基于数据挖掘的《伤寒杂病论》和导师医案脾胃病证治规律研究
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摘要
目的通过数据挖掘的方法对《伤寒杂病论》中脾胃病条文以及导师脾胃病医案进行分析,从而探讨脾胃病的证治规律。
方法①选择条文和病案：根据纳入和排除标准,选择《伤寒杂病论》脾胃病条文及导师脾胃病医案；②数据挖掘：规范化数据后进行频数和关联规则分析。
结果①《伤寒杂病论》中治疗脾胃病的主要方剂是：大黄黄连泻心汤、半夏泻心汤、黄芩加半夏生姜汤、小半夏汤、小半夏加茯苓汤、大承气汤、麻子仁丸、小柴胡汤、吴茱萸汤、四逆汤、白头翁汤、桃花汤；主要药物是：大黄、黄芩、黄连,半夏、干姜、生姜、附子、桂枝、人参、大枣、甘草、茯苓、厚朴、枳实、芍药、茯苓、猪苓、柴胡、麻子仁、赤石脂；常用药对是：黄芩-黄连、人参-甘草、人参-干姜、半夏-大枣、大黄-枳实、厚朴-枳实、桂枝-白术。②导师治疗脾胃病的主要方剂是：补中益气汤、香砂六君子汤、资生丸、理中丸、香连丸、痛泻要方、四神丸、八珍汤、逍遥散、二陈汤、平胃散、保和丸、丹参饮、金铃子散、麻子仁丸、四逆散、小承气汤、增液汤；主要药物是炙甘草、炒白术、党参、太子参、山药、炒陈皮、炒枳壳、制香附、郁金、柴胡、淡吴萸、茯苓、炒薏苡仁、煨木香、砂仁、蔻仁、藿香、制川朴、焦神曲、炙鸡金、焦山楂、丹参、赤芍、炒当归、川芎、炒白芍、黄连、黄芩、制半夏、竹茹、升麻、柴胡、桔梗、煨葛根、炒防风、肉苁蓉、麦冬、生地、瓜蒌仁、火麻仁、芡实、五味子、补骨脂。常用药对是：生黄芪-升麻、山药-芡实、柴胡-郁金、柴胡-制香附、郁金-制香附、芡实-炒扁豆、制香附-郁金、柴胡-炒白芍、柴胡-赤芍、炒白术-茯苓、制半夏-茯苓、制半夏-黄连、当归-炒白芍、党参-炒白术、炒白术-茯苓、煨木香-黄连。
结论①脾胃病病症的病位在脾胃,与肝胆、大肠、肺、肾、冲任相关；②主要病机是脾胃气机升降失调、肝胆疏泄失司,此外尚有寒热失调、瘀血食积、痰饮腑实等；③治以益气健脾、燥湿运脾、调和胃肠、调和肝脾、和解少阳为主要法则,尚有消食和胃、理气和血、补脾益肾、行气除满、化痰蠲饮、清热泻火、温中祛寒、泻下通腑、润肠通腑、涩肠固脱等法；④用药可从甘温益气药、苦辛通降药、淡渗利湿药、芳香化湿药、醒脾消食药、苦寒清热药、辛温散寒药等加减化裁。
Objective Analyzing original text of Shanghan Zabing Lun and supervisor's medical records of spleen and stomach disease,to discover the rule of its pathogenesis and treatment.
Methods①Selecting original text and medical records:select original text of Shanghan Zabing Lun and supervisor's medical records of spleen and stomach disease according to inclusion and exclusion criteria;②Data mining:Analyzing frequency and asocciation rules after standardiziong datas.
Results①The main formulas in treating spleen and stomach diseases in Shanghan Zabing Lun are:Dahuang huanglian Xiexin Tang, Banxia xiexin Tang, Huangqin jia banxia shengjiang Tang, Xiao banxia Tang, Xiao banxia jia fuling Tang, Da chengqi Tang, Maziren wan, Xiao chaihu tang, Wuzhuyu Tang, Sini tang, Baitouweng tang, Taohua tang. Main herbs are:Dahuang, Huangqin, Huanglian, Banxia, Ganjiang, Shengjiang, Fuzi, Guizhi, Renshen, Dazao, Gancao, Fuling, Houpu, Zhishi, Shaoyao, Fuling, Zhuling, Chaihu, Maziren, Chish zhi; Main couplet medicines are:Huangqin-Huanglian, Renshen-Gancao, Renshen-Ganjiang, Banxia-Dazao, Dahuang-Zhishi, Houpu-Zhishi,Guizhi-Baizhu.②My supervisor's main formulas in treating spleen and stomach diseases of are:Buzhong Yiqi Tang, Xiangsha liu junzi Tang, Zisheng wan, Lizhong wan, Xianglian wan, Tongxie yao fang, Sishen wan, Bazhen Tang, Xiaoyao san,erchen tang, Pingwei san, Baohe wan, Danshen yin, Jinlingzi san, Maziren wan, sini san, Xiao chengqi Tang, zengye tang. Main herbs are: Zhi gancao, Chao baizhu, Dangshen, Taizisheng, Shanyao, Chao chenpi, Chao zhike, Zhi xiangfu, Yujin, Chaihu, Dan wuyu, Fuling, Chao yiyiren, Wei muxiang, Sharen, Kouren, Houpu, Zhi houpu, Jiao shenqu, Zhi jijin, Jiao Shanzha, Danshen, Chishao, Chao danggui, Chuanxiong, Chao baishao, Huanglian, Huangqin, Zhi banxia, Zhuru, Shengma, Chaihu, Jiegeng, Wei gegen, Chao fang feng, Roucongrong, Maidong, Shengdi, Gualouren, Huomaren, Qianshi, Wuweizi, Buguzhi. Main couplet medicines are:Sheng huangqi-Shengma, Shanyao-Qianshi, Chaihu-Yujin, Chai hu-Zhi xiangfu, Yujin-Zhi xiangfu, Qianshi-Chao biandou, Zhi xiangfu-Yujin, Chaihu-Chao baishao, Chaihu-Chishao, Chao baizhu-Fuling, Zhi banxia-Fuling, Zhi banxia-Huanglian, Dang gui-Chao baishao, Dangshen-Chao baizhu, Chao bai zhu-Fuling, Wei muxiang.
Conclusion①The location of spleen and stomach disease is spleen and stomach, and associating with liver, gallbladder, large intestine, lung, kidney, chong and ren meridian.②The main pathogenesis of spleen and stomach disease are disorder of spleen and stomach qi, dysfunction of liver and gallbladder qi, and associating with cold and heat disorders, blood stasis, phlegm retention and fecal stagnation. Others including replenishing qi, invigorating spleen, drying dampness, reconciling stomach and intestine, harmonizing liver and spleen, and compromiing Shaoyang, etc.③The main treating principles are replenishing qi, invigorating spleen, drying dampness, reconciling stomach and intestine, harmonizing liver and spleen, and compromiing Shaoyang. Others including eliminating food retention, regulating qi and blood, invigorating spleen and kidney, promoting qi circulation, resolving phlegm and fluid, clearing heat and purging fire, warming middle qiao and expelling cold, purgativing fecal stagnation, moistening intestine to promote bowel movement, relieving diarrhea with astringent,etc.④Alternative herbs:qi-tonifying herbs with sweet and warm nature, qi-activating herbs with bitter and pungent nature, diuretics with light nature, damp dispersing herbs with aromatic nature, food resolving herbs with aromatic nature, heat-clearing herbs with bitter and cold nature, cold-expeling herbs with pungent and warm nature.
方法①选择条文和病案：根据纳入和排除标准,选择《伤寒杂病论》脾胃病条文及导师脾胃病医案；②数据挖掘：规范化数据后进行频数和关联规则分析。
结果①《伤寒杂病论》中治疗脾胃病的主要方剂是：大黄黄连泻心汤、半夏泻心汤、黄芩加半夏生姜汤、小半夏汤、小半夏加茯苓汤、大承气汤、麻子仁丸、小柴胡汤、吴茱萸汤、四逆汤、白头翁汤、桃花汤；主要药物是：大黄、黄芩、黄连,半夏、干姜、生姜、附子、桂枝、人参、大枣、甘草、茯苓、厚朴、枳实、芍药、茯苓、猪苓、柴胡、麻子仁、赤石脂；常用药对是：黄芩-黄连、人参-甘草、人参-干姜、半夏-大枣、大黄-枳实、厚朴-枳实、桂枝-白术。②导师治疗脾胃病的主要方剂是：补中益气汤、香砂六君子汤、资生丸、理中丸、香连丸、痛泻要方、四神丸、八珍汤、逍遥散、二陈汤、平胃散、保和丸、丹参饮、金铃子散、麻子仁丸、四逆散、小承气汤、增液汤；主要药物是炙甘草、炒白术、党参、太子参、山药、炒陈皮、炒枳壳、制香附、郁金、柴胡、淡吴萸、茯苓、炒薏苡仁、煨木香、砂仁、蔻仁、藿香、制川朴、焦神曲、炙鸡金、焦山楂、丹参、赤芍、炒当归、川芎、炒白芍、黄连、黄芩、制半夏、竹茹、升麻、柴胡、桔梗、煨葛根、炒防风、肉苁蓉、麦冬、生地、瓜蒌仁、火麻仁、芡实、五味子、补骨脂。常用药对是：生黄芪-升麻、山药-芡实、柴胡-郁金、柴胡-制香附、郁金-制香附、芡实-炒扁豆、制香附-郁金、柴胡-炒白芍、柴胡-赤芍、炒白术-茯苓、制半夏-茯苓、制半夏-黄连、当归-炒白芍、党参-炒白术、炒白术-茯苓、煨木香-黄连。
结论①脾胃病病症的病位在脾胃,与肝胆、大肠、肺、肾、冲任相关；②主要病机是脾胃气机升降失调、肝胆疏泄失司,此外尚有寒热失调、瘀血食积、痰饮腑实等；③治以益气健脾、燥湿运脾、调和胃肠、调和肝脾、和解少阳为主要法则,尚有消食和胃、理气和血、补脾益肾、行气除满、化痰蠲饮、清热泻火、温中祛寒、泻下通腑、润肠通腑、涩肠固脱等法；④用药可从甘温益气药、苦辛通降药、淡渗利湿药、芳香化湿药、醒脾消食药、苦寒清热药、辛温散寒药等加减化裁。
Objective Analyzing original text of Shanghan Zabing Lun and supervisor's medical records of spleen and stomach disease,to discover the rule of its pathogenesis and treatment.
Methods①Selecting original text and medical records:select original text of Shanghan Zabing Lun and supervisor's medical records of spleen and stomach disease according to inclusion and exclusion criteria;②Data mining:Analyzing frequency and asocciation rules after standardiziong datas.
Results①The main formulas in treating spleen and stomach diseases in Shanghan Zabing Lun are:Dahuang huanglian Xiexin Tang, Banxia xiexin Tang, Huangqin jia banxia shengjiang Tang, Xiao banxia Tang, Xiao banxia jia fuling Tang, Da chengqi Tang, Maziren wan, Xiao chaihu tang, Wuzhuyu Tang, Sini tang, Baitouweng tang, Taohua tang. Main herbs are:Dahuang, Huangqin, Huanglian, Banxia, Ganjiang, Shengjiang, Fuzi, Guizhi, Renshen, Dazao, Gancao, Fuling, Houpu, Zhishi, Shaoyao, Fuling, Zhuling, Chaihu, Maziren, Chish zhi; Main couplet medicines are:Huangqin-Huanglian, Renshen-Gancao, Renshen-Ganjiang, Banxia-Dazao, Dahuang-Zhishi, Houpu-Zhishi,Guizhi-Baizhu.②My supervisor's main formulas in treating spleen and stomach diseases of are:Buzhong Yiqi Tang, Xiangsha liu junzi Tang, Zisheng wan, Lizhong wan, Xianglian wan, Tongxie yao fang, Sishen wan, Bazhen Tang, Xiaoyao san,erchen tang, Pingwei san, Baohe wan, Danshen yin, Jinlingzi san, Maziren wan, sini san, Xiao chengqi Tang, zengye tang. Main herbs are: Zhi gancao, Chao baizhu, Dangshen, Taizisheng, Shanyao, Chao chenpi, Chao zhike, Zhi xiangfu, Yujin, Chaihu, Dan wuyu, Fuling, Chao yiyiren, Wei muxiang, Sharen, Kouren, Houpu, Zhi houpu, Jiao shenqu, Zhi jijin, Jiao Shanzha, Danshen, Chishao, Chao danggui, Chuanxiong, Chao baishao, Huanglian, Huangqin, Zhi banxia, Zhuru, Shengma, Chaihu, Jiegeng, Wei gegen, Chao fang feng, Roucongrong, Maidong, Shengdi, Gualouren, Huomaren, Qianshi, Wuweizi, Buguzhi. Main couplet medicines are:Sheng huangqi-Shengma, Shanyao-Qianshi, Chaihu-Yujin, Chai hu-Zhi xiangfu, Yujin-Zhi xiangfu, Qianshi-Chao biandou, Zhi xiangfu-Yujin, Chaihu-Chao baishao, Chaihu-Chishao, Chao baizhu-Fuling, Zhi banxia-Fuling, Zhi banxia-Huanglian, Dang gui-Chao baishao, Dangshen-Chao baizhu, Chao bai zhu-Fuling, Wei muxiang.
Conclusion①The location of spleen and stomach disease is spleen and stomach, and associating with liver, gallbladder, large intestine, lung, kidney, chong and ren meridian.②The main pathogenesis of spleen and stomach disease are disorder of spleen and stomach qi, dysfunction of liver and gallbladder qi, and associating with cold and heat disorders, blood stasis, phlegm retention and fecal stagnation. Others including replenishing qi, invigorating spleen, drying dampness, reconciling stomach and intestine, harmonizing liver and spleen, and compromiing Shaoyang, etc.③The main treating principles are replenishing qi, invigorating spleen, drying dampness, reconciling stomach and intestine, harmonizing liver and spleen, and compromiing Shaoyang. Others including eliminating food retention, regulating qi and blood, invigorating spleen and kidney, promoting qi circulation, resolving phlegm and fluid, clearing heat and purging fire, warming middle qiao and expelling cold, purgativing fecal stagnation, moistening intestine to promote bowel movement, relieving diarrhea with astringent,etc.④Alternative herbs:qi-tonifying herbs with sweet and warm nature, qi-activating herbs with bitter and pungent nature, diuretics with light nature, damp dispersing herbs with aromatic nature, food resolving herbs with aromatic nature, heat-clearing herbs with bitter and cold nature, cold-expeling herbs with pungent and warm nature.
引文
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[2]张仲景.金匮要略.北京：人民卫生出版社,2005.1-108
[3]国家技术监督局.中华人民共和国国家标准·中医临床诊疗术语.北京：中国标准出版社,1997.1-217
[4]中医药学名词审定委员会.中医药学名词.北京：科学出版社,2004.1-463
[5]王洪图.黄帝内经素问白话解.北京：人民卫生出版社,2004.207
[6]张年顺.李东垣医学全书.北京：中国中医药出版社,2006.115
[7]陆拯.王肯堂医学全书.北京：中国中医药出版社.2005.65
[8]张景岳.景岳全书.山西：山西科学技术出版社,2006.270
[9]周仲瑛.中医内科学.北京：中国中医出版社.2004,135
[10]黄英志.叶天士医学全书.北京：中国中医药出版社,1999.226
[11]灵枢经.北京：人民卫生出版社,2005.15
[12]临证名医卷·综合·杂病·杂病源流犀烛.北京：人民卫生出版社,2011.83
[13]黄英志.叶天士医学全书.北京：中国中医药出版社,1999.246
[14]灵枢经.北京：人民卫生出版社,2005.15
[15]林佩琴.类证治裁.北京：人民卫生出版社.2005.371-372
[16]王洪图.黄帝内经素问白话解.北京：人民卫生出版社,2004.603
[17]灵枢经.北京：人民卫生出版社,2005.56
[18]周仲瑛.中医内科学.北京：中国中医出版社.2004,135
[19]陈言.三因极一病证方论.北京：人民卫生出版社,2007.223
[20]张仲景.金匮要略.北京：人民卫生出版社,2005.63
[21]孙思邈.备急千金要方.北京.中国医药科技出版社.2011.281
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