邓文祥, 张冀东, 张文安, 何清湖. 基于数据挖掘探索国医大师熊继柏治疗痹证的用药经验[J]. Digital Chinese Medicine, 2022, 5(2): 154-168. DOI: 10.1016/j.dcmed.2022.06.005
引用本文: 邓文祥, 张冀东, 张文安, 何清湖. 基于数据挖掘探索国医大师熊继柏治疗痹证的用药经验[J]. Digital Chinese Medicine, 2022, 5(2): 154-168. DOI: 10.1016/j.dcmed.2022.06.005
DENG Wenxiang, ZHANG Jidong, ZHANG Wenan, HE Qinghu. Traditional Chinese medicine Master XIONG Jibo’s medication experience in treating arthralgia syndrome through data mining[J]. Digital Chinese Medicine, 2022, 5(2): 154-168. DOI: 10.1016/j.dcmed.2022.06.005
Citation: DENG Wenxiang, ZHANG Jidong, ZHANG Wenan, HE Qinghu. Traditional Chinese medicine Master XIONG Jibo’s medication experience in treating arthralgia syndrome through data mining[J]. Digital Chinese Medicine, 2022, 5(2): 154-168. DOI: 10.1016/j.dcmed.2022.06.005

基于数据挖掘探索国医大师熊继柏治疗痹证的用药经验

Traditional Chinese medicine Master XIONG Jibo’s medication experience in treating arthralgia syndrome through data mining

  • 摘要:
    目的本研究旨在通过数据挖掘,验证和推广国医大师熊继柏在诊治痹证方面的用药经验和组方。
    方法收集国医大师熊继柏2014年1月1日至2018年12月31日的门诊病例,以及2019年12月出版的 《一名真正的名中医:熊继柏临证医案实录1》中记录的病例。收集病例中患者的五类信息,即中医四诊信息、中西医诊断、证型、治法和方药,采用Excel建立数据库。基于Python环境,建立关于熊继柏诊疗痹证定制改造的自然语言处理(NLP)模型,对数据进行预处理与词云分析。采用中医传承计算平台(V3.0)和RStudio(V4.0.3)对国医大师熊继柏治疗痹证的用药进行频数分析、关联规则分析、聚类分析以及可视化分析。
    结果从数据库中共收集到610份国医大师熊继柏的临床病历。根据数据筛选标准,最终共纳入103份病历,包括187次(45张)处方和1 506次(125种)中药。中药主要归经为肝经、脾经和肾经。中药四气以温、平和寒为主,五味以苦、辛和甜为主。痹证的主要证型有湿热证、痰瘀互结证和项痹证。痹证的高频中药有川牛膝、黄柏、苍术、秦艽、甘草、黄芪和川芎。最常见的中药功效是活血化瘀,其次是补虚(补气,补血和补阳)和祛风除湿。药物关联规则按支持度大于等于15%,置信度100%,去重后分析得出二阶关联规则5条,三阶关联规则39条,四阶关联规则39条,五阶关联规则2条。各关联规则排名第一的分别是:苍术→黄柏、苍术 + 川牛膝→黄柏、川牛膝 + 当归 + 甘草 → 秦艽和川牛膝 + 当归 + 甘草 + 黄柏 → 秦艽 。对前30种中药进行聚类分析,得到5个聚类,聚类的中药功效以燥湿、益气和活血为主。国医大师熊继柏治疗痹证的核心处方是二妙散、葛根姜黄散和黄芪虫藤饮。核心处方的药物包括苍术、川牛膝、甘草、黄柏、木瓜、秦艽、当归和薏苡仁。
    结论国医大师熊继柏治疗痹证最常用的治疗方法是清热利湿、通络止痛和益气活血;此外,借助定制的NLP模型,可以提高中药数据挖掘的效率。

     

    Abstract:
    ObjectiveThis study aimed to examine and propagate the medication experience and group formula of traditional Chinese medicine (TCM) Master XIONG Jibo in diagnosing and treating arthralgia syndrome (AS) through data mining.
    MethodsData of outpatient cases of Professor XIONG Jibo were collected from January 1, 2014 to December 31, 2018, along with cases recorded in A Real Famous Traditional Chinese Medicine Doctor: XIONG Jibo's Clinical Medical Record 1, which was published in December 2019. The five variables collected from the patients’ data were TCM diagnostic information, TCM and western medicine diagnoses, syndrome, treatment, and prescription. A database was established for the collected data with Excel. Using the Python environment, a customized modified natural language processing (NLP) model for the diagnosis and treatment of AS by Professor XIONG Jibo was established to preprocess the data and to analyze the word cloud. Frequency analysis, association rule analysis, cluster analysis, and visual analysis of AS cases were performed based on the Traditional Chinese Medicine Inheritance Computing Platform (V3.0) and RStudio (V4.0.3).
    Results A total of 610 medical records of Professor XIONG Jibo were collected from the case database. A total of 103 medical records were included after data screening criteria, which comprised 187 times (45 kinds) of prescriptions and 1 506 times (125 kinds) of Chinese herbs. The main related meridians were the liver, spleen, and kidney meridians. The properties of Chinese herbs used most were mainly warm, flat, and cold, while the flavors of herbs were mainly bitter, pungent, and sweet. The main patterns of AS included the damp heat, phlegm stasis, and neck arthralgia. The most commonly used herbs for AS were Chuanniuxi (Cyathulae Radix), Huangbo (Phellodendri Chinensis Cortex), Cangzhu (Atractylodis Rhizoma), Qinjiao (Gentianae Macrophyllae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqi (Astragali Radix), and Chuanxiong (Chuanxiong Rhizoma). The most common effect of the herbs was “promoting blood circulation and removing blood stasis”, followed by “supplementing deficiency (Qi supplementing, blood supplementing, and Yang supplementing)”, and “dispelling wind and dampness”. The data were analyzed with the support ≥ 15% and confidence = 100%, and after de-duplication, five second-order association rules, 39 third-order association rules, 39 fourth-order association rules, and two fifth-order association rules were identified. The top-ranking association rules of each were “Cangzhu (Atractylodis Rhizoma) → Huangbo (Phellodendri Chinensis Cortex)” “Cangzhu (Atractylodis Rhizoma) + Chuanniuxi (Cyathulae Radix) → Huangbo (Phellodendri Chinensis Cortex)” “Chuanniuxi (Cyathulae Radix) + Danggui (Angelicae Sinensis Radix) + Gancao (Glycyrrhizae Radix et Rhizoma) → Qinjiao (Gentianae Macrophyllae Radix)” and “Chuanniuxi (Cyathulae Radix) + Danggui (Angelicae Sinensis Radix) +Gancao (Glycyrrhizae Radix et Rhizoma) + Huangbo (Phellodendri Chinensis Cortex) → Qinjiao (Gentianae Macrophyllae Radix)”, respectively. Five clusters were obtained using cluster analysis of the top 30 herbs. The herbs were mainly drying dampness, supplementing Qi, and promoting blood circulation. The main prescriptions of AS were Ermiao San (二妙散), Gegen Jianghuang San (葛根姜黄散), and Huangqi Chongteng Yin (黄芪虫藤饮). The herbs of core prescription included Cangzhu (Atractylodis Rhizoma), Chuanniuxi (Cyathulae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Huangbo (Phellodendri Chinensis Cortex), Mugua (Chaenomelis Fructus), Qinjiao (Gentianae Macrophyllae Radix), Danggui (Angelicae Sinensis Radix), and Yiyiren (Coicis Semen).
    ConclusionClearing heat and dampness, relieving collaterals and pain, and invigorating Qi and blood are the most commonly used therapies for the treatment of AS by Professor XIONG Jibo. Additionally, customized NLP model could improve the efficiency of data mining in TCM.

     

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