1.上海中医药大学,上海市健康辨识与评估重点实验室(上海 201203)
王滢迪,女,博士,主治医师,主要从事中医治疗心脑血管疾病的研究工作
李小茜,副教授,硕士研究生导师;E-mail: lixiaoqian5258@126.com
何建成,教授,博士研究生导师;E-mail: hejc8163@163.com
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王滢迪,何竹青,李小茜,等.基于多元数据挖掘方法探究古籍文献中充血性心力衰竭的证治规律[J].上海中医药杂志,2022,56(11):13-20.
WANG Yingdi,HE Zhuqing,LI Xiaoqian,et al.Exploration on law of syndrome and treatment of congestive heart failure in ancient literatures based on multivariate data mining methods[J].Shanghai Journal of Traditional Chinese Medicine,2022,56(11):13-20.
王滢迪,何竹青,李小茜,等.基于多元数据挖掘方法探究古籍文献中充血性心力衰竭的证治规律[J].上海中医药杂志,2022,56(11):13-20. DOI: 10.16305/j.1007-1334.2022.2108075.
WANG Yingdi,HE Zhuqing,LI Xiaoqian,et al.Exploration on law of syndrome and treatment of congestive heart failure in ancient literatures based on multivariate data mining methods[J].Shanghai Journal of Traditional Chinese Medicine,2022,56(11):13-20. DOI: 10.16305/j.1007-1334.2022.2108075.
目的,2,基于数据挖掘方法探讨古籍文献中充血性心力衰竭(CHF)的中医证治规律。,方法,2,收集《中华医典》(第5版)、超星数字图书、纸本文献等数据库中符合CHF诊断的医案古籍文献,运用R语言及SPSS 25.0软件进行统计分析与数据挖掘,分析方法包括频次分析、关联分析、共现分析、因子分析、聚类分析、复杂网络分析等。,结果,2,①CHF最常见的症状包括喘、咳嗽、胸闷、不能平卧、短气、脚肿等,舌象以舌苔白为主,脉象以沉、细、弦为主,证候要素以痰浊、水饮、阳虚、气虚、阴虚等为主。②双关联症状主要包括喘+咳嗽、喘+不能平卧、喘+短气、喘+痰、喘+脚肿、不能平卧+咳嗽、喘+胸闷等,三关联症状主要为喘+不能平卧+咳嗽。③病性证素阳虚与痰浊、水饮最相关,病性证素气虚与痰浊、水饮、阴虚最相关,病性证素痰浊与水饮、气虚最相关;病性证素阳虚、水饮与病位证素肺、脾、肾最相关;病性证素痰浊、气虚与病位证素心、肺、脾、肾最相关;病性证素阴虚与病位证素心最相关。④CHF阳虚水泛证的核心症状有脚肿、肢冷、腹水、脸肿、烦躁、水肿、自汗、小便少、睡眠差、不能平卧、短气;气虚痰浊证的核心症状有咳嗽、痰、纳差/食少、喘、泄泻、心痛、睡眠差;气阴两虚证的核心症状有心悸、神昏、头晕、便秘、惊恐、小便少、无力、睡眠差、喘,因程度不同可出现脉濡、脉数、脉细、脉无力等脉象;气虚血瘀证的核心症状有胸痛、胸闷、心痛、纳差/食少、动则喘促、疲倦、短气、无力、小便少,因程度不同可出现脉沉、脉弦或脉无力。⑤治疗CHF最常用药物包括茯苓、附子、党参、肉桂、白术、陈皮、熟地黄、泽泻等,主要用方包括金匮肾气丸、济生肾气丸、葶苈大枣泻肺汤、真武汤、二陈汤、瓜蒌薤白半夏汤、四君子汤、补中益气汤、天王补心丹等。,结论,2,通过对古籍文献中的医案进行数据挖掘发现,CHF的证治有一定规律可循,治疗方法多元,可为临床治疗提供古籍文献的佐证。
Objective,2,To explore the law of traditional Chinese medicine syndrome and treatment for congestive heart failure (CHF) in ancient literatures based on the data mining methods.,Methods,2,The medical records conforming to CHF diagnosis in ancient literatures from the databases including Chinese Medical Code (the fifth edition), Chaoxing digital books, paper documents, etc were collected. The statistical analysis and data mining were carried out by R language and SPSS 25.0 software, and the analysis methods included frequency analysis, association analysis, co-occurrence analysis, factor analysis, cluster analysis, complex network analysis, etc.,Results,2,①The most common symptoms of CHF included asthma, cough, chest tightness, inability to lie down, shortness of breath, swollen feet and so on. The tongue image was mainly white coating and the pulse condition was mainly deep, thin and string pulse. The syndrome elements were mainly phlegm turbidity, fluid retention, yang deficiency, qi deficiency, yin deficiency and so on. ②The double-related symptoms mainly included asthma + cough, asthma + inability to lie down, asthma + shortness of breath, asthma + phlegm, asthma + swollen feet, inability to lie down + cough, asthma + chest tightness, etc, and the three associated symptoms were mainly asthma + inability to lie down + cough. ③Among disease nature elements, yang deficiency was most related to phlegm turbidity and fluid retention, qi deficiency was most related to phlegm turbidity, fluid retention and yin deficiency, and phlegm turbidity was most related to fluid retention and qi deficiency. Yang deficiency and fluid retention of disease nature elements were most related to lung, spleen and kidney of disease location elements. Phlegm turbidity and qi deficiency of disease nature elements were most related to heart, lung, spleen and kidney of disease location elements. Yin deficiency of disease nature elements was most related to heart of disease location elements. ④The core symptoms of yang deficiency and water flooding syndrome of CHF included swollen feet, cold limbs, ascites, swollen face, irritability, edema, spontaneous sweating, less urination, poor sleep, inability to lie down, and shortness of breath. The core symptoms of qi deficiency and phlegm turbidity syndrome included cough, phlegm, poor appetite, asthma, diarrhea, heartache, and poor sleep. The core symptoms of qi and yin deficiency syndrome included palpitations, coma, dizziness, constipation, fantod, less urination, weakness, poor sleep, and asthma, with soft pulse, rapid pulse, thin pulse, weak pulse, and so on according to the different degree of the disease. The core symptoms of qi deficiency and blood stasis syndrome included chest pain, chest tightness, heartache, poor appetite, asthma with moving, fatigue, shortness of breath, weakness, and less urination, with deep pulse, string pulse and weak pulse according to the different degree of the disease. ⑤The most commonly used Chinese medicines in the treatment of CHF included Proia, Aconiti Lateralis Radix Praeparata, Codonopsis Radix, Cinnamomi Cortex, Atractylodis Macrocephalae Rhizoma, Citri Reticulatae Pericarpium, Rehmanniae Radix Praeparata, Alismatis Rhizoma, etc. The main prescriptions included Jinkui Shenqi Pill, Jisheng Shenqi Pill, Tingli Dazao Xiefei Decoction, Zhenwu Decoction, Erchen Decoction, Gualou Xiebai Banxia Decoction, Sijunzi Decoction, Buzhong Yiqi Decoction, Tianwang Buxin Pill, etc.,Conclusion,2,Through the data mining on medical records in ancient literatures, it can be seen that, the syndrome and treatment of CHF have certain laws and the therapeutic methods are multiple, which can provide an ancient literature evidence for clinical treatment.
充血性心力衰竭古籍文献数据挖掘证候方药
congestive heart failureancient literaturedata miningsyndromeprescription
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