基于古籍医案文献分析的心力衰竭证治规律研究

目的探讨心力衰竭的中医证治规律。方法全面收集心力衰竭的中医古籍医案文献,分别建立症状、用药数据库,运用统计软件分别进行症状及用药频数分析、因子分析、聚类分析。结果收集到符合标准的医案文献334篇。心衰患者临床常见中医症状:喘息不得卧、胸闷、气短、心悸等;舌象:舌淡红、苔薄白、舌胖大、苔白腻等;脉象:脉沉细无力、脉迟缓、脉结代、脉涩等;症状因子分析得出心气亏虚、心阴不足、心阳不振等病机变化;心衰的症状聚类为心气亏虚、心阴不足、心阳不振等;因子分析和聚类分析的结果相符合。临床常用中药频次为人参、附子、茯苓、桂枝、生白术等;药物种类频次为补气药、温阳药、利水药等;通过对高频次用药的因子和聚类分析,可以得出与归类频数统计相同结论,心衰患者临床常用药物为补气药、温阳药、利水药、化痰药、养阴药、活血化瘀药。结论心阳不振、气阴两虚、痰浊水饮内停、瘀血内阻为心力衰竭的基本证型,温振心阳、益气养阴、化痰利水、活血化瘀为心力衰竭的基本治疗原则。

Rules of the Pattern/Syndrome Treatment of Heart Failure Based on the Analysis of the Literatures of Ancient Medical Cases

Objective To discuss the rules of pattern/syndrome treatment of heart failure in traditional Chinese medicine.Methods The Chinese medicine literatures of ancient medical cases of heart failure were collected.The databases of symptoms and medications were set up separately.The statistical software was used for the frequency analysis,factor analysis and cluster analysis of symptoms and medication.Results Three hundred and thirty-four qualified literatures of medical cases were collected.The common clinical symptoms of heart failure in traditional Chinese medicine included： asthmatic breathing,failure to lye flat,chest oppression,shortness of breath,palpitation,etc.Tongue conditions： slight red tongue,thin white coating,swollen coating,white sticky coating,etc.Pulse conditions： deep,thready and weak pulse,slow pulse,missed-beat pulse,hesitant pulse,etc.The symptom factor analysis indicated heart qi deficiency,heart yin insufficiency and heart yang deficiency in terms of pathogenesis.The symptom cluster factor showed heart qi deficiency,heart yin insufficiency and heart yang deficiency.The results of factor analysis and cluster analysis were coincident with each other.The common Chinese herbal medicine in clinic： Ginseng,Radix Aconiti Carmichaeli,Poria Cocos;Cassia Twig;Rhizoma Atractylodis Macrocephalae,etc.The common categories of medicine： drugs of qi tonification;drugs of warming yang,drugs of diuresis,etc.The factor and cluster analysis of the high-frequent application of drugs indicated the same results as classification frequency statistical analysis.The clinical common medicines for heart failure included the drugs of qi tonification,drugs of warming yang,drugs of diuresis,drugs of resolving phlegm,drugs of nourishing yin and drugs of activating blood and resolving stasis.Conclusion The basic patterns / syndromes of heart failure are heart yang deficiency,qi and yin deficiency,retention of phlegm and harmful fluids and blockage of stasis.The basic principles of treatment of heart failure are warming up and strengthening heart yang,benefiting qi and nourishing yin,resolving phlegm and promoting water metabolism,activating blood circulation and resolving stasis.