本文選題：周仲瑛 + 高脂血癥��； 參考：《南京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的:本文以國醫(yī)大師周仲瑛教授近三十年來所積累高脂血癥病案為研究對象,運(yùn)用現(xiàn)代計(jì)算機(jī)數(shù)據(jù)挖掘技術(shù),以"痰瘀"為切入點(diǎn),從癥狀、舌脈、病機(jī)、藥物等角度,歸納周老對高脂血癥病因病機(jī)的認(rèn)識(shí),以及臨證辨證要領(lǐng)和用藥經(jīng)驗(yàn),探討其從痰瘀辨治高脂血癥的學(xué)術(shù)思想體系,為臨床辨治高脂血癥提供新思路。方法:運(yùn)用MedcaseV3.2倉公診籍病案數(shù)據(jù)記錄及分析系統(tǒng),運(yùn)用強(qiáng)化FPGrowth算法構(gòu)建加強(qiáng)關(guān)聯(lián)規(guī)則數(shù)據(jù)挖掘模型,使用Xminer Operation Tool運(yùn)算工具對研究數(shù)據(jù)進(jìn)行挖掘處理和邏輯分析,對計(jì)量性趨勢數(shù)據(jù)運(yùn)用Medcase Chart進(jìn)行解構(gòu)分析與圖形表達(dá)。結(jié)合數(shù)據(jù)分析結(jié)果,以周仲瑛教授臨證辨治思路為模型,運(yùn)用中醫(yī)基本理論,重點(diǎn)從病機(jī)認(rèn)識(shí)、辨治思路、臨床用藥等多方位、多角度進(jìn)行經(jīng)驗(yàn)探討與總結(jié)。結(jié)果:病案數(shù)據(jù)共861診次(285人次),其中男性156例,女性129例。發(fā)病年齡最低8歲,最高86歲,平均年齡54.65歲,60-69歲之間發(fā)病人群最廣;癥狀分布前10的癥狀分別是頭暈、口干、肢體麻木、肢體疼痛、便溏、乏力、胸悶、肢體酸軟、失眠、肢體腫;舌象多以暗紅(53%)暗紫(30%)舌、苔黃薄膩(51%)為主;臨床多見滑、細(xì)、弦、澀四種脈象,分別占64%,62%,28%,19%;病機(jī)概要多肝腎虧虛(27%)、痰瘀阻絡(luò)(24%);臟腑涉及肝、脾、腎、肺、心、胃、膽、血脈等,以肝(55%)、腎(47%)、脾(10%)三臟為主,重視絡(luò)(28%)的損傷;病理因素痰、瘀分別占了 40%和39%;其次是濕、熱,占25%,27%,風(fēng)、火,濁、毒,分別占22%,3%,3%,1%;病理因素的兼夾以痰瘀(32.5%)、瘀熱(25.2%)、濕熱(22.3%)最為常見;治療藥物頻次前30分別是丹參、炙僵蠶、山楂肉、澤瀉、桑寄生、制首烏、天麻、枸杞子、夏枯草、地黃、白蒺藜、川芎、決明子、鬼箭羽、葛根、石斛、澤蘭、郁金、海藻、法半夏、玄參、茵陳、制黃精、麥冬、地骨皮、赤芍、炒蒼術(shù)、黃連、雞血藤、柴胡。癥狀內(nèi)關(guān)聯(lián)中頭暈→頭痛→視糊→耳鳴→胸悶之間的關(guān)聯(lián)緊密(置信度0.4-0.8),舌象中舌質(zhì)暗(紅)→苔黃薄膩關(guān)聯(lián)緊密;病機(jī)中肝腎虧虛→痰瘀阻絡(luò)的支持度最高(0.1206),脈象內(nèi)關(guān)聯(lián)中置信度為1.0的有沉→細(xì)、數(shù),弦→滑、數(shù),小→滑,病機(jī)中肝腎虧虛→痰瘀阻絡(luò)的支持度最高,藥物內(nèi)關(guān)聯(lián)中制首烏→桑寄生→炙僵蠶→丹參→山楂肉→澤瀉之間的關(guān)聯(lián)度最大。運(yùn)用聚類法聚類出三類核心方:(1)制首烏、桑寄生、鬼箭羽、丹參、炙僵蠶、澤蘭、制黃精、海藻、澤瀉、山楂肉;(2)天麻、白蒺藜、決明子、夏枯草、澤瀉、制首烏、枸杞子、炙僵蠶、丹參;(3)玄參、茵陳、炒蒼術(shù)、黃柏、澤瀉、炙僵蠶、鬼箭羽、荷葉、炙水蛭、虎杖。結(jié)論:1.本病臨床證候復(fù)雜多端,涉及多臟腑多系統(tǒng)病變,常見頭暈頭痛、心胸疼痛、胸悶、肢體麻木疼痛、脅痛、腹脹、視力模糊等,多見暗紅(紫)舌、苔黃薄膩;多見滑、細(xì)、弦、澀四種脈象。2.本病本虛標(biāo)實(shí),病變臟腑主要在肝、腎、脾,與心、腦相關(guān),久病及絡(luò)。病理因素以痰、瘀、濕、熱、風(fēng)、火,濁、毒為主,痰、瘀最為常見并貫穿整個(gè)病理過程,是高脂血癥進(jìn)展的關(guān)鍵因素。核心病機(jī)為肝腎虧虛、痰瘀阻絡(luò),常見有肝郁脾虛,痰凝瘀阻;肝腎虧虛,痰瘀阻絡(luò);痰瘀阻絡(luò)、濕熱內(nèi)蘊(yùn);痰濁瘀阻、內(nèi)風(fēng)擾動(dòng);痰瘀阻絡(luò)、心營不暢;痰瘀阻絡(luò)、氣血(陰)兩虛六個(gè)證型。3.周仲瑛教授治療本病多從痰瘀立論,多采用化痰逐瘀、驅(qū)邪通脈之法,配合疏導(dǎo)氣機(jī),注重調(diào)補(bǔ)臟腑,從本緩治,臨床當(dāng)辨別痰瘀的屬性、部位、兼夾及先后等不同而治療各異。4.臨證用藥多以化痰行瘀為主,配合滋補(bǔ)肝腎藥、清熱利濕藥、祛風(fēng)通絡(luò)藥、益氣養(yǎng)陰藥等,特色用藥如天南星、海藻、僵蠶、姜黃、山楂、荷葉、玄參、水蛭、鬼箭羽、澤瀉等。
[Abstract]:Objective: This article, based on the modern computer data mining technology and using the modern computer data mining technology and using the "phlegm and blood stasis" as the breakthrough point, summed up the understanding of Zhou Lao on hyperlipidemic disease pathogenesis, as well as the key points of syndrome differentiation and the experience of drug use by using modern computer data mining technology and using the modern computer data mining technology and using the modern computer data mining technology and the "phlegm and blood stasis" as the breakthrough point. To discuss the academic thought system of hyperlipidemia from phlegm and blood stasis, and to provide new ideas for clinical diagnosis and treatment of hyperlipidemia. Method: using the data recording and analysis system of MedcaseV3.2 Cang medical records, using the enhanced FPGrowth algorithm to build the data mining model of the association rules, and using the Xminer Operation Tool operation tool to carry out the research data. Mining processing and logical analysis, and using Medcase Chart for deconstruction analysis and graphic expression on the measurement trend data. Combined with the results of data analysis, this paper takes professor Zhou Zhongying's syndrome differentiation and treatment thought as model, and uses the basic theory of traditional Chinese medicine, focusing on the understanding of the pathogenesis, the idea of differentiation and treatment, clinical medication and other aspects. Results: the medical record data were 861 times (285 times), of which 156 were male and 129 in women. The age of onset was 8, the highest was 86 years, the average age was 54.65 years, and the most widespread among the 60-69 years old. The first 10 symptoms were dizziness, dry mouth, numbness of limbs, limb pain, loose stools, weakness, chest tightness, sleeplessness, swollen limbs, swollen limbs. With dark red (53%) dark purple (30%) tongue and thin and greasy fur (51%), four pulse images, including 64%, 62%, 28%, 19%, were seen in clinic, including 64%, 62%, 28%, 19%, and the pathogenesis of the liver, spleen, kidney, lung, heart, stomach, gallbladder, blood and so on, the liver (55%), the kidney (47%), the spleen (10%) and the blood vessels, and the injury of the collaterals and the pathological factors. Phlegm and blood stasis accounted for 40% and 39% respectively, followed by damp, heat, 25%, 27%, wind, fire, turbid, and poison, respectively 22%, 3%, 3%, 1%, and the most common pathological factors were phlegm and stasis (32.5%), blood stasis heat (25.2%), and damp heat (22.3%), respectively. Before the frequency of treatment, 30 were respectively Dan Shen, broiled silkworm, hawthorn, Alisma Alisi, mulberry parasite, Radix Polygoni multiflorum, Rhizoma prunicae, radix rehmanniae, white Tribulus terrestris, Ligusticum chuanxiong, cassia seed, kudzu root, Dendrobium, Dendrobium, tulips, tulips, seaweed, French pinellia, Radix sargyata, Yellowstone, Radix Ophiopogon, Radix Paeoniae, Radix Paeoniae, Rhizoma Coptis, Coptis chinensis, bupleurum. The association between dizziness, headache, pasta, tinnitus and chest tightness (confidence degree 0.4-0.8), the dark (red) tongue in the tongue and thin greasy tongue in the tongue The support of liver and kidney deficiency, phlegm and stasis obstructing collaterals in the pathogenesis is the highest (0.1206), and the median confidence of 1 in the pulse image is sink, fine, number, string, slip, number, and slippery, and the support of the liver and kidney deficiency and phlegm and stasis obstructing collaterals in the pathogenesis is the highest. In the drug association, it is used to make the interrelation of the drug between the Radix Polygoni Multiflori, the silkworm silkworm, the salvia miltiorrhiza, the haw meat to the Alisma orientalis. Three core parties are clustered with clustering method: (1) the system of Radix Polygoni Multiflori, mulberry parasitic, ghosts and arrow feathers, Salvia miltiorrhiza, broiled silkworm, salvia, Rhizoma Alisma, hawthorn meat; (2) Tianma, Tribulus terrestris, cassia seed, rhizome, Rhizoma Alisma, Salvia miltiorrhiza, Salvia miltiorrhiza, Rhizoma corydalis, Rhizoma phellodendron, Rhizoma Alisma, roasted silkworm, roasted silkworm, ghosts arrow feathers, and lotus leaves, Conclusion: the clinical syndromes of the 1. diseases are complex and multiterminal, involving multiple viscera and multi system lesions, common dizziness and headache, pain in the chest, chest pain, numbness and pain, hypochondriac pain, abdominal distension, and blurred vision, and many dark red (purple) tongues and four kinds of.2. diseases, which are slippery, fine, chord and astringent, and the disease is mainly in the liver, kidney and spleen. The main pathological factors are phlegm, stasis, damp, heat, wind, fire, turbidity, poison, phlegm and stasis, which are the most common and throughout the whole pathological process. The key pathogenesis is liver and kidney deficiency, phlegm stasis, phlegm stasis, phlegm stasis, phlegm stasis, damp heat, phlegm and stasis, phlegm and stasis, phlegm and stasis, phlegm, phlegm, phlegm, phlegm and phlegm. Turbid stasis, internal wind disturbance, phlegm and stasis obstructing collaterals, obstruction of heart camp, phlegm and blood stasis, Qi and blood (Yin) and two deficiency of the six syndrome type.3. treatment of the disease mostly from Phlegm Stasis Theory, the use of phlegm and stasis, exorcism through the way, with the dredging air machine, pay attention to the adjustment of the viscera, from this slow treatment, clinical when identifying phlegm and stasis attributes, parts, pinch and successively different, and so on. The treatment of different.4. is mainly treated with phlegm and blood stasis, combined with nourishing liver and kidney medicine, clearing heat and dampness medicine, removing wind and dredging collaterals, supplementing qi and nourishing Yin medicine, such as Rhizoma planus, seaweed, silkworm, turmeric, hawthorn, lotus leaf, Radix sage, leech, ghosts, arrows feathers, Alisma and so on.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R249;R259

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