基于数据挖掘探索浙江名中医高祥福治疗强直性脊柱炎的处方用药规律

[目的]通过数据挖掘的方法探究高祥福教授治疗强直性脊柱炎的处方用药规律,以便更好指导和应用于临床。[方法]收集2018年1月至2020年3月于浙江中医药大学附属第三医院高祥福教授门诊就诊的强直性脊柱炎患者资料,运用Excel 2019对使用的中药进行频数分析,包括性味、归经、功效等,并选取使用频次>49次的高频中药,采用SPSS 23.0软件进行分层聚类分析。[结果]符合纳入标准的病案共计340诊次,共使用中药115味,总频次为4766。药物四气前3位为寒、温和平;五味前3位为苦味、甘味和辛味;药物归经前3位是肝经、脾经和肺经;按功效排序,前3位为补虚药、清热药和解表药。高频中药共28味,以补虚药、解表药、活血化瘀药、清热药、祛风湿药和健脾化湿药6大类为主。聚类分析提示高频中药可聚为3类,且聚拢趋势较好,第一类为杜仲、续断、延胡索、防风、山药、生地黄、丹参,第二类为黄芩、黄连、葛根、淫羊藿、薏苡仁、牛膝、苍术、牡丹皮、黄柏、穿山龙、茯苓、川乌、青风藤、佛手,第三类为黄芪、当归、麻黄、附子、桂枝、知母、川芎。[结论]高祥福教授治疗强直性脊柱炎以扶正祛邪为原则,用药上寒温苦辛甘并用,多应用补虚药和解表药,病程中注意活血化瘀,标本兼治,同时配伍清热泻火、祛风除湿中药,从而可起到扶正不留邪、祛邪不伤正的效果。

Analysis on the Medication Rules of Professor GAO Xiangfu in the Treatment of Ankylosing Spondylitis Based on Data Mining

[Objective]To explore the medication rules of Professor GAO Xiangfu in the treatment of ankylosing spondylitis(AS)by data mining,so as to better guide and apply in clinical practice.[Methods]Data of patients with AS were collected from Professor GAO Xiangfu's outpatient work,the Third Affiliated Hospital of Zhejiang Chinese Medical University,from January 2018 to March 2020.Excel 2019 was used for frequency analysis of traditional Chinese medicines used,including natures,flavors,meridians and efficacy,etc.High frequency traditional Chinese medicines,which were used more than 49 times by Professor GAO Xiangfu,were selected for cluster analysis by SPSS 23.0 software.[Results]Total 340 cases met the inclusion criteria,altogether 115 herbs were used and total frequency was 4766.The top three natures were cold,warm and neutral;the top three flavors were the bitter,sweet and pungent;the top three meridians were liver meridian,spleen meridian and lung meridian;the top three in the efficacy of drugs were deficiency nourishing herbs,heat clearing herbs and exterior syndrome relieving herbs.There were 28 high frequency traditional Chinese medicines,mainly including six categories:Deficiency nourishing herbs,exterior syndrome relieving herbs,blood circulation activating and stasis dissipating herbs,heat clearing herbs,wind and dampness expelling herbs,and spleen invigorating and dampness eliminating herbs.Cluster analysis suggested that the trend of high-frequency Chinese medicine clustering into three clusters was better.The first category was Eucommia ulmoides,Dipsacus asperoides,Corydalis rhizoma,Radix saposhnikoviae,Dioscorea opposita,Rehmannia glutinosa,and Salvia miltiorrhiza Bge.The second category was Radix scutellariae,Rhizoma coptidis,Radix pueraiae,Epimedium brevicornu Maxim,Semen coicis,Achyranthes bidentata Blume,Atractylodis rhizoma,Moutan cortex,Cortex phellodendri,Dioscorea nipponica Makino,Wolfiporia cocos,Radix aconiti,Caulis sinomenii,and Fructus citri sarcodactylis.The third category was Radix astragali,Angelica sinensis,Ephedra sinica Stapf,Radix aconiti lateralis preparata,Ramulus cinnamomi,Rhizoma anemarrhenae,and Ligusticum chuanxiong Hort.[Conclusion]Professor GAO Xiangfu treats AS with the principle of reinforcing healthy Qi and dispelling pathogen,the natures of herbs are cold and warm,and their flavors are bitter,sweet and pungent.Deficiency nourishing herbs,exterior syndrome relieving herbs are commonly used,combined with blood circulation activating and stasis dissipating herbs in the course of the disease,which treat both manifestation and root cause of disease.And heat clearing herbs and wind and dampness expelling herbs are used,so as to achieve the purpose of strengthening vital Qi without leaving evil and eliminating evil without hurting vital Qi.