1. 上海中医药大学附属龙华医院中医预防保健科,上海,200032
2. 上海中医药大学教学实验中心,上海,201203
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成颜琦, 陈希, 吴雨沁, 等. 基于分型数据挖掘的中医药防治非危重型新型冠状病毒肺炎组方用药规律探析[J]. 上海中医药杂志, 2020,54(5):32-39.
CHENG Yanqi, CHEN Xi, WU Yuqin, et al. Analysis on rules of TCM prescriptions in treating and preventing COVID-19 based on data mining[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(5):32-39.
成颜琦, 陈希, 吴雨沁, 等. 基于分型数据挖掘的中医药防治非危重型新型冠状病毒肺炎组方用药规律探析[J]. 上海中医药杂志, 2020,54(5):32-39. DOI: 10.16305/j.1007-1334.2020.05.098.
CHENG Yanqi, CHEN Xi, WU Yuqin, et al. Analysis on rules of TCM prescriptions in treating and preventing COVID-19 based on data mining[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(5):32-39. DOI: 10.16305/j.1007-1334.2020.05.098.
目的:基于数据挖掘方法分析与总结国家及各省、自治区、直辖市卫生健康委员会 、中医药管理局(或医药卫生管理机构)发布的新型冠状病毒肺炎(简称“新冠肺炎”)防治方案中,以中医药方剂防治非危重型(轻型、普通型、重型)新冠肺炎的组方用药规律。 方法:收集国家及24个省、自治区和直辖市所发布的新冠肺炎中医药防治方案中的处方,将其作为数据源,通过筛选后建立方剂数据库,运用中医传承辅助系统集成的频次分析、关联规则Apriori 算法及复杂系统熵聚类等分析方法进行数据分析与挖掘,对核心药物及其性味归经、用药模式和新处方等进行总结分析。 结果:①对最终筛选出的149首方剂、涉及的146味中药进行分析,发现其中使用频次的前7位药物分别是甘草、苦杏仁、麻黄、陈皮、石膏、苍术、藿香,药味以苦味为主,药性以温性居多,归经主入肺,其次为脾、胃和心经。②关联规则初步分析,将药对频次由高到低排序,前3位分别是“苦杏仁,麻黄”“甘草,苦杏仁”“石膏,苦杏仁”。③关联系数0.040以上的药对有11个,如“麻黄-赤芍”“麻黄-白术”“麻黄-人参”等。④分型处方规律分析得出,轻型处方以三拗汤为核心,合用了藿香正气散、达原饮与防风通圣散等;普通型处方合用了麻杏石甘汤、达原饮与银翘散等;重型处方相当于麻杏石甘汤、宣白承气汤与四逆汤类的救心方剂合用。⑤复杂系统熵聚类分析,演化出14组含3~4味核心药物的组合,如“葶苈子-桃仁-白术”“葶苈子-大黄-白术”“连翘-金银花-芦根”;以及7个新处方,如“葶苈子-桃仁-白术-赤芍-瓜蒌”“苦杏仁-黄芪-桃仁-麻黄-石膏”“陈皮-半夏-藿香-茯苓-大黄-石膏-瓜蒌”。 结论:目前各地新冠肺炎中医诊疗方案推荐处方中的用药法则以化痰止咳平喘、解表理气、清热化湿、补气等为重,治肺为关键,兼顾脾胃;治疗期三型的组方用药规律分别为轻型组方重解表化湿,普通型组方重表里双解、祛湿清热,重型组方重泻热攻里、益气回阳。统计分析结果与专家共识基本吻合,也发现了一些新的具有潜在临床价值的组方用药规律,可为临床治疗及新药开发提供理论依据。
Objective:To analyze and summarize rules of traditional Chinese medicine (TCM) prescriptions in the prevention and treatment of non-critical coronavirus disease 2019 (COVID-19) (including mild, moderate and severe types) by data mining through multiple versions of Diagnosis and Treatment protocol for Coronavirus Disease 2019 (hereinafter referred to as “COVID-19”) Prevention and Control Program issued by the State and the health committees of all provinces, autonomous regions and municipalities directly under the Central Government and the Administration of Traditional Chinese Medicine (or medical and health management institutions). MethodsTCM prescriptions in the multiple versions of Diagnosis and Treatment Protocol for COVID-19 issued by the state and 24 provinces, autonomous regions and municipalities directly under the Central Government were retrieved. The prescription database was established after screening the source data, and the data analysis and mining were carried out by using frequency analysis, Apriori algorithm in association rules and complex system entropy clustering algorithm methods embedded in TCMISS (V2.0.1), so as to analyze the core medicinal herbs and the corresponding properties, tastes, tropisms, medication modes and generate new prescriptions. Results:①A total of 149 formulas and 146 kinds of medicinal herbs were analyzed after screening. It was found that the top 7 medicinal herbs used frequently were Gancao (Glycyrrhizae Radix), Ku Xingren (Armeniacae Semen), Mahuang (Ephedrae Herba), Chenpi (Citri Reticulatae Pericarpium), Shigao (Gypsum Fibrosum), Cangzhu (Atractylodis Rhizoma) and Huoxiang (Agastaches Herba) respectively. Most medicinal herbs have bitter taste, warm property and enter the lung, spleen, stomach and heart meridians. ②According to the preliminary analysis of association rules, the medicinal pairs were ranked from high to low in frequency, and the top three were “Ku Xingren (Armeniacae Semen) & Mahuang (Ephedrae Herba)”, “Gancao (Glycyrrhizae Radix) & Ku Xingren (Armeniacae Semen)”, and “Shigao (Gypsum Fibrosum) & Ku Xingren (Armeniacae Semen)”. ③There were 11 medicinal pairs with correlation coefficient above 0.040, such as “Mahuang (Ephedrae Herba) & Chishao (Paeoniae Radix Rubra)”, “Mahuang (Ephedrae Herba) & Baizhu (Atractylodis macrocephalae Rhizoma)” and “Mahuang (Ephedrae Herba) & Renshen (Ginseng Radix)”, etc. ④According to the analysis of prescriptions in types, San’ao decoction was used as the core formula for the treatment of mild cases together with Huoxiang Zhengqi powder, Dayuan decoction and Fangfeng Tongsheng powder. Maxing Shigan decoction, Dayuan decoction and Yinqiao Powder were used jointly for the treatment of moderate cases. The combination of Maxing Shigan decoction, Xuanbai Chengqi decoction and Sini formulas for heart resurrection was used for the treatment of severe cases. ⑤According to the complex systems entropy cluster algorithm, 14 medicinal groups containing 3 to 4 core medicinal herbs were deduced, such as “Tinglizi (Lepidii Semen), Taoren (Persicae Semen) and Baizhu (Atractylodis macrocephalae Rhizoma)”, “Tinglizi (Lepidii Semen), Dahuang (Rhei Radix et Rhizoma) and Baizhu (Atractylodis macrocephalae Rhizoma)”, “Lianqiao (Forsythiae Fructus), Jinyinhua (Lonicerae Flos) and Lugen (Phragmitis Rhizoma)”, etc; and 7 new prescriptions were generated, such as “Tinglizi (Lepidii Semen), Taoren (Persicae Semen), Baizhu (Atractylodis macrocephalae Rhizoma), Chishao (Paeoniae Radix Rubra) and Gualou (Trichosanthis Fructus)”, “Ku Xingren (Armeniacae Semen), Huangqi (Astragali Radix), Taoren (Persicae Semen), Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum)”, “Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Huoxiang (Agastaches Herba), Fuling (Poria), Dahuang (Rhei Radix et Rhizoma), Shigao (Gypsum Fibrosum) and Gualou (Trichosanthis Fructus)”, etc. Conclusion:At present, the rules of the recommended prescriptions in multiple versions of Diagnosis and Treatment Protocol for COVID-19 focus on eliminating phlegm, relieving cough and asthma, relieving exterior and regulating qi, clearing heat and resolving dampness, invigorating qi, etc., with the treatment of lung as the key and treatment of the spleen and stomach as the complementation. During the treatment period, the rules of prescriptions for the treatment of three types vary:the mild type focuses on relieving exterior and eliminating dampness, the moderate type focuses on relieving both the exterior and interior, eliminating dampness and clearing heat and the severe type focuses on purging heat and attacking interior, invigorating qi and restoring yang. The statistical analysis results are basically consistent with the consensus of experts, and some new prescription rules with potential clinical value have also been found, which can provide theoretical basis for clinical treatment and new drug development.
新型冠状病毒肺炎新型冠状病毒处方用药规律中药数据挖掘关联规则聚类算法
COVID-19SARS-CoV-2rules of prescriptionsChinese herbal medicinedata miningassociation rulesclustering algorithm
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