摘要
目的:基于古今医案云平台(V2.3.9)分析中国知网、万方数据知识服务平台、维普中文期刊数据库自建库以来至2024年12月中医药治疗慢性阻塞性肺疾病(COPD)稳定期的用药规律。方法:搜集3个数据库自建库至2024年12月中医药治疗COPD的临床研究文献,将规范化后的处方信息输入“古今医案云平台V2.3.9”,分别进行中药功效类别、频次、性味归经、关联规则、聚类、证候-中药相关性分析,总结中医药治疗COPD的用药规律。结果:共纳入符合标准的中药复方222首,涉及217味中药,药物功效以利水消肿、润肠通便、燥湿化痰、生津养血使用频次较高;使用频次>50次的药物14味,其中黄芪、党参、茯苓、五味子使用频次较多;药性以温性药和平性药为主,药味以甘、辛、苦为主,归经多归肺经、脾经、心经、肾经;关联规则分析得到6条支持度较高的药物组合,包括“党参—黄芪”“白术—黄芪”“五味子—黄芪”等药对;高频中药聚类分析得到5个药物组合:(1)黄芪、党参,是临床常用的补气药对;(2)茯苓、白术,用于脾虚中阳不振,痰饮内停;(3)甘草、陈皮、半夏,三药合用为二陈汤加减,擅治湿痰咳嗽;(4):五味子、紫苏子、熟地黄、紫菀、款冬花,本组合近似射干麻黄汤加减,宣肺祛痰,降气止咳。(5):炙甘草、当归、桃仁、人参、蛤蚧、桔梗、苦杏仁、防风、丹参、桑白皮、麦冬、山药、地龙、山茱萸、淫羊藿、川芎、补骨脂、黄精。本药物组合为人参蛤蚧散+膈下逐瘀汤+六味地黄丸+归脾汤加减,补肺益肾、止咳定喘,同时兼顾益气养血、活血化瘀。由药物聚类分析可推断,现代医家治疗COPD稳定期多采用补益肺气、健脾化痰、补肾纳气、活血化瘀诸法灵活施治。复杂网络分析得到3个证型-中药分布图,证型分别是肺气虚证、肺脾气虚证和肺肾两虚证,黄芪、五味子、茯苓、党参、陈皮、白术、丹参等与证型关联度较强。结论:中医药治疗COPD稳定期以补肺益肾健脾为基本原则,辅以降气化痰、调气活血之法,可为临床提供组方用药依据。
Objective:To analyze the medication patterns of traditional Chinese medicine(TCM)for stable chronic obstructive pulmonary disease(COPD)based on the Ancient and Modern Medical Case Cloud Platform(V2.3.9),utilizing data from CNKI,Wanfang Data,and VIP Chinese Journal Database from their inception to December 2024.Methods:Clinical research literature on TCM treatment of COPD was collected from the three databases.Standardized prescription information was input into the“Ancient and Modern Medical Case Cloud Platform V2.3.9”for analysis,including TCM efficacy categories,frequency,properties,flavors and meridian tropism,association rules,clustering,and syndrome-herb correlations,to summarize medication patterns.Results:A total of 222 TCM compound prescriptions meeting the criteria were included,involving 217 herbs.High-frequency efficacy categories included promoting diuresis to alleviate edema,moistening intestines to relieve constipation,drying dampness and resolving phlegm,and generating fluid to nourish blood.Fourteen herbs were used over 50 times,with Huangqi,Dangshen,Fuling,and Wuweizibeing the most frequent.Herbal properties were predominantly warm and neutral;flavors were mainly sweet,pungent,and bitter;and meridians chiefly involved the lung,spleen,heart,and kidney channels.Association rule analysis yielded six high-support herb combinations,such as“Dangshen-Huangqi”,“Baizhu-Huangqi”,and“Wuweizi-Huangqi”.Cluster analysis of high-frequency herbs identified five groups:(1)Huangqi and Dangshen:a common qi-tonifying pair;(2)Fuling and Baizhu:for spleen deficiency with phlegm retention;(3)Gancao,Chenpi,and Banxia:decoction of two old ingredients(Erchen Tang),effective for damp-phlegm cough;(4)Wuweizi,Zisuzi,Shudihuang,Ziwan,and Kuandonghua:similar to modified Belamcanda and Ephedra Decoction(Shegan Mahuang Tang),ventilating lung and dispelling phlegm,descending qi and relieving cough;(5)Zhigancao,Danggui,Taoren,Renshen,Gejie,Jiegeng,Kuxingren,Fangfeng,Danshen,Sangbaipi,Maidong,Shanyao,Dilong,Shanzhuyu,Yinyanghuo,Chuanxiong,Buguzhi,and Huangjing:combining Ginseng and Gecko Powder(Renshen Gejie San),Infradiaphragmatic Stasis-Expelling Decoction(Gexia Zhuyu Tang),Six-Ingredient Rehmannia Pill(Liuwei Dihuang Wan),and Returning to Spleen Decoction(Guipi Tang)to tonify lung and kidney,relieve cough and wheezing,while tonifying qi and nourishing blood,and activating blood circulation to resolve stasis.Clustering suggests modern TCM practitioners treat stable COPD by flexibly combining methods to tonify lung and replenish qi,invigorate spleen and resolve phlegm,tonify kidney and regulate qi reception,and activate blood circulation to resolve stasis.Complex network analysis revealed three syndrome-herb distribution patterns:lung-qi deficiency,lung-spleen qi deficiency,and lung-kidney deficiency.Herbs like Huangqi,Wuweizi,Fuling,Dangshen,Chenpi,Baizhu,and Danshen showed strong syndrome correlations.Conclusion:TCM treatment for stable COPD centers on tonifying the lung and kidney and fortifying the spleen,supplemented by methods to descend qi and resolve phlegm,regulate qi and activate blood,providing a clinical basis for prescription formulation.
作者
戴钟元
王纪翔
黄平富
Dai Zhongyuan;Wang Jixiang;Huang Pingfu(Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Anhui University of Traditional Chinese Medicine,Chuzhou Anhui 239000;First Clinical Medical College of Anhui University of Traditional Chinese Medicine,Hefei Anhui 230031)
出处
《山西中医药大学学报》
2025年第8期827-832,837,共7页
Journal of Shanxi University of Chinese Medicine
基金
新安医学与中医药现代化研究所“揭榜挂帅”项目(2023CXMMTCM005)
2024年中医药防治肺系重大疾病应用转化安徽省重点实验室项目(2024ZYFBAHKLA01)。
关键词
慢性阻塞性肺疾病稳定期
中医药
数据挖掘
用药规律
stable chronic obstructive pulmonary disease
traditional Chinese medicine
data mining
medication pattern
