【作者】 向楠；

【导师】 刘昭纯；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2011， 博士

【副题名】基于现代中风病病案的统计学处理探讨瘀血与内风的相关性

【摘要】 目的:探索活血化瘀药物在中风病中的应用及配伍规律,证实瘀血与内风的密切相关性,检验“瘀血生风”病机假说。方法:采用流行病学研究方法。收集山东省中医药大学附属医院、山东省千佛山医院、淄博市张店区中医院中风住院病案833例,以EXCEL系统建立病案数据库,以SAS12.0作为统计软件对病案中的方药进行频数统计、因子分析及聚类分析。按照“方证相应、以方(药)测证”的基本原理对结果进行阐释,找出其中的方药应用规律及病因病机规律。结果:①活血化瘀药物在两个年龄段中风病病案中的使用频率均为第一位,66岁以上组高于66岁以下组(P<0.01)。通过因子分析共得到影响两年龄组的因子14个和15个。其中与瘀血有关的因子分别为10个和7个。通过聚类分析,两组分别得到聚类方13个和11个,其中和活血化瘀药相关的聚类方分别为6个和7个。②两个病程组中,活血化瘀药物的使用频率均位于第一位,其频率病程超过180天组高于病程不足180天组(P<0.01)。通过因子分析两组分别得到因子15个和21个。与瘀血相关的因子分别为7个和8个。通过聚类分析得到影响两不同病程组治疗的聚类方11个和14个,其中与活血化瘀药物的使用有关的聚类方分别为5个和8个。③脑梗塞组和脑出血组中活血化瘀药物的使用频率均为第一位,脑梗塞组高于脑出血组(P<0.01)。通过因子分析两组分别得到因子8个和17个,两组中与瘀血相关的因子分别为4个和8个。通过聚类分析两组分别得到聚类方20个和9个。其中和活血化瘀药物使用有关的聚类方分别为10个和5个。④各研究点活血化瘀药物的使用频率均位于第一位。因子分析得到影响三个研究点中风病患者治疗的因子分别为32个、17个和23个。其中与瘀血有关的因子分别为18个、15个和15个。聚类分析共分别得到聚类方27个,13个和10个,其中与瘀血有关的聚类方分别是8个、5个和5个。⑤全部中风病病案中活血化瘀药物的使用频率为第一位。因子分析共得到影响中风病治疗的因子20个,其中与瘀血相关的因子8个。聚类分析共得到影响中风病治疗的聚类方20个,其中与活血化瘀药使用有关的聚类方10个。上述各类因子分析得到的与瘀血有关的因子总的体现了瘀血单独致病,瘀血与正虚相兼,瘀血与痰湿、痰热、火热等其他致病邪气相兼并存的病机变化。上述聚类分析得到的聚类方总的体现了活血化瘀药物之间,活血化瘀药与补虚药,活血化瘀药与祛邪药的配伍规律。结论:活血化瘀类药物在现代中风病的治疗中起到了非常重要的作用;瘀血是导致中风病发生的独立因子,又多与其他病机相兼并存;瘀血生风是老年中风病的主要病机,可贯穿中风病始终;瘀血生风多继发于慢性病,并可见于各类中风病;瘀血生风病机具有普遍性。更多还原

【Abstract】 Objective: To explore the application and compatible regularity of Chinese herbs with the function of promoting blood circulation and removing blood stasis.To verify the correlativity of blood stasis and endogenous wind and to test the hypothesis of blood stasis leading to endogenous wind. method: Inpatient records of strokes were collected from Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Qianfo Hospital of Shandong Province, Chinese Medicine Hospital of Zhangdian District Zibo City respectively. Database of records were established with EXCEL system. Frequence analysis, factor analysis and cluster analysis on the Chinese herbs used in records was made with SAS12.0. Application regularity of Chinese prescriptions and herbs, regularity of etiology and pathogenesis were explored with the guidance of principle of disproofing syndrome by elucidating mechanism of Chinese formula.results:①The rank of applying Chinese herbs with the function of promoting blood circulation and removing blood stasis was first in two different age groups. The frequency in high age group was higher than low age group(P<0.01). 14 factors and 15 factors were got in two age groups through factor analysis respectively. 10 factors and 7 factors in the factor analysis results were thought as having close relationship with blood stasis in each group. 13 and 11 medicine combinations in each age groups were got through cluster analysis. 6 and 7 combinations in the cluster analysis results were thought as having close relationship with herbs having the function of promoting blood circulation and removing blood stasis.②The rank of applying herbs with the function of promoting blood circulation was first in two different course of disease groups. The frequency in the long course group was higher than the low course group(P<0.01). 15 and 21 factors were collected in two course groups respectively.7 and 8 factors were thought as having relationship with blood stasis.11 and 14 medicine combinations were collected in two course groups respectively through cluster analysis.5 and 8 combinations had relationships with herbs with function of promoting blood circulation.③The frequency of application of herbs with the function of promoting blood circulation in cerebral infarction and cerebral hemorrhage groups was highest. The frequency in cerebral infarction group was higher than it in cerebral hemorrhage group(P<0.01). 8 and 17 factors were got from two groups through factor analysis. 4 and 8 factors were though as having relationship with blood stasis. 20 and 9 medicine combinations were got through cluster analysis. 10 and 5 combinations were though as having relationship with herbs of promoting blood circulation and removing blood stasis.④The rank of applying herbs with function of promoting blood circulation and removing blood stasis in different study points was first. 32, 17 and 23 factors were got in different study points respectively through factor analysis. 18, 15 and 15 factors were thought as having close relationship with blood stasis. 27, 13 and 10 medicine combinations were got in different study points through cluster analysis. 8, 5 and 5 medicine combinations were thought as having relationship with herbs of promoting blood circulation.⑤The rank of application of herbs with function of promoting blood circulation in all the records was first. 20 factors were got in all the records through factor analysis. 8 factors were though as having relationship with blood stasis. 20 medicine combinations were got in all the records through cluster analysis. 10 combinations were thought as have relationship with application of herbs with the function of promoting blood circulation. Blood stasis leading disease individually, blood stasis companied by Zheng Qi deficiency, blood stasis companied by other pathogenic factors were summarized as the regularity of factors got through statistics.The combination of herbs with the function of promoting blood stasis, herbs of promoting blood stasis and strengthening qi, herbs of promoting blood circulation and expelling other pathogenic factors was summarized as the regularity of medicine combinations got through cluster analysis.conclusions: Chinese medicine with the function of promoting blood circulation and removing blood stasis pays an important part in treating strokes. Blood stasis is a individual factor causing strokes. Blood stasis is always companied by other etiology and pathogenesis. Blood stasis causing wind is the main pathogenesis of stroke occurred in old people. This pathogenesis can be found in the whole course of stroke and it usually occurred after some chronic diseases. This pathogenesis can be found in all kinds of strokes. Blood stasis causing wind is universal.更多还原