本文選題：病案回顧性分析　切入點(diǎn)：數(shù)據(jù)挖掘　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：首批國(guó)醫(yī)大師周仲瑛教授主張臨證應(yīng)"活化辨證",強(qiáng)調(diào)辨證應(yīng)首重病機(jī),提出"病機(jī)十三條",構(gòu)建了"中醫(yī)病機(jī)辨證新體系",基本思路是"以病理因素為綱,臟腑理論為基礎(chǔ)",表明辨識(shí)臟腑病機(jī)是臨床辨證的重要內(nèi)容,充分體現(xiàn)周仲瑛教授從中醫(yī)整體觀出發(fā),認(rèn)為五臟六腑實(shí)為一個(gè)整體,其內(nèi)涵包括五臟相關(guān)、臟腑表里、臟腑同治等多個(gè)方面。本研究以周仲瑛教授辨治四種常見(jiàn)消化系統(tǒng)疾病為例,總結(jié)其重視臟腑病機(jī)進(jìn)行辨證論治的臨床經(jīng)驗(yàn)。研究目的:以周仲瑛教授臨床病案為研究對(duì)象,通過(guò)數(shù)據(jù)挖掘分析與研讀典型病案的方法,探討周教授基于整體觀,運(yùn)用臟腑病機(jī)相關(guān)理論,倡導(dǎo)"臟腑同治"法治療消化系統(tǒng)四種常見(jiàn)疾病(肝硬化、膽石病、慢性胃炎、慢性結(jié)腸炎)的臨床經(jīng)驗(yàn)。研究方法:在周仲瑛教授工作室病案數(shù)據(jù)庫(kù)資料的基礎(chǔ)上,篩選、清洗常見(jiàn)的消化系統(tǒng)疾病病案,嚴(yán)格按照診斷與排除標(biāo)準(zhǔn),將符合要求的600例病案納入研究范圍并建立新的數(shù)據(jù)庫(kù),包括有肝硬化、膽石病、慢性胃炎、慢性結(jié)腸炎四個(gè)西醫(yī)疾病。借助數(shù)據(jù)統(tǒng)計(jì)分析軟件著重對(duì)病案的病機(jī)、臟腑病位、處方用藥、藥物歸經(jīng)、處方配伍等進(jìn)行分析,采用頻數(shù)統(tǒng)計(jì)、復(fù)雜網(wǎng)絡(luò)核心成分分析、關(guān)聯(lián)規(guī)則等方法,以及人機(jī)結(jié)合、病案研讀,客觀總結(jié)周仲瑛教授在治療常見(jiàn)消化系統(tǒng)疾病方面的臨床經(jīng)驗(yàn)。研究結(jié)果:(1)一般情況:四種疾病各150例病人,其性別人數(shù)及平均年齡分別為:肝硬化患者男性104例,女性46例,平均年齡(46.90±12.83)歲;膽石病患者男性58例,女性92例,平均年齡(49.92±13.75)歲;慢性胃炎患者男性60例,女性90例,平均年齡(47.14±14.13)歲;慢性結(jié)腸炎患者男性80例,女性70例,平均年齡(40.27±13.51)歲。(2)病機(jī)分布:600例病案中涉及病機(jī)描述261種,較為常見(jiàn)的臟腑關(guān)系病機(jī)有:肝胃不和(103次)、肝脾兩傷(79次),肝膽疏泄失司(72次),肝膽濕熱(56次),腑氣失調(diào)(49次),肝郁脾虛(31次),肝脾不調(diào)(30次)等。(3)藥物歸經(jīng)分布:600例病案共出現(xiàn)藥物331種,其中肝硬化的治療用藥歸經(jīng)主要以肝、脾經(jīng)為主(84.4%),膽石病的治療用藥歸經(jīng)主要以肝、膽經(jīng)為主(78.3%),慢性胃炎的治療用藥歸經(jīng)主要以脾、胃經(jīng)為主(89.7%),慢性結(jié)腸炎的治療用藥歸經(jīng)主要以肝、脾、胃、腸經(jīng)為主(88.1%)。(4)常用核心方劑:治療肝硬化時(shí),常選用茵陳蒿湯、鱉甲煎丸、犀角地黃湯、茵陳四苓湯、一貫煎、六味地黃丸、己椒藶黃丸等;治療膽石病時(shí),常選用四金散、大柴胡湯、柴胡疏肝散、逍遙散、半夏厚樸湯、左金丸等;治療慢性胃炎時(shí),常選用四君子湯、(香砂)六君子湯、左金丸、二陳湯、沙參麥冬湯、橘皮竹茹湯、(黃連)溫膽湯等;治療慢性結(jié)腸炎時(shí),常選用烏梅丸、赤石脂禹余糧丸、參苓白術(shù)散、二妙丸、交泰丸、木香檳榔丸、痛瀉要方等。(5)關(guān)聯(lián)規(guī)則結(jié)果:通過(guò)關(guān)聯(lián)規(guī)則分析常見(jiàn)臟腑病機(jī)與藥物之間的關(guān)系,如與肝腎虧虛病機(jī)有關(guān)的藥物有女貞子、旱蓮草、枸杞子等。研究結(jié)論:(1)周教授從整體觀、復(fù)合病機(jī)出發(fā),認(rèn)為五臟六腑為一整體,重視臟腑病機(jī)相關(guān),結(jié)合病理因素,以"臟腑同治"法辨治常見(jiàn)消化系統(tǒng)疾病。(2)治療肝硬化時(shí),抓住肝脾病機(jī)為核心,重視通腑,配合利膽、和胃、理腸等治療思路。治療膽結(jié)石時(shí),主要以疏肝利膽排石為主,常選方劑四金散和大柴胡湯,佐以調(diào)理脾胃與腸的功能。治療慢性胃炎時(shí),從氣機(jī)角度出發(fā),調(diào)理脾胃氣機(jī),重視肝膽氣機(jī)。治療慢性結(jié)腸炎時(shí),肝脾腸同治,兼顧其他臟腑。(3)在病機(jī)的描述中,周教授常采用臟腑病位與病理因素相結(jié)合的形式,如肝膽濕熱等,選方用藥在兼顧臟腑歸經(jīng)的前提下,針對(duì)病理因素,復(fù)法組方。(4)重視顧護(hù)脾胃功能,在消化系統(tǒng)不同疾病中均有用藥體現(xiàn)。
[Abstract]:The first batch of Chinese medicine master professor Zhou Zhongying advocated the clinical "activation" syndrome differentiation, syndrome differentiation should first emphasize ill machine, put forward the "pathogenesis thirteen", to build a new system of TCM syndrome differentiation, the basic idea is "to the pathological factors as the key link, based on the theory of viscera", shows that the identification of viscera pathogenesis is important the content of clinical syndrome, fully embodies the holistic concept of traditional Chinese medicine Professor Zhou Zhongying from the view that the viscera is a whole, its connotation includes the correlation of five viscera table, and multiple organs Tongzhi etc. in this study by Professor Zhou Zhongying treating four common diseases of the digestive system as an example, to summarize the clinical experience of the viscera pathogenesis syndrome the treatment. Objective: To study clinical professor Zhou Zhongying as the research object, method of analysis and study of typical cases through data mining, based on the overall view of Professor Zhou, the viscera pathogenesis theory, advocate "viscera Tongzhi "method in the treatment of digestive system of four kinds of common diseases (liver cirrhosis, cholelithiasis, chronic gastritis, chronic colitis). Methods: the clinical experience of screening based on Professor Zhou Zhongying studio record database data, cleaning, the common disease of digestive system of medical records, in strict accordance with the diagnosis and exclusion criteria, will meet the requirements of the medical records of 600 cases into the scope of the study and the establishment of a new database, including cirrhosis, cholelithiasis, chronic gastritis, chronic colitis four western medicine disease. By means of statistical analysis software on the pathogenesis of medical records, viscera disease, prescription drugs, prescription drugs go through, such as analysis, using frequency statistics, analysis of complex network core composition, association rules method, and case study, the objective of man-machine combination, summarize the clinical experience of Professor Zhou Zhongying in the treatment of common diseases of the digestive system. The results of the study: (1) general 鍐，

本文編號(hào)：1623965