【作者】 王科军；

【导师】 刘华生；

【作者基本信息】 黑龙江中医药大学 ， 中医基础理论， 2014， 博士

【摘要】 目的：搜集与梳理喘证的古代中医文献,并从中提取关于喘证的医案,建立喘证医案数据库,应用现代计算机技术和统计学分析相结合的方法对其进行数理统计挖掘研究,揭示喘证的证治规律,以期为临床治疗喘证提供更多的借鉴和新的思路。方法：①应用文献学的方法,搜集并梳理喘证古代文献,对历代医家关于喘证的认识进行全面回顾和总结。②提取古代医家治疗喘证的医案,将所收集到的医案进行数据标准化处理,建立古代喘证医案的一般情况、病因、病位、病机、方剂、症状和药物数据库,然后利用SAS9.1统计软件对数据库分别进行频数分析、因子分析、聚类分析、典型相关性分析和关联规则分析,从中研究挖掘出喘证的症与症、药与药、症与药、病位与药、病机与药之间的相互关系,探讨古代医家对喘证的认识和证治规律。结果：有性别、年龄记载的医案中男性占52.42%,中老年人群占61.58%；病因库中病理产物、外感因素、饮食因素、劳逸因素和情志因素累积出现频率为85.28%,失治、误治因素占10.35%；病位库中肺、脾、肾三脏的累积出现频率为84.50%,两脏同时受累频率为45..70%；,病机库中虚实夹杂频率为49.42%,痰湿水饮频率为37.30%,气虚、阴虚、阳虚累积频率为54.30%；通过对症状库和药物库频数分析、因子分析、聚类分析和关联分析分别得到63个高频症状、6个症状因子、16个症状聚类组合、11个两症状组合、60味高频药物、7个药物因子、13个药物聚类组合、37个两味药组合、45个三味药组合和36个四味药组合；通过对症状库与药物库间典型相关性分析得出7对典型相关变量。结论：①喘证可能多发于中老年人群且男性发病率较高。②喘证主要病因有病理产物、外感因素、饮食因素、劳逸因素和情志因素,失治、误治因素在喘证病变中不容忽视。③喘证为本虚标实之证,虚实夹杂为其主要病机。④五脏六腑皆可致喘,病位与肺、脾、肾关系最为密切,发病多以两脏相关为主。⑤喘证常见辨证分型有表寒肺热、肺热炽盛、痰热郁肺、痰浊阻肺等17个证候类型。⑥治疗喘证时常应用的药物类型有补气药、化痰止咳平喘药等14种,药对有人参配甘草、白术配人参、黄芪配人参等37对,三味药物组合有人参+甘草+白术、橘皮+人参+甘草等15组,四味药物组合有橘皮+人参+甘草+白术、茯苓+人参+白术+甘草等9组,方剂有金匮肾气丸、补中益气汤等15个。⑦数理统计学与中医文献研究相结合的方法能挖掘出潜在的新知识,对中医古籍研究具有重大的现实意义。更多还原

【Abstract】 Objective:In the study, in order to offer more reference and new ideas for the clinical treatment of Gasp Syndrome, we probed the diagnosis and treatment regularity through collecting the ancient medical documents of Gasp Syndrome and researching the medical case of Gasp Syndrome selected from the ancient documents by modern computer technology and statistical analysis.Methods:①We reviewed and summarized the understanding of the ancient Chinese Doctor on Gasp Syndrome from through collecting the ancient medical documents of Gasp Syndrome and using literature study methods.②We selected the ancient medical cases of Gasp Syndrome from the ancient medical documents and normalized the data of the cases to establish the database of the general information, etiology, disease location, pathogenesis, prescription, medicines and symptoms. Then we analyzed the database using the methods of mathematical statistics and data mining, such as frequency analysis, factor,an.alysis, clustering analysis,canonical correlation analysis and association rules analysis via statistical software SASV9.1. We mined the potential relationship of symptoms-symptoms, medicines-medicines, symptoms-medicines, disease location-medicines and pathogenesis-medicines to summarize and generalized the understanding and the diagnosis and treatment regularity of the Gasp Syndrome.Results:In the cases with gender and age record,52.42%of the patients were men, and61.58%of the patients were middle-aged and aged people. The etiologies of85.28%of the cases were pathological products, exogenous factors, dietary factor, over-work and over-rest factor, and emotional factors. The etiology of10.35%of the cases was the therapeutic error factor. The disease location of84.50%of the cases were lung, spleen and kidney.45.70%of the cases were affected by two organs at the same time. The pathogenesis of the49.42%of the cases was intermingled deficiency and excess. The pathogenesis of37.30%of the cases was water, dampness, phlegm and fluid. The pathogenesis of54.30%of the cases was Qi deficiency, Yang deficiency and Yin deficiency. Then we analyzed the database of the symptoms and medicines using the methods of frequency analysis, factor analysis, clustering analysis, canonical correlation analysis and association rules analysis and got63common symptoms,6symptom factors,16symptom clusters,11groups with two symptoms,60common medicines,7medicine factors,13medicine clusters,37groups with two medicines,45groups with three medicines,36groups with four medicines and seven pairs of canonical correlation variables.Conclusions:①Gasp Syndrome is possibly common in middle-aged and aged people and male patients are more than female patients.②The main etiologies of the Gasp Syndrome are pathological products, exogenous factors, dietary factor, over-work and over-rest factors and emotional factors. And the therapeutic error factor can not be ignored.③The Gasp Syndrome is the syndrome of deficiency in origin and excess in superficiality, and its main pathogenesis is deficiency syndrome accompanied with excess syndrome.④Five organs and six fu can lead to the Gasp Syndrome, and the closest organs are lung, spleen, and kidney. Two related organs leading to the Gasp Syndrome are very common.⑤There are17types of the Gasp Syndrome, including superficies cold and interior heat, intense lung heat, turbid phlegm obstructing lung and so on.⑥We can use17medicine types including qi-invigorating drugs, expectorant cough suppressant and anti-asthmatic drugs and so on,37common medicine pairs including ginseng+liquorice, atractylodes ovata+ginseng, astragalus membranaceus+ginseng and so on,15groups of three medicines including ginseng+liquorice+atractylodes ovata, tangerine peel+ginseng+liquorice and so on,9groups of four medicines including tangerine peel+ginseng+liquorice+atractylodes ovata, poria cocos+ginseng+atractylodes ovata+liquorice and so on, and15prescriptions including kidney-qi-tonifying pill, buzhong yiqi decoction and so on to treat the Gasp Syndrome. ⑦There is a great significance to research the ancient books of TCM using the modern computer technology and statistical analysis.更多还原