刘弼臣教授调肺论治学术思想数据化挖掘研究

【作者】 杨蕾；

【导师】 王素梅；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 研究目的：基于信息挖掘技术,整理、挖掘刘弼臣教授“调肺论治”学术思想中小儿咳嗽的诊治规律,包括辨证、选方、用药、中药随证加减、药对的使用等情况,总结出具有临床指导意义的小儿咳嗽的证治规律和特色方药；同时,分析总结刘弼臣教授调肺基本方——辛苍五味汤的使用特点。研究方法：采用传统研究与计算机信息技术相结合的方法,遵循“人机结合,以专家为主”的原则,利用中国中医研究院暨广安门医院承担的北京市科技计划重大项目课题——“基于信息挖掘技术的名老中医临床诊疗经验研究”所提供的数据库-数据仓库,对刘弼臣教授的临证医案进行结构化、数据化处理后,进一步对刘弼臣教授独特的证-法-方-药规律进行分析挖掘研究。研究结果：1刘弼臣教授小儿咳嗽诊疗病历情况1.1症状分布规律：小儿咳嗽除咳嗽外,最常见还有咽红、鼻塞、纳差、有痰、流涕、双肺呼吸音粗、呕吐、喷嚏、盗汗、口渴、气喘等症状。1.2证型分布规律：刘弼臣教授论治小儿咳嗽临床证型大致分为外感,内伤两方面,其中外感包括外感寒邪、外感热邪、外感燥邪,内伤又包括热、痰、虚三个方面,其中热指肺经实火、肺经伏热；痰指痰热内扰、痰湿内阻；虚指肺气虚,肺阴虚、肺气阴两虚。1.3治法分布规律：小儿咳嗽中常用治法有化痰、止咳、宣肺、清热、清肺、疏风、利咽、平喘、通窍、理气、解表、泻肺等。1.4遣方规律：根据小儿咳嗽不同的证候,常在辛苍五味汤作为基础的情况下,选用不同的方剂。外感风寒常用止嗽散,外感风热常用桑菊饮、银翘散、辛夷散、新加香薷散；外感燥邪常用杏苏散、桑杏汤；肺经实火常用麻杏石甘汤；肺经伏热常用泻白散、栀子豉汤；痰热内扰常用止嗽散、银花乌梅汤、柴芩温胆汤、苏子降气汤、苏葶丸、苦辛汤、四逆散；痰湿内阻常用三子养亲汤、二陈汤、温胆汤、旋复代赭汤；肺气虚常用玉屏风散;肺阴虚常用沙参麦冬汤、养阴清肺汤、当归六黄汤；肺气阴两虚常用生脉散、牡蛎散等。1.5用药规律：1.5.1根据症状选择不同的药物,以辛夷、苍耳子、玄参、板蓝根、山豆根、杏仁、桔梗、淡竹叶、芦根,紫菀、百部、炙枇杷叶等为基本方,咽红加牛蒡子、蝉蜕、僵蚕、青果、炙菰笋、贯众等；气喘加地龙、钩藤、秦皮、紫石英、乌梅、五味子、银花等；鼻塞加白芷、薄荷、细辛、升麻、木通、石菖蒲、茶、当归、葱白等；纳差加茯苓、焦三仙、陈皮、半夏、炒白术、甘草、炒白芍、太子参、谷芽、鸡内金、山药等；汗多加浮小麦、牡蛎、生黄芪、熟地、大枣、黛蛤散、龙骨等；大便干加芒硝、大黄、扁豆、薄荷、连翘、谷芽、麦芽、神曲、枳壳、淡豆豉等。1.5.2常用药对：治疗咳嗽常用药对包括：杏仁、苏子；桔梗、杏仁；百部、紫菀；芦根、淡竹叶；芦根、牛蒡子；淡竹叶、牛蒡子；炙菰笋、贯众；枇杷叶、紫菀；杏仁、半夏等。根据“症-证-法-方-药”分析挖掘的结果,可以得出刘弼臣教授诊治小儿咳嗽始终注意其“调肺思想”的运用。2刘弼臣教授调肺基本方-辛苍五味汤使用规律2.1辛苍五味汤论治的疾病：咳嗽、感冒、多发性抽搐症、心悸、癫痫、哮证、厌食、水肿、鼻渊、尿血等涉及五个脏系的疾病。2.2辛苍五味汤论治的证型：外感风热、气阴虚、痰湿阻肺、脾气虚、痰热内扰、肺气虚、肝风夹痰、湿热内蕴、肝脾不和、乳食积滞、气阴不足、脾肾两虚等。2.3辛苍五味汤对应的治法：化痰、清热、宣肺、止咳、息风、通络、平肝、止痉、调肺、通窍等2.4辛苍五味汤配伍的方剂：生脉散、止嗽散、四逆散、菖蒲郁金汤、三子养亲汤、二陈汤、五草汤、杏苏散、当归六黄汤、苏葶丸、半夏泻心汤、保和丸等。根据方-证、方-病、方-法的结果,可以总结出辛苍五味汤是刘弼臣教授“调肺论治“思想的基础应用,广泛运用于儿科各种系统病变的治疗中。3.2问题与展望研究过程中我们发现了一些问题,比如电子病历的质量控制,数据资料的规范化,研究目的细则化等。在今后的研究中不仅需要改进目前问题,还需加大挖掘的深度和广度,进一步全面挖掘刘弼臣教授诊疗经验。更多还原

【Abstract】 Purpose:To summary Professor Liu Bichen’s clinical experiences of treating Cough using a computer information technology named Data Mining (DM) which was very different from the traditional research method used before. Further to explore the regularity of using a prescription named Decoction of Flos Magnoliae and Fructus Xanthii which represets Professor Liu Bichen’s technicality.Methods:According to the principle of "man-machine combination of expert-based "and integrating the traditional research methods into the computer information technology,to mining the feature of Professor Liu Bichen’s clinical experiences.Results:1 Professor Liu Bichen’s clinical experiences of treating Cough:1.1 Distribution of symptoms and signs:besides cough, the common clinical symptoms include red throat, gasping, snuffle, inappetence, phlegm, snivel, vomit, night sweat, astriction and so on.1.2 Syndrome type distribution:cough can be broadly divided into two aspects:exogenous attack and internal injury. The exogenous factors include exogenous cold, heat, and dryness. The internal factors include heat, phlegm and deficiency, heat includes lung excess heat and lung deficiency heat; phlegm includes phlegm-fire and phlegm-dampness; deficiency includes lung yin deficiency and lung qi deficiency.1.3 Distribution of treatment principle:the treatments of Cough commonly include resolving phlegm, relieving cough, dispersing the lung, clearing away heat, clearing the lung, soothing the throat, relieving asthma, ect.1.4 The Principle of prescription:Cough under multiple different syndromes uses different prescriptions. exogenous cold common uses Cough Stopping Powder; exogenous heat common uses Decoction of Mulberry Leaf and Chrysanthemum; exogenous dryness common uses Bitter Apricot Kernel and Perilla Powder; lung excess heat common uses Decoction of Ephedra, Apricot Kernel, Gypsum and Licorice; lung deficiency heat common uses Power of Dispersing the Lung; phlegm-fire uses Decoction for Gallbladder; phlegm-damp uses Two Old Herbs of Decoction; yin deficiency uses Decoction of Glehnia Ophiopogon.; lung qi deficiency uses Jade-Screen Powder.1.5 The Principle of using herbs:1.5.1 According different symptoms to choose the different herbs, angina selects Fructus Arctii, Periostracum Cicadae, Bombyx Batryticatus, Fructus Canarii ect; asthma selects Pheretima, Ramulus Uncariae Cum Uncis, Cortex Fraxini, Fluoritum, Fructus Mume; snuffle selects Radix Angelicae Dahuricae, Herba Menthae, Radix et Rhizoma Asari, Caulis Clematidis Armandii, Bulbus Allii Fistulosi; inappetence selects Poria,, Pericarpium Citri Reticulatae, Rhizoma Pinelliae,, Endothelium Corneum Gigeriae Galli, Rhizoma Dioscoreae; night sweat selects Fructus Tritici Levis, Concha Ostreae, Radix Astragali, Fructus Jujubae, Os Draconis; Fossilia Ossis Mastodi; astriction selects Fructus Forsythiae, Natrii Sulfas, Radix et Rhizoma Rhei, Semen Lablab Album, Fructus Setariae Germinatus, Fructus Hordei Germinatus, Massa Medicata Fermentata ect.1.5.2 Herb pair:the common herb pairs used by professor Liu are:Semen Armeniacae Amarum、Fructus Perillae; Radix Platycodonis、Semen Armeniacae Amarum; Radix Stemonae、Radix et Rhizoma Asteris; Rhizoma Phragmitis、Herba Lophatheri; Rhizoma Phragmitis、Fructus Arctii; Herba Lophatheri、Fructus Arctii; Folium Eriobotryae、Radix et Rhizoma Asteris; Semen Armeniacae Amarum、Rhizoma Pinelliae ect. we can conclud that:Professor Liu have paid great attention to "from the lungs of governance"in the treatment of Cough.2 Professor Liu Bichen-regularity of using a prescription named Decoction of Flos Magnoliae and Fructus Xanthii which represents technicality.2.1 Treatment diseases of the prescription:the treatment range of the prescription is widely,there are cough,cold、Tourette’s syndrome, falling sickness, asthma, anorexia, dropsy ect.2.2 Syndrome type distribution:there are many syndromes can be treated by the prescription: exogenous heat, qi and yin deficiency. phlegm-damp, deficiency of spleen qi, phlegm-fire, deficiency of lung qi, disharmony between the liver and spleen ect.2.3 Distribution of treatment principle:the prescription can be used to resolving phlegm, clearing away heat, dispersing the lung, relieving cough, stopping wind, dredging collaterals, soothing the liver, dredging orifice ect.2.4The Principle of Prescription combine:the prescription can be used with many other prescription, such as PulseActivating Powder, Cold Limbs Powder, Cough Stopping Powder, Decoction of Three Kinds of Seeds for the Aged, Decoction of Five Herbs, Two Old Herbs of Decoction; Bitter Apricot Kernel and Perilla Powder; Decoction of Chinese Angelica and Six Yellow Ingredients;Pinellia Heart Purging Decoction; Preserving Pills ect. the prescription of Decoction of Flos Magnoliae and Fructus Xanthii is basic for Professor Liu Bichen to treat diseases, it represent Professor Liu’s technicality to lung3. Problems and Prospects According the result of the study we found that there are some problems, such as data quality of Computer-based patient record (CRP), data standardization of CRP, the purpose of study and so on.In the future study.we should try to resolve this problems,and at the same times we should try to in-depth excavation Professor Liu Bichen clinic experience.更多还原