【摘要】：目的:瀉心湯類方為中醫(yī)經(jīng)典方劑,其中半夏瀉心湯最為代表,臨床應(yīng)用十分廣泛。為了系統(tǒng)研究半夏瀉心湯,采取反向挖掘方法,通過(guò)查閱臨床醫(yī)家報(bào)道醫(yī)案文獻(xiàn),獲得該方的臨床運(yùn)用信息,利用規(guī)范化的數(shù)據(jù)挖掘系統(tǒng)對(duì)其進(jìn)行建庫(kù)、挖掘和分析。通過(guò)對(duì)半夏瀉心湯應(yīng)用病種、臨床表現(xiàn)、病機(jī)、方藥配伍等項(xiàng)集進(jìn)行挖掘,為臨床更準(zhǔn)確應(yīng)用半夏瀉心湯提供客觀依據(jù)和方法學(xué)參考。方法:通過(guò)對(duì)中國(guó)知網(wǎng)2016年9月之前中醫(yī)期刊文獻(xiàn)庫(kù)進(jìn)行搜索,獲取半夏瀉心湯運(yùn)用的醫(yī)案信息,并對(duì)其進(jìn)行篩選、清洗、整理。采用MedcaseV3.2數(shù)據(jù)記錄挖掘系統(tǒng)對(duì)符合納入標(biāo)準(zhǔn)的醫(yī)案進(jìn)行數(shù)據(jù)庫(kù)構(gòu)建、數(shù)據(jù)挖掘分析,重點(diǎn)挖掘醫(yī)案中的病種、癥狀、病機(jī)、方藥等內(nèi)容,并分析探討半夏瀉心湯臨床應(yīng)用規(guī)律。結(jié)果:260診次醫(yī)案中,男性患者共143診次,女性患者117診次,年齡分布較廣,以中年為主。臨床表現(xiàn)方面,主癥共計(jì)30余項(xiàng),以納差、胃脹、口干等為主,非脾胃系統(tǒng)癥狀表現(xiàn)主要涉及寐差、心煩、口腔潰瘍等。舌苔方面,以舌質(zhì)紅,苔黃膩?zhàn)顬槌Ｒ?jiàn)。癥狀與舌苔外關(guān)聯(lián)中,胃脹、胃痛與苔黃膩支持度較高,胃痛、口腔潰瘍與舌質(zhì)紅支持度最高。病機(jī)主要涉及寒熱錯(cuò)雜、濕熱中阻、脾胃虛弱,其中痞結(jié)不開(kāi)與濕熱中阻關(guān)聯(lián)度最高。脈象以弦脈頻率最高,其次為細(xì)脈。藥物涉及廣泛,高頻藥物主要有:半夏、黃連、黃芩、甘草、干姜、黨參、大棗、茯苓、白術(shù)等,原方中人參使用頻次較低,核心藥對(duì)半夏-黃連。主要藥物與癥狀外關(guān)聯(lián)中,法半夏與口干、便溏關(guān)聯(lián)度高,而姜半夏與胃脹、納差關(guān)聯(lián)度高。黃連與呃逆、腹痛、惡心關(guān)聯(lián)度高,而與黃芩關(guān)聯(lián)性高的主癥有面部紅斑、咽部異物感、粉刺。所有醫(yī)案診次中,西醫(yī)病種涉及84個(gè),其中以慢性胃炎、口腔潰瘍、失眠、胃潰瘍等為主。中醫(yī)病種涉及53個(gè),以胃痞、胃痛、口瘡、不寐、腹痛為主。結(jié)論:本次研究得出臨床應(yīng)用半夏瀉心湯涉及病種十分廣泛,以慢性胃炎、口腔潰瘍、失眠、胃潰瘍等疾病居多,凸顯中醫(yī)異病同治特色。此方以改善納差、胃脹、口干、口腔潰瘍、寐差等癥狀為主�；颊叨嘁�(jiàn)舌紅、苔膩或黃,脈象以弦脈較常見(jiàn)。半夏瀉心湯除主治寒熱錯(cuò)雜證,還常用于治療濕熱中阻證。原方中半夏-黃連為核心藥對(duì),現(xiàn)多用黨參替人參,臨證精于炮制,常配合行氣藥、化濕藥同用。識(shí)病(異病同治)-辨證-立法-處方,環(huán)環(huán)相扣,緊密相連。方從法出,法隨證立,證從癥出,四診和參,中醫(yī)臨床診治思維言簡(jiǎn)意賅、博大精深。
[Abstract]:Objective: Xiexin decoction is a classical prescription of traditional Chinese medicine, among which Banxia Xiexin decoction is the most representative, and its clinical application is very wide. In order to systematically study Banxia Xiexin decoction, the reverse mining method was adopted to obtain the clinical application information of Banxia Xiexin decoction by consulting the medical documents reported by clinicians, and the standardized data mining system was used to build the database, mine and analyze it. In order to provide objective basis and methodological reference for more accurate clinical application of Banxia Xiexin decoction, a collection of disease types, clinical manifestations, pathogenesis and compatibility of prescription and medicine were excavated in order to provide more accurate clinical application of Banxia Xiexin decoction. Methods: the medical records of Banxia Xiexin decoction were obtained by searching the literature database of Chinese medical journals before September 2016, and were screened, cleaned and sorted out by using Banxia Xiexin decoction. The MedcaseV3.2 data record mining system is used to construct the database of the medical records which meet the inclusion criteria, to analyze the data mining, and to mine the diseases, symptoms, pathogenesis, prescription and medicine in the medical records, especially the contents of the diseases, symptoms, pathogenesis, prescription and medicine in the medical records. The clinical application of Banxia Xiexin decoction was analyzed and discussed. Results: among 260 medical cases, 143 were male and 117 were female. The age distribution was wide, mainly middle-aged. In clinical manifestation, the main symptoms were more than 30 items, such as anorexia, gastric distension, dry mouth and so on. The symptoms of non-spleen and stomach system were mainly related to poor sleep, upset, oral ulcer and so on. In terms of tongue coating, red tongue and yellow coating are the most common. Symptoms and tongue coating external correlation, stomach distension, stomach pain and moss yellow greasy support is higher, stomach pain, oral ulcer and tongue red support degree is the highest. The pathogenesis is mainly related to the disorder of cold and heat, dampness and heat, spleen and stomach weakness, among which ruffian knots do not open and dampness-heat middle resistance has the highest correlation degree. The chordal pulse frequency is the highest, followed by the veinlets. Drugs involved in a wide range of high-frequency drugs are: Pinellia, Rhizoma Coptidis, Scutellaria baicalensis, licorice, dried ginger, Codonopsis, jujube, Poria cocos, Atractylodes, etc., the use of ginseng in the original prescription is low, the core drug to Pinellia-Coptis. Among the main drugs and symptoms, there was a high correlation between French pinellia and dry mouth, loose stool, while ginger pinellia was highly correlated with stomach distension and tolerance. Coptis has a high correlation with hiccup, abdominal pain, nausea, and Scutellaria baicalensis with a high correlation between the main symptoms are facial erythema, pharynx foreign body feeling, acne. Among all medical records, 84 types of diseases were involved, including chronic gastritis, oral ulcers, insomnia, gastric ulcers and so on. Traditional Chinese medicine diseases involving 53, to stomach ruffiti, stomach pain, sore, insomnia, abdominal pain. Conclusion: the clinical use of Banxia Xiexin decoction involves a wide range of diseases, mainly chronic gastritis, oral ulcer, insomnia, gastric ulcer and other diseases, highlighting the characteristics of different diseases and common treatment of traditional Chinese medicine. This prescription to improve anaesthesia, stomach distension, dry mouth, oral ulcer, such as poor symptoms. Patients with red tongue, greasy or yellow, pulse is more common chord pulse. Banxia Xiexin decoction in addition to the main treatment of cold-heat dislocation syndrome, but also used in the treatment of damp-heat obstruction syndrome. The original prescription of Pinellia pinelliae-Coptis as the core drug pair, now more used for ginseng, clinical syndrome is fine in processing, often combined with qi medicine, dampening drugs used together. Knowledge (different diseases are treated with each other)-syndrome differentiation-legislation-prescription, linked closely to each other. Prescription from law, law with syndrome, syndrome from syndrome, four diagnostic and reference, clinical diagnosis and treatment of traditional Chinese medicine thinking concise, broad and profound.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R289.5

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