【作者】 郭君哲；

【导师】 马健；

【作者基本信息】 南京中医药大学 ， 中医临床基础， 2013， 博士

【摘要】 口的：通过收集、整理古今消渴病医案文献,探析消渴病的源流,并运用数理统计方法及数据挖掘技术分析医案数据中隐含的规律,探求消渴病的证治规律及其演变。为中医医案的研究提供思路与方法学上的借鉴,为消渴病的临床辨治和实验研究提供新的思路和线索。方法：1.收集并梳理古今消渴病医案文献,掌握其历史分布情况,对消渴病的病名、病因病机、治则治法进行整理与分析,从整体上、系统的认识消渴病的发展规律。2.利用SAS9.1统计软件,运用频数、因子、聚类、典型相关、关联规则几种方法挖掘消渴病医案中症与症、药与药及症与药之间的隐含规律,从而归纳出金元、明清、近现代三个历史时期消渴病的证治规律演变,总结消渴病的病位、病机、证候类型和治疗原则。结果：1.通过对总库消渴病医案中的高频药物进行关联规则分析,得到消渴病治疗中常用的42对药对,按功效可分为8类：养阴生津类、补益兼利水降火类、益肾健脾类、益气生津类、清热生津类、养阴类、清热类、利水降火类。2.对总库消渴病医案中的高频症状和高频药物进行典型相关分析,得出17对典型相关变量,结合中医理论归纳为10组证治组合,所反映的病机分别为肝阳上扰、瘀血内阻、脾虚湿阻、气虚气滞、心肝火旺、肺胃燥热、肾阴亏虚、精血不足、肾阳虚衰、津亏肠燥;对应的治法分别为柔肝潜阳、化瘀和血、化湿和中、补气行气、清心养肝、清热生津、养阴固肾、补益精血、温阳化气、润燥通腑。3.对金元时期消渴病医案中12个高频症状进行分析,得到3个聚类组,结合中医理论分析其反映了阴虚燥热之证候病机；对46味高频药物进行分析,得到6个因子及7个聚类组,结合中医理论归纳为8条治则：清热泻火、益气健脾、行气祛湿、养阴降火、收敛固精、化瘀和血、平抑肝阳、泻下积滞。4.对明清时期消渴病医案中25个高频症状进行分析,得到8个因子和8个聚类组,结合中医理论合并为6个证候病机：脾肾亏虚、津亏燥热、内热亢盛、肺脾气虚、肝阳上亢、痰浊内阻;对60味高频药物进行分析,得到10个因子及10个聚类组,结合中医理论归纳为7条治则：养阴生津、益气健脾、化瘀和血、温肾化气、清热泻火、化湿祛痰、补肾固摄。5.对近现代消渴病医案中55个高频症状进行分析,得到10个因子和11个聚类组,结合中医理论合并为6个证候病机：阴虚内热、津亏燥热、脾虚不运、气滞血瘀、阳虚水停、肝郁化火；对101味高频药物进行分析,得到11个因子及15个聚类组,结合中医理论归纳为10条治则：养阴清热、清热泻火、健脾和中、温肾化气、祛湿行气、活血化瘀、补益肝肾、收敛固精、平肝疏肝、安神定志。结论：1.梳理了消渴病的源流,掌握了消渴病的证治规律在金元、明清、近现代三个历史时期的演变,为文献研究奠定基础。2.总结了消渴病的病位和阴、阳、气、血、湿、瘀六大病理类型和,为临床辨证提供依据。3.总结了消渴病的常用药物,分析了常用药对的配伍规律,为组方用药提供参考,为实验研究提供线索。4.总结了消渴病的治疗九法,指导临床治疗;5.提出了消渴病的辨治思路,为糖尿病、尿崩症、精神性多饮症、甲状腺功能亢进症等现代疾病的中医辨治提供参考。更多还原

【Abstract】 Objective:The dissertation aims to approach the historical origin and development of consumptive-thrist disease by collecting and unscrambling the information in ancient and modern medical records, to obtain the diagnosis and treatment rules implicit in the records using statistical method and data mining technique, and to analyze the evolution of the rules, thereby providing methodological reference for researches on traditional Chinese medical records, new thoughts for clinical diagnosis and treatment of consumptive-thrist disease, and clues for experimental research.Method:1. Ancient and modern medical records about consumptive-thrist disease are collected and sorted through to grasp their distribution in different period of history, to analyze and unscramble names, causes, pathogenesis and therapeutic methods of consumptive-thrist disease, which helps to get a thorough and systematic understanding about the historical development of consumptive-thrist disease.2. Using SAS9.1, frequency, factor, cluster, canonical correlation analysis and association rules are applied to explore connotative association of3aspects, including association among symptoms, association among drugs and association between symptoms and drugs, which helps to summize the evolution of diagnosis and treatment rules during3periods of history (Jin and Yuan Dynasty, Ming and Qing Dynasty and modern times) as well as location, pathogenesis, pathologic patterns and therapeutic rules of consumptive-thrist disease.Result:1. As a result of applying association rules to ananlyze the association among high-frequency drugs selected from all the medical records,42pairs of drugs are obtained and further divided into8groups according to their effect, namely nourishing yin and body fluid, tonifying cooperated with hydragogue and fire-lowering, tonifying kidney and spleen, tonifying qi and body fluid, heat-clearing and body fluid nourishing, yin nourishing, heat clearing and hydragogue and fire-lowering.2. Applying canonical correlation analysis to study the relation between high-frequency symptoms and drugs selected from all the medical records,17canonical correlation variables are obtained, and10combinations of syndrome and treatment can be extracted according to Traditional Chinese Medicine theory. The pathogenesis reflected by the10groups are liver-yang flaming, blood stasis, spleen deficiency accompanied with pathogenic dampness, qi deficiency and stagnation, heart and liver fire hyperactivity, lung and stomach dryness-heat, kidney yin deficiency, essence and blood deficiency, kidney yang deficiency and intestinal dryness caused by body fluid deficiency. Correspondingly,10therapeutic rules can be deduced:nourishing liver and tranquilizing yang, dissolving blood stasis and restoring function of blood, removing dampness to regulate stomach, tonifying qi and promoting flow of qi, clearing heart-fire and nourishing liver, clearing heat and nourishing body fluid, tonigying yin and astringing essence of kidney, nourishing essence and blood, warming yang to regain function of qi and moistening dryness and purging intestines.3. Analyzing the12selected high-frequency symptoms from medical records of Jin and Yuan Dynasty obtains3clusters which reflect the pathogenesis of yin deficiency and dryness-heat. Analyzing the46selected high-frequency drugs from medical records of the same period obtains6factors and7clusters which can be reduced to8therapeutic rules:clearing heat and fire, replenishing qi to invigorate the spleen, promoting flow of qi and dispelling dampness, nourishing yin for lowering fire, astringing essence, dissolving blood stasis and restoring function of blood, repressing liver yang and purging intestines.4. Analyzing the25selected high-frequency symptoms from medical records of Ming and Qing Dynasty obtains8factors and8clusters which can be reduced to6pathogenesis: spleen and kidney deficiency, dryness and heat caused by body fluid deficiency, internal heat flaming, lung and spleen deficiency, liver-yang flaming and phlegm stasis. Analyzing the60selected high-frequency drugs from medical records of the same period obtains10factors and10clusters which can be reduced to7therapeutic rules:nourishing yin and body fluid, replenishing qi to invigorate the spleen, dissolving blood stasis and restoring function of blood, warming kidney and regaining function of qi, clearing heat and fire, dispelling dampness and eliminating phlegm and reinforcing kidney to astringe essence.5. Analyzing the55selected high-frequency symptoms from medical records of modern times obtains10factors and11clusters which can be reduced to6pathogenesis:internal heat caused by yin deficiency, dryness and heat caused by body fluid deficiency, spleen dysfunction in transforming and transporting, qi stagnation and blood stasis, yang deficiency and water retention and pathogenic fire derived from liver depression. Analyzing the101selected high-frequency drugs from medical records of the same period obtains11factors and15clusters which can be reduced to10therapeutic rules:tonifying yin to clear heat, clearing heat and fire, tonifying spleen to regulate stomach, warming kidney and regaining function of qi, dispelling dampness to promote flow of qi, promoting circulation to dissolve blood stasis, nourishing liver and kidney, astringing essence, tranquilizing liver and smoothing liver-qi stagnation and tranquilizing mind and spirit.Conclusion:1. A thorough and systematic understanding about the historical development of consumptive-thrist disease and the evolution of diagnosis and treatment rules dealing with consumptive-thrist disease during3periods of history (Jin and Yuan Dynasty, Ming and Qing Dynasty and modern times) are obtained, which lay the basis for future research on literature.2. The pathogenesis of consumptive-thrist disease can be reduced to6aspects:yin, yang, qi, blood, dampness and blood stasis, according to which6pathologic types are established and the disease location is summrized, which provide reference for syndrome differentiation.3. Commom drugs treating consumptive-thrist disease and regularity in drug combinations are analyzed and concluded, which offer principles for forming prescription as well as clues for for experimental research.4.9therapeutic methods treating consumptive-thrist disease are conclued to conduct clinical treatment.5. New thoughts for clinical diagnosis and treatment of consumptive-thrist disease is concluded, which provides the basis for Traditional Chinese Medicine diagnosis and intervention of some modern disease:part of diabetes mellitus, diabetes insipidus, primary polydipsia and hyperthyroidism.更多还原