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基于中医传承辅助平台探究名老中医治疗先兆流产的用药规律
【作者】 李珊珊；
【导师】 佟庆；
【作者基本信息】 北京中医药大学 ， 中医妇科学（专业学位）， 2019， 硕士
【摘要】 研究目的通过对现代名老中医治疗先兆流产的医案进行整理,利用中医传承辅助平台系统软件,挖掘分析医案中的相关信息,总结现代名老中医在先兆流产证候治法方面的临床辨证规律,从而为以后的临床及科研工作提供参考。研究方法搜集中国知网、维普、万方数据库及北京中医药大学图书馆馆存的专著和现刊中现代名老中医治疗先兆流产的方剂,利用中医传承辅助平台软件进行关联规则分析或复杂系统熵聚类分析,然后结合临床和中医理论,予以分析讨论。结果本课题整理医案共计173个,方剂191首,使用药物共计154种。研究结果显示,现代名老中医治疗先兆流产,常用药物为桑寄生、白芍、续断、菟丝子、阿胶、白术、黄芩、杜仲、苎麻根、黄芪,药用以温性、平性及寒性药为核心,甘味药最多,归经以肝经、肾经、脾经为主。通过组方规律分析,常用的药对配伍为:①续断、桑寄生;②菟丝子、桑寄生;③白芍,桑寄生;④阿胶,桑寄生;⑤续断,白芍;⑥菟丝子,续断;⑦白术,桑寄生;⑧杜仲,桑寄生;⑨阿胶,续断;⑩阿胶,菟丝子。名老中医治疗先兆流产的核心药物为:桑寄生、白芍、续断、菟丝子、阿胶、白术、杜仲、黄芩、苎麻根、党参、黄芪。核心组合为①菟丝子,续断→桑寄生(0.90);②阿胶,菟丝子→桑寄生(0.86);③阿胶,续断→桑寄生(0.84);④菟丝子→桑寄生(0.83);⑤续断→桑寄生(0.83);⑥续断,白芍→桑寄生(0.82);⑦菟丝子,白芍→桑寄生(0.82);⑧生地黄→白芍(0.82);⑨生地黄→桑寄生(0.80);⑩杜仲->桑寄生(0.80)。基于熵聚类分析产生的新方有7个:①牡蜗-龟甲-赤石脂-小蓟;②南瓜蒂-覆盆子-桑螵蛸-谷芽;③黄芩-生地黄-旱莲草-艾叶;④桑寄生-菟丝子-续断-龟甲;⑤当归-甘草-山药-炙甘草;⑥党参-黄芪-白术-龙骨-太子参-麦冬-桑叶;⑦菟丝子-党参-杜仲-黄芪-太子参-麦冬-栀子-桑叶。结论名老中医治疗先兆流产的常用药物为桑寄生、白芍、续断、菟丝子、阿胶、白术、黄芩、杜仲、苎麻根、黄芪:名老中医治疗先兆流产的常用药物组合为①续断、桑寄生;②菟丝子、桑寄生;③白芍,桑寄生;④阿胶,桑寄生;⑤续断,白芍;⑥菟丝子,续断;⑦白术,桑寄生;⑧杜仲,桑寄生;⑨阿胶,续断;⑩阿胶,菟丝子。名老中医治疗先兆流产仍遵循古人的治疗原则,以寿胎丸(桑寄生、续断、阿胶、菟丝子)为核心基础,加以补益药白芍、杜仲、白术、党参等药物,再配伍止血药苎麻根及清热药黄芩、生地黄,补肾健脾为主,清热凉血为辅,随证辨证论治,再予以加减。而熵聚类后的新方组合,我们也不难发现,不忘补肾健脾为本,如桑寄生、续断、菟丝子、南瓜蒂、菟丝子、覆盆子、杜仲等补益肾气,黄芪、太子参、党参、白术等健脾益气,血热明显者,加以生地黄、黄芩、小蓟、旱莲草清热凉血止血;若胃阴有热,心烦不安,加以麦冬、桑叶、栀子养阴生津,清热除烦;若兼见怔忡不安之证,可加龙骨镇心安神;若兼见脾胃不和者,可予以谷芽健脾和胃;若临证用药,需根据当今妊娠用药禁忌及患者的实际情况酌情加减。
【Abstract】 Objective:We aim to collate clinical cases by modern famous Chinese medicine practitioners in particular to treatment for threatened abortion.With the aid of the Traditional Chinese Medicine inheritance platform system software,we would then organize and analyze the relevant information in hope to summaries the clinical syndrome differentiation law by modern famous Traditional Chinese Medicine doctors with regards to the treatment of threatened abortion syndrome.We hope that we can provide a reliable and safe reference for future clinical and scientific research work.Method:We will collate all the relevant prescriptions available using China Knowledge Network,Weipu,Wanfang Database,relevant written books and clinical cases by Traditional Chinese medicine practitioners.We will then use the Traditional Chinese Medicine inheritance platform system software to conclude an association rule analysis or complex system entropy aggregation Class analysis and then combine with current clinical and Traditional Chinese Medicine theory for further analysis and discussion.Results:This study included a total of 173 medical records,191 prescriptions and a total of 154 herbs.The results showed that the most commonly used herbs in the treatment of threatened abortion were mulberry parasitic,white peony,intermittent,dodder silk,glue,Atractylodes macrocephala,Scutellaria baicalensis,Eucommia ulmoides,ramie root and Astragalus membranaceus.These herbs that were used in the treatment of threatened abortion could be classified according to their nature,mainly warm,calm and cold.We found out that sweetness herbs were most commonly used that also belong to the liver,kidney and spleen meridians.Through the analysis of prescription law,the commonly used compatibility of drug pairs are as follow:①Radix Dipsaci,Chinese taxillus herb;②dodder seed,Chinese taxillus herb;③Radix Paeoniae Alba,Chinese taxillus herb;④Colla Corii Asini,Chinese taxillus herb;⑤Radix Dipsaci,Radix Paeoniae Alba;⑥dodder seed,Radix Dipsaci;⑦Rhizoma Atractylodis Macrocephalae,Chinese taxillus herb;⑧Cortex Eucommiae,Chinese taxillus herb;⑨Colla Corii Asini,Radix Dipsaci;⑩Colla Corii Asini,dodder seed.The top ten combination that are oftenly used in TCM prescription are as follow:①dodder seed,Radix Dipsaci→Herba Taxilli(0.90);②Colla Corii Asini,Herba Taxilli→Herba Taxilli(0.86);③Colla Corii Asini,Radix Dipsaci→Herba Taxilli(0.84);④Herba Taxilli→Herba Taxilli(0.83);⑤Radix Dipsaci→Herba Taxilli(0.83);⑥Radix Dipsaci,Radix Paeoniae Alba→Herba Taxilli(0.82);⑦dodder seed,Radix Paeoniae Alba→Herba Taxilli(0.82);⑧Radix Rehmanniae Recens→Radix Paeoniae Alba(0.82);⑨Radix Rehmanniae Recens→Herba Taxilli(0.80);⑩Cortex Eucommiae→Herba Taxilli(0.80)①dodder seed,Radix Dipsaci→Herba Taxilli(0.90);②Colla Corii Asini,Herba Taxilli→Herba Taxilli(0.86);③Colla Corii Asini,Radix Dipsaci→Herba Taxilli(0.84);④Herba Taxilli→Herba Taxilli(0.83);⑤Radix Dipsaci→Herba Taxilli(0.83);⑥Radix Dipsaci,Radix Paeoniae Alba→Herba Taxilli(0.82);⑦dodder seed,Radix Paeoniae Alba→Herba Taxilli(0.82);⑧Radix Rehmanniae Recens→Radix Paeoniae Alba(0.82);⑨Radix Rehmanniae Recens→Herba Taxilli(0.80);⑩Cortex Eucommiae→Herba Taxilli(0.80)Seven New Generations Based on Entropy Clustering Analysis:①Concha Ostreae-Carapax et Plastrum Testudinis-Halloysitum Rubrum-Herba Cirsii;②Pumpkin pedicle-Fructus Rubi-Ootheca Mantidis-Fructus Setariae Germinatus;③Radix Scutellariae-Radix Rehmanniae Recens-Herba Ecliptae-Folium Artemisiae Argyi;④Chinese taxillus herb-dodder seed-Radix Dipsaci-Carapax et Plastrum Testudinis;⑤Radix Angelicae Sinensis-Radix Glycyrrhizae-Rhizoma Dioscoreae-Radix Glycyrrhizae Preparata;⑥Radix Changii-Radix Astragali seu Hedysari-Rhizoma Atractylodis Macrocephalae-OsDraconis-Radix Pseudostellariae-Radix Ophiopogonis-Folium Mori;⑦dodder seed-Radix Changii-Cortex Eucommiae-Radix Astragali seu Hedysari-Radix Pseudostellariae-Radix Ophiopogonis-Fructus Gardeniae-Folium Mori)。Conclusion:The main principle for the treatment of threatened abortion by famous TCM practitioners aligns with ancient treatment theory,mainly by invigorating the kidney and spleen,supplemented by clearing away heat and cooling blood.Afterwhich,each patient will then be treated according to syndrome differentiation,whereby TCM practitioners will adjust their prescription accordingly from the core formula.Those with obvious blood-heat should be treated with Herba Cirsii and Herba Ecliptae to clear heat and cool blood to stop bleeding.Those with heart-kidney incompatibility can be treated with Os Draconis;If both spleen and stomach disharmony occurs,Fructus Setariae Germinatus can be used to invigorate the spleen and stomach;if both stomach yin and stomach yin have heat,Radix Liriopes,Folium Mori,Fructus Gardeniae,and many more can also be used to nourish yin and nourish body fluid,clear away heat and remove boredom.Each formula prescribed clinically is customized specially according to patients’ constitution and clinical symptoms.