷叶,桔梗-陈皮,甘草-枇杷叶,甘草-陈皮,甘草-紫菀,桔梗-紫菀。挖掘核心处方6条。结论 段富津教授针对小儿发病风热、痰湿居多的特征,结合小儿病理生理特性,用药具有轻灵,量少效宏,散邪清补,肺脾同调的特点,谨守病机,灵活施治,其诊疗思想对临床治疗有指导意义。

医教协同背景下中医专业学位硕士学位课程体系建设探索

研究生教育是国民教育的顶端,同时还是推动国家体系创新发展的生力军,并且是我国实现“科教兴国”以及建设成为创新型国家的重要人才支撑,为此医学专业高阶人才的培养与发展对于推动实现人才强国战略目标顺利实现存在积极的现实价值。伴随着医学教系统背景的深度发展,文章通过总结与分析在此教学背景下中医专业学位硕士学位课程体系建设过程中所存在的不足之处,针对具体问题、具体分析,主动寻找科学地解决对策,旨在提高研究生培养工作的质量以及水平,也为其他课程体系的建设与完善提供一定的借鉴依据,现内容具体如下所示。