基于验案的脱疽用药特点的研究

文章信息/Info

• Title:基于验案的脱疽用药特点的研究

• 卷期:2024年22卷18期

• 作者:徐家祥1，张玥2*，程志新2，赵亚男2，公瑞1，张军1

• 1.山东中医药大学第一临床医学院，山东 济南 250014；2.山东中医药大学附属医院周围血管病科，山东 济南 250014

• Author(s):Xu Jia-xiang1, ZHANG Yue 2*

• 1 The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China;2. Department of peripheral vascular diseases, Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong, China

• 关键词脱疽；中医医案；数据挖掘；中药

• Keywords:Gangrene. Data mining; The test case; Traditional Chinese medicine

• 摘要:目的：通过数据挖掘方法探讨验案中治疗脱疽的用药特点。方法：搜集古今医案云平台（v1.5.6）及中华医典（v5.0）的脱疽验案并进行筛选，统计方剂及药物组成并建立数据库，运用古今医案云平台数据挖掘模块及IBM SPSS Modeler 18.0软件对药物频数及组方配伍规律进行数据挖掘。结果：共纳入124首有效方剂，包括446味中药，其中频次大于150次的有当归、黄芪、赤芍、牛膝、金银花；统计性味、归经可见，居前三的分别为温、微寒、平，甘、辛、苦，肝、脾、心经；关联分析得出置信度最高药对为“牛膝→当归”，聚类分析分为3类，复杂网络分析得到核心组方，包括当归、黄芪、赤芍、牛膝、桂枝、丹参、鸡血藤、附子、川芎、桃仁、红花、地龙、白芍。结论：脱疽验案医家组方思路以活血化瘀为主要原则，在辨证的基础上加以温通、清热等祛邪之法，同时气血双补，补行兼施、补虚泻实。                                                                                                                                                                                

• AbstractThe data mining method was used to explore the drug characteristics of the treatment of decabination in the case examination. Methods: The desipation tests of ancient and modern medical case cloud platform (v1.5.6) and Chinese medical code (v5.0) were collected and screened, the composition of formulas and drugs was counted and a database was established, and the data mining module of ancient and modern medical case cloud platform and IBM SPSS Modeler 18.0 software were used to mine the frequency of drugs and the matching law of formulas. Results: A total of 124 effective formulas were included, including 446 flavors of traditional Chinese medicine, among which angelica, astragalus, red peony, Achyranthes bidentata and honeysuckle were more than 150 times. Statistical taste and attribution can be seen, the top three are warm, slightly cold, flat, sweet, hard, bitter, liver, spleen, heart meridian; The correlation analysis showed that the drug pair with the highest confidence was " achyranthes bidentata → angelica", and the cluster analysis was divided into three categories, and the core components were obtained by complex network analysis, including angelica, astragalus, red peony, achyranthes bidentata, Cassia twig, danshen, Caulis spatholobi, aconite, Chuanxiong, peach kernel, safflower, ground dragon, and white peony. Conclusion: The idea of the medical team of the demobilization case is based on the main principle of activating blood and removing stasis, and on the basis of dialectics, the methods of dispelling evil spirits such as warming and clearing heat are applied, and at the same time, qi and blood are supplemented, and supplementation is applied at the same time.

  脱疽是指四肢末端疼痛、坏死，严重时趾（指）节坏死脱落的一种疾病，相当于现代医学外周动脉闭塞性疾病终末期引起肢体溃烂坏疽的统称[1]。从古至今脱疽都因高致残率、高病死率而备受关注[2]，中医医案是对疾病的症状体征、辨证要点、治疗方案以及疗效转归等临床实践活动的真实记录，尤其是中医验案中的组方用药，不仅经过实践的验证，而且充分反映了医家的临证经验以及诊治思路，具有很高的研究价值。脱疽作为临床常见的疑难病症，在古代医学典籍及现代文献中都有诸多验案记载。搜集整理这些医案，归纳总结出其治法特色对现代脱疽的临床治疗有着很高的实用价值。