本文選題：銀屑病 + 中醫(yī)傳承輔助平臺��； 參考：《廣州中醫(yī)藥大學》2017年博士論文

【摘要】：背景:銀屑病又名"牛皮癬",是一種無明顯原因的有特征性紅斑、丘疹、鱗屑的皮膚病,呈慢性發(fā)展,本病除了皮損癥狀外,患者同時伴發(fā)心血管疾病、代謝綜合征、淋巴癌、黑色素瘤和皮膚癌等風險。銀屑病的西醫(yī)病因病機尚不明確,目前考慮受遺傳、感染、外傷、飲食、精神狀態(tài)、內分泌因素、免疫、某些藥物等影響下誘發(fā)或加重本病,至今國際上仍未有明確治愈及根治的方法,根據現代診療指南治療銀屑病的藥物大部分都對肝、腎等內臟造成損害,副作用亦較明顯,患者難以堅持使用。由于銀屑病皮損影響外觀,病情反復,甚或伴有瘙癢或關節(jié)疼痛等癥狀,影響患者日常生活和社交,造成心理負擔和困擾,以及患者自我形象低下,或因此繼發(fā)心理精神障礙如抑郁及自殺行為。銀屑病為難治性疾病,其有效根治手段現成為國際上的研究重點。中醫(yī)治療銀屑病的療效顯著,副作用少,價錢相宜,國內的數據庫蘊藏著大量有效治療銀屑病的寶貴經驗,但因未有系統(tǒng)和科學化整理,令到相關知識未能應用于臨床和指導科研。所以研究名老中醫(yī)的用藥規(guī)律,探討核心藥物組合以及潛在新方組合,對銀屑病的臨床和科研具有重要意義,故此,以科學方法分析相關文獻是必需的。目的:通過對當代名老中醫(yī)治療銀屑病相關文獻進行整理,挖掘分析文獻中的相關信息,探索當代名老中醫(yī)在銀屑病證候治法方面潛在有價值的臨床規(guī)律,以期達到為臨床診療工作及科研設計提供參考。此外,按地域分類,透過對嶺南地區(qū)的當代名老中醫(yī)診療銀屑病的文獻作分類整理,與總體數據作比較分析,了解嶺南地區(qū)銀屑病的病機和治法與總體數據的異同。方法:1.收集1996—2016年當代名老中醫(yī)診治銀屑病的文獻,對銀屑病的皮損情況、四診信息、證候、理法方藥等信息進行數據統(tǒng)計與分析,系統(tǒng)總結當代名老中醫(yī)對銀屑病的理法方藥規(guī)律。2.利用中醫(yī)傳承輔助平臺建立數據庫,運用頻數分析、關聯(lián)規(guī)則及聚類分析挖掘銀屑病文獻數據庫中核心用藥組合、組方規(guī)律及新方,結合傳統(tǒng)中醫(yī)藥理論和現代藥理分析,從而歸納出各醫(yī)家對銀屑病的診治規(guī)律。成果:1.頻數分析得到高頻藥物23味,證候14種,治則治法55種。經單味藥物頻率統(tǒng)計,首三味藥物為生地黃、赤芍和甘草,藥物的四氣屬性以寒、溫為主,而五味以苦、甘為主,藥物歸經依次為肝經、心經、胃經。藥物分類主要屬清熱藥(清熱涼血藥、清熱解毒藥、清熱燥濕藥、清熱瀉火藥)、活血化瘀藥(活血調經藥、破血消ve藥、活血止痛藥)、補益藥(補氣藥、補血藥)、解表藥(發(fā)散風寒藥)、祛風濕藥(祛風濕散寒藥)。高頻證候(頻率"g10%)由最高依次為血熱證、血瘀證、火毒證、濕熱證、血虛風燥證。高頻治法(頻率"g5%)由最高依次為清熱解毒、清熱涼血、活血化瘀、涼血化瘀、養(yǎng)血潤燥。2.對銀屑病文獻中的藥物進行關聯(lián)分析,得到核心藥對17個,涉及中藥共9種;基于復雜熵聚類的藥物核心組合共26個(浮萍-馬齒莧-辛夷;白芍-當歸-水牛角;連翹-金銀花-野菊花;麥冬-地膚子-北沙參;杏仁-生石膏-生姜;板藍根-白花蛇舌草-車前草;黃芩-莪術-桃仁;生地黃-甘草-紅花;黃柏-黃連-焦梔子;苦參-焦梔子-夏枯草;皂角刺-白芷-當歸尾;雞血藤-丹參-三棱;浮萍-全蝎-刺蒺藜-茯苓皮;白芍-水牛角-赤芍-牡丹皮;金銀花-白茅根-首烏藤;麥冬-天冬-北沙參;杏仁-生石膏-枇杷葉;板藍根-白花蛇舌草-蒲公英;莪術-烏梅-腫節(jié)風;生地黃-白花蛇舌草-甘草-牡丹皮;黃芩-黃柏-黃連-梔子;苦參-龍膽-地榆-夏枯草;皂角刺-白芷-乳香;皂角刺-側柏葉-炮姜;水牛角-雞血藤-丹參-小紅參),基于熵層次聚類的新處方共13個(浮萍-馬齒莧-辛夷-全蝎-刺蒺藜-茯苓皮;白芍-當歸-水牛角-赤芍-牡丹皮;連翹-金銀花-野菊花-白茅根-首烏藤;麥冬-地膚子-北沙參-天冬;杏仁-生石膏-生姜-枇杷葉;板藍根-白花蛇舌草-車前草-蒲公英;黃芩-莪術-桃仁-烏梅-腫節(jié)風;生地黃-甘草-紅花-白花蛇舌草-牡丹皮;黃柏-黃連-焦梔子-黃芩-梔子;苦參-焦梔子-夏枯草-龍膽-地榆;皂角刺-白芷-當歸尾-乳香;皂角刺-側柏葉-透骨草-炮姜;雞血藤-丹參-三棱-水牛角-小紅參)。3.對最高頻(會10%)的5種銀屑病證型用藥進行關聯(lián)分析,歸納出血熱證的核心藥物組合為犀解地黃湯加味,血瘀證的核心藥物組合為桃紅四物湯或補陽還五湯加減,火毒證的核心藥物組合為黃連解毒湯加味,濕熱證的的核心藥物組合為清熱解毒藥、清熱涼血藥及清熱燥濕藥的配伍,血虛風燥證的核心藥物組合為當歸飲子加減。4.對嶺南地區(qū)醫(yī)家的用藥進行關聯(lián)分析,得出核心藥對87個,利用傳統(tǒng)中醫(yī)藥學分析核心藥物,由藥物的主治功效推斷嶺南地區(qū)銀屑病的病因屬濕、熱、毒、瘀。結論:1.按中藥、證候及治則治法頻數分析,就整體而言,可推斷當代名老中醫(yī)主要"從血論治"銀屑病,治法以清熱解毒、清熱涼血和活血化瘀為主要規(guī)則,從關聯(lián)分析得出的用藥組合,可以觀察到治療上常以犀角地黃湯(水牛角、生地黃、赤芍及牡丹皮)作基礎方,配以功能清熱解毒的土茯苓、白花蛇舌草,達致直折火勢,現代藥理表明兩藥具抑制表皮細胞增殖作用;為加強涼血功效,處方中可加入具涼血兼活血的紫草;火熱之邪久則耗傷營血,核心用藥組合中的補虛藥(當歸、甘草)能調養(yǎng)營血的作用,以防病勢轉趨血虛生風化燥,兩藥應用起到防治轉變作用。用藥規(guī)律體現清熱解毒藥和清熱涼血藥治其標(病因屬火熱之邪),補虛藥治其本(病機為熱入營血,久則耗氣傷血),三種類型藥物的配合能達標本同治之功。2.本研究總結了不同證型銀屑病的用藥規(guī)律,發(fā)現相關的藥物組合沿自經典方劑如犀角地黃湯、桃紅四物湯、補陽還五湯、黃連解毒湯及當歸飲子,與目前中醫(yī)教科書或皮膚科專著的理法用藥是相符的。3.挖掘出常見病機外,亦發(fā)現新的銀屑病證候如肝腎虧虛、氣滯證、脾氣虛證、陽虛證等,為日后臨床及科研帶來參考。4.熵聚類所得到的新方及組合中,部分源自經典(黃連解毒湯)或類方(仙方活命飲)的組合,大部分新方涉及藥物以清熱解毒藥、活血調經藥、破血消ve藥等配伍,皆屬常見的用藥組合,其中部分新方的配伍較少見,如以清熱瀉火藥與化痰止咳平喘藥相配(杏仁-石膏-生姜-枇杷葉),提示"痰"、"熱"病因與銀屑病的相關性,現代藥理表明四藥分別具抗腫瘤及調整免疫的作用,為治療銀屑病的新方發(fā)現提供了新的線索。5.中醫(yī)傳承輔助系統(tǒng)軟件分析治療銀屑病的用藥規(guī)律具有一定的科學性,能夠快速提取高頻藥物、常用藥對、核心藥物組合、優(yōu)化新方,為臨床用藥提供客觀有效的數據支持與參考,避免個人經驗的局限性,熵聚類所得到的新方及組合,能夠發(fā)現隱性規(guī)律,對于研究中藥組方規(guī)律和發(fā)現新處方有重要意義。
[Abstract]:Background: psoriasis is also known as "psoriasis". It is a characteristic erythema, papule, and scaly skin disease with chronic development. In addition to skin lesions, this disease is associated with cardiovascular disease, metabolic syndrome, lymphadenocarcinoma, melanoma and skin cancer. The pathogenesis of Western medicine for psoriasis is not yet clear and is currently considered. Under the influence of heredity, infection, trauma, diet, mental state, endocrine, immunity, some drugs and so on, there is no clear cure and radical cure in the world. According to the modern medical guide, most of the drugs for the treatment of psoriasis have caused damage to the liver, kidney and other viscera, and the side effects are more obvious, and the patients are hard to be hard to be determined. Because the skin lesions of psoriasis affect the appearance, relapse, or even accompanied by pruritus or joint pain and other symptoms, affect the patient's daily life and social life, cause psychological burden and trouble, and the patient's self image is low, or the secondary mental disorders such as depression and self killing. It has become an international research focus. The therapeutic effect of TCM on psoriasis is obvious, the side effects are few, the price is appropriate, the domestic database contains a lot of valuable experience in the effective treatment of psoriasis, but because of the lack of systematic and scientific arrangement, the related knowledge is not applied to the bed and the guidance of scientific research. It is important for the clinical and scientific research of psoriasis to explore the core drug combination and potential new combination. Therefore, it is necessary to analyze the relevant literature by scientific methods. In order to provide reference for clinical diagnosis and research work and scientific research design, it is possible to provide reference for clinical diagnosis and research work and scientific research design. In addition, according to regional classification, the paper classifies the literature of the diagnosis and treatment of psoriasis in Contemporary Chinese traditional Chinese medicine in south of the Five Ridges, and compares with the general data to understand the pathogenesis and treatment of psoriasis in south of the Five Ridges. The differences and similarities of the total data. Methods: 1. collect the literature of the diagnosis and treatment of psoriasis from 1996 to 2016, the skin lesions of the psoriasis, the information of four diagnosis, the syndromes, the prescription and medicine, and the analysis of the data, and systematically summarize the data of the rule of prescription and prescription of the contemporary Chinese traditional Chinese medicine to the psoriasis.2. and establish the data by using the auxiliary platform of traditional Chinese medicine. Library, using frequency analysis, association rules and cluster analysis to excavate the core drug combination in the psoriasis database, the law of organizing and the new prescription, combined with the traditional Chinese medicine theory and modern pharmacology analysis, so as to conclude the rule of diagnosis and treatment of psoriasis by the doctors. The results are: 1. frequency analysis to get 23 flavors of high frequency medicine, 14 syndromes and 55 kinds of treatment methods. Through the single drug frequency statistics, the first three drugs are rehmannia, Radix Paeoniae and licorice. The four Qi properties of the drugs are cold and warm, and the five tastes are bitter and Gump. The drugs are classified as liver meridian, heart meridian, and stomach meridian. The main drugs belong to the antipyretic medicine (Qingzhi cool blood medicine, heat clearing and detoxifying drug, clearing heat dampness and clearing medicine, clearing heat purging powder) and activating blood and removing blood stasis medicine (activating blood circulation medicine). Tonic medicine, blood elimination ve medicine, blood activating analgesics), tonic medicine (Qi supplementing medicine, blood supplement medicine), dispelling wind and damp medicine (dispelling wind and wet powder). High frequency syndrome (frequency "g10%") is the highest in order of blood heat syndrome, blood stasis syndrome, fire poison syndrome, damp heat syndrome, blood deficiency wind dryness syndrome. High frequency treatment (frequency "g5%) is the highest in order of clearing heat and detoxification, clearing heat and cool blood The drug of activating blood and removing stasis, cooling blood and removing stasis and nourishing blood and moistening dryness.2. were related to the analysis of the drugs in the literature of psoriasis. 17 core drugs were obtained, including 9 kinds of traditional Chinese medicine; 26 drug core combinations based on complex entropy clustering (duckweed - purslane - Xinyi, Paeonia lactiflora - Angelica - water ox horn, Alice - Honeysuckle - wild chrysanthemum flower, Ophiopogon japonicus - North Sand cucumber; almond - Sheng " Gypsum - ginger; Radix Isatidis - Hedyotis chinensis; Scutellaria - zedoary turmeric - peach kernel; rehmannia - licorice - safflower; cypress - yellow Coptis - Gardenia; Radix Sophorae - Gardenia jasminoides; dahurica dahurica - Angelica; zigzanas - Salvia miltiorrhiza; duckweed - Tribulus terrestris tuckahoe skin; Paeonia lactiflora - water ox horn the peony peony bark; Honeysuckle root - shiswu rattan; wheat rattan; wheat Winter - Winter - North American ginseng; almond - anhydrite - loquat leaf; isatis root - Hedyotis dandelion; zedoary - euleus mume - Pony; Radix Rehmanniae - Hedyotis licorice - Peony skin; Scutellaria baicalei - Huanglian - Gardenia; Radix Sophorae Gentianae - Radix elmizae; dahurica dahurica - frankincense; saponens prickly - Platycladus officinalis leaf; water cow's horns - vines - Salvia miltiorrhshen and red ginseng), 13 new prescriptions based on entropy hierarchical clustering (duckweed - purslane - Xinyi - scorpion - tribulus tuckahoe skin, Paeonia lactiflora - Angelica - water ox horn - Red Peony Peony skin, forsythia forsythi - Wild Chrysanthemum - white grass root - Radix Polygoni multiflorum, Radix Ophiopogonis - rhizome - asparagus - asparagus, almond - gesso - ginger - loquat leaf, isatis root - white flower hedyotis herb - dandelion; yellow Scutellaria - zedoary - zedoary - peach kernel - Euler - sopezia; rehmannia - licorice - safflower - Hedyotis peonies, Cortex Phellodendri - Gardenia jasminoides - Scutellaria - Gardenia; kusen - Gardenia - gentian - Sony; saponus dahuricum - Angelica - frankincense; saponins - Platycladus orientalis - ginger; chicken blood rattan - Salvia miltiorrhiza - water ox horn - small red ginseng).3. (1 0%) the correlation analysis of 5 kinds of psoriasis syndrome types, the core drug combination of the syndrome of hemorrhagic fever is rhinos Dihuang Decoction, the core drug combination of the blood stasis syndrome is the peach red four material soup or the tonifying yang five soup, the core drug combination of the fire syndrome is the Huanglian detoxification soup, the core drug combination of the damp heat syndrome is the antipyretic antidote drug, Qing Dynasty The combination of hot cooling blood medicine and heat clearing and humid medicine, the core drug combination of blood deficiency and wind dryness syndrome is the association analysis of the medicine of doctors in south of the Five Ridges area with the decoction of Angelica sinensis added and subtract.4., and the core drug is 87, using traditional Chinese medicine to analyze the core drugs, and infer that the etiology of psoriasis in south of the Five Ridges area is wet, hot, poisonous and blood stasis. 1. according to the analysis of the frequency of traditional Chinese medicine, syndrome and rule of rule, we can infer that the main rule of the contemporary Chinese medicine is to treat psoriasis mainly from the theory of blood. The main rule is to clear heat and detoxify, to cool the blood and to promote blood circulation and to remove blood stasis as the main rule. And peony skin) as the foundation side, with the function of heat and detoxification of soil Poria cocos and white flower hydtweth to achieve direct folding fire. Modern pharmacology shows that two drugs can inhibit the proliferation of epidermal cells; in order to strengthen the cooling blood effect, the prescription can add cold blood and blood activating of purple grass; The grass) can adjust the function of blood in the camp in order to prevent the disease from turning to blood deficiency and weathering dryness. The application of the two drugs can be used to prevent and cure the transformation. The rule of drug use reflects the antipyretic antidote drugs and the antipyretic and cool blood medicine to cure its standard (the pathogenic factor belongs to the pathogenic heat of fire), the supplement of the deficiency medicine is used to treat the medicine (the disease machine is hot into the camp blood and the gas is injured for a long time), and the coordination of the three types of drugs can reach the standard of the same treatment. .2. this study summarized the use of different syndrome types of psoriasis, and found that the related drug combination along the classic prescription such as rhino hornie Rehmannia soup, peach red Siwu soup, Buyang Huanwu five soup, Huanglian detoxification soup and Angelica sinensis, and the current TCM textbooks or department of Dermatology monograph are consistent with the common pathogenesis of.3. mining, but also found new The syndrome of psoriasis, such as deficiency of liver and kidney, qi stagnation syndrome, spleen qi deficiency syndrome and yang deficiency syndrome, is a combination of the reference.4. entropy clustering for future clinical and scientific research, and part of the combination of the classic (Huanglian detoxification soup) or the class square (Xianfang living drink). Most of the new parties involve drugs such as antipyretic antidetoxifying drugs, blood activating medicine, and breaking blood and eliminating ve drugs. The compatibility of some new drugs is common, and the compatibility of some new sides is rare, such as the combination of the purgatory powder with the expectorant and antitussive antiasthmatic medicine (almond gypsum - ginger - loquat leaf), which suggests the relationship between the "phlegm", the "heat" cause and the psoriasis, and the modern pharmacology shows that the four drugs have the effect of anti-tumor and immunologic adjustment to the new prescription for the treatment of psoriasis. It provides a new clue.5. traditional Chinese Medicine Inheritance auxiliary system software analysis for the treatment of psoriasis medicine law has certain scientific nature, can quickly extract high frequency medicine, common drug pair, core drug combination, optimize new prescription, provide objective and effective data support and reference for clinical medication, avoid the limitations of personal experience, entropy clustering income It is important to study the law of Chinese herbal prescription and discover new prescriptions by discovering new rules and combinations.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R249;R275.9

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