本文關(guān)鍵詞：基于古今醫(yī)案數(shù)據(jù)分析的偏頭痛病證治規(guī)律研究　出處：《廣州中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

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【摘要】：目的:通過(guò)收集和整理古今偏頭痛病醫(yī)案文獻(xiàn)資料,探析偏頭痛病的源流,并運(yùn)用數(shù)理統(tǒng)計(jì)方法及數(shù)據(jù)挖掘技術(shù)分析醫(yī)案數(shù)據(jù)中隱含的規(guī)律,探求偏頭痛病的證治規(guī)律及其演變。從而為中醫(yī)的醫(yī)案研究提供思路與方法學(xué)上的借鑒,為偏頭痛病的臨床辨治和實(shí)驗(yàn)研究提供新的思路和線索。方法:1.全面收集和整理歷代偏頭痛病的醫(yī)案、醫(yī)話等文獻(xiàn)資料,掌握其歷史分布情況,對(duì)偏頭痛病的病名、病因病機(jī)、治則治法進(jìn)行全面整理和分析,實(shí)現(xiàn)對(duì)偏頭痛病的發(fā)展規(guī)律的全面、系統(tǒng)的認(rèn)識(shí)。2.對(duì)梳理后的醫(yī)案進(jìn)行數(shù)據(jù)匯總,建立數(shù)據(jù)庫(kù),進(jìn)行標(biāo)準(zhǔn)化處理后構(gòu)建出明清時(shí)期數(shù)據(jù)庫(kù)、近現(xiàn)代時(shí)期數(shù)據(jù)庫(kù)和綜合數(shù)據(jù)庫(kù)庫(kù),然后采用spss statistics 20進(jìn)行統(tǒng)計(jì)分析,對(duì)數(shù)據(jù)進(jìn)行頻數(shù)和因子的分析,并采用spss modeler 18進(jìn)行關(guān)聯(lián)規(guī)則的分析。3.從各分析結(jié)果中挖掘出癥狀與癥狀、藥物和藥物、疼痛部位和藥物間存在的規(guī)律,歸納不同時(shí)期偏頭痛病證治演變規(guī)律,從而實(shí)現(xiàn)對(duì)偏頭痛病的病位、病因病機(jī)、癥候類型、治則治法的系統(tǒng)整理和總結(jié)。結(jié)果:1.通過(guò)對(duì)偏頭痛病誘因的頻數(shù)統(tǒng)計(jì)發(fā)現(xiàn),高頻誘因包括情緒因素、勞累因素、月經(jīng)因素。2.通過(guò)對(duì)不同歷史時(shí)期和綜合數(shù)據(jù)庫(kù)的頻數(shù)分析得出,偏頭痛病臨床上常見(jiàn)的癥狀有不寐、嘔吐、惡心、便秘、煩躁、口苦、目痛、口干、疲倦、頭暈、耳鳴、心悸等。通過(guò)各時(shí)期癥狀頻數(shù)分析、高頻藥物的因子分析、關(guān)聯(lián)規(guī)則分析等得出偏頭痛病病機(jī)類型包括:肝陽(yáng)上亢、肝動(dòng)化風(fēng)、風(fēng)邪外襲、肝火上炎、膽郁痰擾、痰濁內(nèi)蘊(yùn)、肝熱夾痰、血虛、氣虛、氣血兩虛、陰虛、陽(yáng)虛、腎精不足、瘀血阻絡(luò)、肝郁氣滯。3.通過(guò)對(duì)明清時(shí)期、近現(xiàn)代時(shí)期和綜合數(shù)據(jù)庫(kù)醫(yī)案的高頻藥物進(jìn)行歸類分析,得出治療偏頭痛病的常用藥物的類型有解表藥、平肝息風(fēng)藥、清熱藥、補(bǔ)虛藥、化痰藥、祛風(fēng)藥、活血藥、溫里藥、理氣藥、和解藥。4.通過(guò)對(duì)不同歷史時(shí)期和綜合數(shù)據(jù)庫(kù)高頻藥物歸類分析,得出臨床上偏頭痛病的治則包括平肝潛陽(yáng)法、平肝息風(fēng)法、疏風(fēng)解表法、清肝瀉火法、清熱化痰法、補(bǔ)血養(yǎng)血法、補(bǔ)益氣血法、活血化瘀法、和解少陽(yáng)法。5.通過(guò)對(duì)數(shù)據(jù)庫(kù)中所使用的高頻藥物進(jìn)行關(guān)聯(lián)規(guī)則發(fā)現(xiàn)藥對(duì)16對(duì),包括細(xì)辛+川芎、川芎+羌活、川芎+白芷、川芎+當(dāng)歸、川芎+赤芍、鉤藤+僵蠶、黃連+黃芩、柴胡+黃芩、柴胡+黃連、竹茹+半夏、桂枝+白芍、熟地+白芍、香附+柴胡、川芎+香附、香附+白芍、枳殼+柴胡。6.通過(guò)對(duì)數(shù)據(jù)庫(kù)中所使用的高頻藥物進(jìn)行關(guān)聯(lián)規(guī)則分析,得出治療偏頭痛病的代表方劑有:天麻鉤藤飲、羚角鉤藤湯、川芎茶調(diào)散、芎芷石膏湯、半夏白術(shù)天麻湯、二陳湯、四物湯、四君子湯、異功散、小柴胡湯、四逆散、柴胡疏肝散。7.通過(guò)對(duì)不同時(shí)期偏頭痛病的疼痛部位頻次進(jìn)行分析得出:(1)各個(gè)時(shí)期的或左或右型偏頭痛病出現(xiàn)頻次最高,而偏左型偏頭痛病和偏右型偏頭痛病出現(xiàn)頻次無(wú)明顯差別;(2)明清時(shí)期或左或右型偏頭痛病出現(xiàn)頻次的比例高于近現(xiàn)代時(shí)期,而偏左型偏頭痛病和偏右型偏頭痛病出現(xiàn)頻次比例低于近現(xiàn)代時(shí)期。8.通過(guò)對(duì)不同歷史時(shí)期和綜合數(shù)據(jù)庫(kù)藥物和疼痛部位的關(guān)聯(lián)規(guī)則分析得出(1)明清時(shí)期右偏頭痛病中多屬肝風(fēng)內(nèi)動(dòng)、肝陽(yáng)上亢的證型;近現(xiàn)代時(shí)期右偏頭痛病多屬于肝風(fēng)內(nèi)動(dòng)、瘀血阻絡(luò)、膽郁痰擾的證型。(2)近現(xiàn)代時(shí)期左偏頭痛病多屬于陰虛、外感風(fēng)邪的證型。(3)近現(xiàn)代時(shí)期或左或右偏頭痛病多屬于肝陽(yáng)上亢、陰虛、血虛、膽郁痰擾、肝風(fēng)內(nèi)動(dòng)的證型。結(jié)論:(1)梳理了偏頭痛病的源流,掌握了偏頭痛病的的證治規(guī)律在明清、近現(xiàn)代兩個(gè)歷史時(shí)期的演變,為文獻(xiàn)研究奠定了基礎(chǔ)。(2)通過(guò)統(tǒng)計(jì)結(jié)果分析,整理出明清時(shí)期和近現(xiàn)代時(shí)期醫(yī)家在偏頭痛病的治法上的各自特點(diǎn):①明清時(shí)期醫(yī)家側(cè)重以解表法、清熱法的治療偏頭痛�、诮F(xiàn)代時(shí)期由于偏頭痛病的虛證多于實(shí)證,醫(yī)家用藥以補(bǔ)虛藥、平肝息風(fēng)藥為多。(3)關(guān)聯(lián)規(guī)則分析總庫(kù)醫(yī)案中使用的高頻藥物,篩選出了 16對(duì)常用藥對(duì)。其中有一部分藥對(duì)屬于首次挖掘,進(jìn)一步反映出治療偏頭痛病過(guò)程中藥對(duì)應(yīng)用的特點(diǎn),這提示研究者應(yīng)重視經(jīng)驗(yàn)方中藥對(duì)的歸納總結(jié)和相關(guān)的實(shí)驗(yàn)研究。(4)多角度,深層次挖掘偏頭痛病的證治規(guī)律,歸納發(fā)現(xiàn)了偏頭痛病的15個(gè)證候類型,9個(gè)治則治法,12個(gè)常用方劑。(5)通過(guò)數(shù)據(jù)分析,挖掘出偏頭痛病發(fā)生部位與不同病因病機(jī)間存在一定聯(lián)系,其用藥也有差別,為醫(yī)家臨床治療偏頭痛病提供了新方向(6)突出展現(xiàn)了偏頭痛病的治療中應(yīng)用升降法的重要意義,在一定程度上實(shí)現(xiàn)了對(duì)目前教材偏頭痛病治療理論補(bǔ)充,豐富了偏頭痛病的治療思路。
[Abstract]:Objective: through the collection and collation of ancient and modern literature of migraine disease cases, analysis of the origin of migraine disease, and using the mathematical statistics method and data mining technology to analyze the hidden rules in medical data, explore the migraine disease treatment regulation and evolution. So as to provide reference ideas and methodology for the case study of Chinese medicine, to provide a new the clue for clinical treatment and experimental study of migraine disease. Methods: 1. comprehensive collection and collation of migraine disease medical records, medical words of literature, grasp the historical distribution of migraine disease, etiology and pathogenesis, therapeutic principle and method to conduct a comprehensive collation and analysis, the development regularity of migraine disease of a comprehensive, systematic understanding of.2. data collection, after carding the medical records database, after the standardized treatment was constructed during the Ming and Qing Dynasties database, database of modern times And comprehensive database, and then use SPSS statistics 20 for statistical analysis, analysis of frequency and factor of the data, and dig out the symptoms and symptoms from the analysis results by the analysis of.3. SPSS modeler 18 association rules, drugs and drugs, pain and drugs between the law, summarized the different period of migraine disease treatment of evolution, thus realizing the migraine disease, etiology and pathogenesis, syndrome type, therapeutic principle of the system is summarized. Results: 1. through the frequency statistics of migraine disease causes that high-frequency incentives include emotional factors, factors of fatigue, menstrual factors of.2. by frequency in different historical periods and comprehensive database the analysis shows that migraine disease common clinical symptoms of insomnia, nausea, vomiting, constipation, irritability, mouth pain, dry mouth, eye pain, fatigue, dizziness, tinnitus, palpitation and other symptoms in each period by. The frequency analysis, factor analysis of high frequency drugs, association rules analysis that migraine disease types include: hyperactivity of liver Yang, liver dynamic wind, pathogenic factors are wind, liver inflammation, bile stagnation and phlegm disturbance, phlegm heat, liver blood deficiency, phlegm, Qi deficiency, Qi Yin deficiency, two. Yang deficiency, kidney essence deficiency, blood stasis, liver qi stagnation.3. through to the Ming and Qing Dynasties, classified analysis of modern high-frequency drugs and integrated database of medical record, the types of commonly used drugs for the treatment of migraine disease has diaphoretic, Pinggan Xifeng drugs, antipyretic, tonic, apophlegmatisant, Qufeng medicine, blood medicine, warm in medicine, Qi medicine and cure.4. through different historical periods and comprehensive database of high frequency of drug classification analysis, concluded that treatment of migraine disease clinically includes calming the liver Yang, calming liver wind, dispelling wind and diaphoresis, liver Xiehuo, phlegm method. Nourishing blood, tonifying qi and blood method , Huoxuehuayu, Shaoyang reconciliationlaw.5. by high frequency of drug used in the database of the association rules of 16 drugs, including Asarum + Rhizoma Chuanxiong Rhizoma Chuanxiong Angelica + +, + +, Chuanxiong angelica, Chuanxiong radix paeoniae rubra, Uncaria + silkworm, Coptis + skullcap, bupleurum + skullcap, bupleurum + Coptis. Zhuru + + Banxia Guizhi, Radix Paeoniae Alba, Radix Rehmanniae and Radix Paeoniae Alba, Rhizoma Cyperi Rhizoma Chuanxiong + + bupleurum, Cyperus rotundus, Fructus aurantii + Radix Paeoniae Alba, Radix Bupleuri.6. + through association rules analysis of the high frequency of drug used in the database, the representative prescription for treating migraine disease are: Tianmagoutengyin, Lingjiao Gouteng decoction, Chuanxiong chatiao San, Xiongzhi Shigao decoction, banxiabaizhutianma decoction, Siwu Decoction, two Chen Tang, Four Gentlemen Decoction, Yi Gong powder, Xiaochaihu Decoction, four inverse scattered, CHSGS.7. through the pain of migraine frequency disease in different period were analyzed by: (1) each period or the left or right of migraine disease Most frequently, and the left and right disease migraine migraine disease frequency has no obvious difference; (2) during the Ming and Qing dynasties or the left or right migraine disease frequency is higher than the proportion of the modern period, and left and right disease migraine migraine disease frequency than cases were lower than those in modern times.8. through the association rules in different historical periods and comprehensive database of drugs and pain analysis (1) endogenous mostly during the Ming and Qing Dynasties right migraine disease, liver yang hyperactivity syndrome; modern right migraine disease belongs to endogenous, blood stasis syndrome, bile stagnation sputum interference. (2) the modern period left migraine disease belongs to Yin deficiency, syndrome of exogenous pathogenic wind. (3) the modern period or the left or right of migraine disease belongs to hyperactivity of liver Yang, yin deficiency, blood deficiency, phlegm stagnation syndrome type biliary disturbance, the liver wind. Conclusion: (1) reviews the origin of migraine disease, The migraine disease treatment of the law in the Ming and Qing Dynasties, the evolution of modern two historical periods, which laid the foundation for the research of literature. (2) through statistical analysis, sorting out the respective characteristics of physicians in migraine disease treatment on the Ming and Qing Dynasties and modern times: Mingqing period to physicians focus on solution table method. The heat treatment of migraine disease in modern times because of the deficiency of migraine disease more than empirical, physicians of the drug to fill empty medicine, Pinggan Xifeng drugs for more. (3) the association rules analysis of the high frequency of drug use in the medical records database, we selected 16 of the commonly used medicines. Some medicine for mining to belong, to further reflect the characteristics of traditional Chinese medicine in the treatment of migraine disease process of application, this suggests that researchers should pay more attention to study summarizes the experience of traditional Chinese medicine on the party and relevant. (4) multi angle, deep mining law migraine disease treatment, Concludes that 15 syndrome types of migraine disease, 9 therapeutic methods, 12 prescriptions (5). Through data analysis, to find out some contact parts with different etiology and pathogenesis between migraine disease, the drug also have the difference, for the physicians for treatment of migraine disease provides a new direction (6) highlighted to show the significance of the application of lifting method in the treatment of migraine disease, to a certain extent in the current textbooks on migraine disease treatment theory supplement, enrich the treatment of migraine attack.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R249;R277.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周慎;;歐陽(yáng)，

本文編號(hào)：1369405