通下法治疗中风病的文献数据挖掘分析

目的：运用数据挖掘方法对近30年来以通下法治疗中风病的文献资料进行质量分析并总结中风病发病、证候及方药应用规律。方法收集1979-2013年在CNKI上公开发表的应用通下法治疗中风病的文献，录入设计数据库中，对符合文献纳入标准的文献通过改良Jadad量表进行质量评价。同时对于文献中病例基本资料、辨证分型和方药的使用进行分析，利用Microsoft Excel工具对病例特征进行描述性分析。运用频数分析对病例症状、舌脉、证型、常用方剂和药物规律进行数据挖掘。结果中风病的症状除了中风病本身五大主症外，大便不通、腹胀、喉中痰鸣出现频率高，头痛、烦躁、头晕、发热、呕吐呃逆、面赤、喘息气粗等症状相对出现较多。舌质以红、暗红、绛红和紫瘀为主，脉象多表现为弦脉、滑脉和数脉，脉象并见以弦滑脉最多，其次为弦数脉和滑数脉。主要病理因素中痰证出现频率最高，其次为热证、风证、瘀证、虚证和火证。处方用药除了大量运用泻下剂，也兼顾祛风、清热、祛痰、理血、表里双解和治疡。药物使用频次以大黄、芒硝、胆南星、瓜蒌、枳实、厚朴和菖蒲应用最多。除了使用汤剂、丸剂外，还有胶囊及颗粒剂。方药服用方式包括口服、鼻饲、灌肠、静脉滴注以及浴脐。方剂大多数为4~12味药，总量50~150 g之间居多。结论中风病痰热及腑实证集中出现，且在治疗中以应用泻下药及化痰止咳平喘药物为主，临床辨证时应重视痰热腑实病机对中风病各阶段的影响，灵活应用通下法。

Purgative therapy in treatment of stroke： literature analysis and data mining

Objective To do quality analysis on literatures about purgative therapy in the treatment of stroke for the past 30 years by applying data mining method, and to summarize the discipline of pathogenesis, syndromes, formula administration of stroke. Methods The literatures about purgative therapy in the treatment of stroke were collected which were published on CNKI from 1979 to 2013, and input into the designed database. The literatures meeting the inclusion criteria were reviewed with the modified Jadad scale. Meanwhile the basic information of cases, syndrome differentiation and formula administration were given analysis. Microsoft Excel was used to analyze the characteristics of cases, and frequency analysis was used in the data mining of symptoms, tongue manifestations, pulse conditions, syndrome types, and common formulas and medicinal. Results The symptoms of stroke with high frequency were constipation, abdominal distension and throat phlegm besides of five main symptoms of. Other symptoms such as headache, agitation, dizziness, fever, vomiting and hiccup, red face and rough wheezing showed relatively high frequency. The condition of tongue includes red, dull-red, magenta and bruise-colored tongue primarily. Pulse records showed wiry, slippery and rapid pulse primarily, in which wiry-slippery pulse had the highest frequency, followed by wiry-rapid pulse and slippery-rapid pulse. The pathological factor with the highest frequency was phlegm syndrome, followed by heat syndrome, wind syndrome, stasis syndrome, deficiency syndrome and fire syndrome. The main principle of formula administration was purgation, combined with dispelling wind, clearing heat, eliminating phlegm, regulating blood, relieving exterior-interior syndrome and treating abscesses. The herbs with the high frequency included Dahuang （Radix et Rhizoma Rhei）, Mangxiao （Natrii Sulphas）, Dannanxing （Arisaema cum Bile）, Gualuo （Fructus Trichosanthis）, Zhishi （Fructus Aurantii Immaturus）, Houpo （Cortex Magnoliae Officinalis） and Changpu （Rhizoma Acori Tatarinowii）. Besides decoctions and pills, the forms of formulas also included capsules and granules. The way of administration included oral administration, nasal feeding, enema, intravenous infusion and applying medicinal to the umbilicus. The number of drugs composing formula was 4 to 12, and the weight of formula was 50 g to 150 g. Conclusion The phlegm heat syndrome and bowel excess syndrome occur simultaneously in the course of stroke. The main treatment includes purgatives and expectorant cough suppressant and anti-asthmatic medicinal. The influence of phlegm heat syndrome and bowel excess on different phases of stroke should be paid more attention to in the course of syndrome differentiation, and the purgative therapy should be used flexibly in the treatment.