【摘要】：目的:綜合考慮到婦科疾病發(fā)病率的逐年上升,以及中醫(yī)藥在治療婦科疾病上的優(yōu)勢,筆者認(rèn)為對于新安醫(yī)學(xué)婦科辨證特色與用藥規(guī)律的系統(tǒng)整理刻不容緩,利用現(xiàn)代數(shù)據(jù)挖掘手段對新安醫(yī)家婦科著作進(jìn)行深入剖析,使之在原有基礎(chǔ)上進(jìn)一步弘揚(yáng),結(jié)合原文、醫(yī)案及數(shù)據(jù)挖掘結(jié)果,對新安醫(yī)家婦科病治療的證候特點(diǎn)、辨治特色、組方原理和用藥風(fēng)格進(jìn)行分析、提煉、總結(jié)。與其它婦科流派的辨治思路及用藥特點(diǎn)進(jìn)行比較,從而更加深入的理解新安婦科的辨治特色及用藥規(guī)律。方法:本課題擬采用數(shù)據(jù)挖掘的研究方法,在Windows 7平臺(tái)上,應(yīng)用Excel將所選新安醫(yī)家著作中涉及的婦科方藥及癥狀進(jìn)行數(shù)據(jù)庫錄入,建立新安醫(yī)家婦科方藥數(shù)據(jù)庫,再將數(shù)據(jù)導(dǎo)出,應(yīng)用統(tǒng)計(jì)軟件SPSS 17.0和SPSS Modeler 14.1對數(shù)據(jù)進(jìn)行挖掘,以探索新安婦科常見病辨治特色與用藥規(guī)律。結(jié)果:(一)月經(jīng)病在新安醫(yī)家治療月經(jīng)病時(shí),使用頻率較高的藥物(頻率大于10%)為:當(dāng)歸159(67.95%)、白芍 119(50.85%)、茯苓 76(32.48%)、川芎 58(24.79%)、白術(shù) 55(23.50%)、續(xù)斷 50(21.37%)、甘草 50(21.37%)、熟地 49(20.94%)、丹參 46(19.66%)、香附44(18.80%)、牡蠣 42(17.95%)、生地 39(16.67%)、烏賊骨 38(16.24%)、丹皮 36(15.38%)、澤蘭 35(14.96%)、黃芩 34(14.53%)、白蒺藜 34(14.53%)、紅花 33(14.10%)、柏子仁 30(12.82%)、延胡索 29(12.39%)、茯神 29(12.39%)、茺蔚子 28(11.97%)、陳皮 28(11.97%)、人參 26(11.11%)。在新安醫(yī)家治療月經(jīng)病的醫(yī)案中,除"脈弦、苔白、舌淡、苔薄、脈細(xì)、脈數(shù)"之外,高頻(頻數(shù)大于20)癥狀依次為:崩漏71(30.34%)、小腹痛58(24.79%)、頭暈56(19.66%)、閉經(jīng) 46(19.66%)、腹脹 37(15.81%)、月經(jīng)量多 34(14.53%)、腰酸33(14.10%)、痛經(jīng) 31(13.25%)、月經(jīng)量少 31(13.25%)、納呆 30(12.82%)、心悸27(11.54%)、月經(jīng)有血塊 25(10.68%)、月經(jīng)后期 23(9.83%)、月經(jīng)色淡 23(9.83%)、面色萎黃23(9.83%)、月經(jīng)先期21(8.97%)。新安醫(yī)家治療月經(jīng)病醫(yī)案中常用藥物配伍有:(1)常用藥對配伍:白芍=當(dāng)歸;川芎=當(dāng)歸;白術(shù)=當(dāng)歸;甘草=白芍;甘草=當(dāng)歸;續(xù)斷=白芍;續(xù)斷=當(dāng)歸;熟地=川彎;熟地=白芍;熟地=當(dāng)歸;丹參=當(dāng)歸;香附=當(dāng)歸;牡蠣=白芍;牡蠣=當(dāng)歸;生地=白芍;烏賊骨=續(xù)斷;烏賊骨=當(dāng)歸;丹皮=當(dāng)歸;澤蘭=當(dāng)歸;黃芩=白芍;白蒺藜=續(xù)斷;白蒺藜=白芍;白蒺藜=當(dāng)歸;紅花=當(dāng)歸;柏子仁=白芍;柏子仁=當(dāng)歸;延胡索=當(dāng)歸;獲神=白芍;茯神=當(dāng)歸;陳皮=當(dāng)歸;茺蔚子=當(dāng)歸;人參=當(dāng)歸;雞冠花=烏賊骨;雞冠花=牡蠣;雞冠花=續(xù)斷;肉桂=川芎;肉桂=當(dāng)歸;枸杞=當(dāng)歸;黃芪=白芍;黃芪=當(dāng)歸(2)常用三味藥團(tuán)配伍:熟地+當(dāng)歸=白芍;熟地+當(dāng)歸=川芎;茯苓+當(dāng)歸=白芍;白術(shù)+當(dāng)歸=白芍;甘草+當(dāng)歸=白芍;熟地+白芍=當(dāng)歸;熟地+白芍=川芎;茯傮+白芍=當(dāng)歸;續(xù)斷+當(dāng)歸=白芍;香附+當(dāng)歸=川芎;川芎+白芍=當(dāng)歸;川芎+白芍=當(dāng)歸;熟地+川芎=當(dāng)歸;甘草+白芍=當(dāng)歸;熟地+川芎=白芍;白術(shù)+茯傮=當(dāng)歸;丹參+當(dāng)歸=白芍;白術(shù)+白芍=當(dāng)歸;續(xù)斷+白芍=當(dāng)歸;續(xù)斷+白芍=白蒺藜;白術(shù)+白芍=茯傮;烏賊骨+當(dāng)歸=續(xù)斷;牡蠣+白芍=當(dāng)歸;香附+川芎=當(dāng)歸;牡蠣+當(dāng)歸=白芍;續(xù)斷+白蒺藜=白芍;紅花+當(dāng)歸=川芎;白蒺藜+續(xù)斷=當(dāng)歸;紅花+當(dāng)歸=川芎;白蒺藜+白芍=續(xù)斷;茯神+白芍=當(dāng)歸;白蒺藜+白芍=當(dāng)歸。(3)常用四味藥團(tuán)配伍:熟地+白芍+當(dāng)歸=川芎;甘草+白芍+當(dāng)歸=白術(shù);白術(shù)+白芍+當(dāng)歸=熟地;白術(shù)+白芍+當(dāng)歸=茯苓;香附+川芎+當(dāng)歸=白芍;續(xù)斷+白芍+當(dāng)歸=白蒺藜。(二)帶下病根據(jù)頻數(shù)統(tǒng)計(jì)結(jié)果,新安醫(yī)家治療月經(jīng)病醫(yī)案中共涉及中藥198味。其中使用頻次較高的藥物(頻率大于10%)的有:當(dāng)歸43次(41。35%)、白芍43次(41.35%)、茯苓 43 次(41.35%)、甘草 38 次(36.54%)、牡蠣 33 次(31.73%)、續(xù)斷 27 次(25.95%)、石斛 27 次(25.96%)、白術(shù) 24 次(23.08%)、黃芩 22 次(21.15%)、烏賊骨 22 次(21.15%)、雞冠花 22 次(21.15%)、沙苑子 21 次(20.19%)、丹皮 21 次(20.19%)、枸杞 20 次(19.23%)、柴胡 19 次(18.27%)、白蒺藜 18 次(17.31%)、陳皮 18 次(17.31%)、茯神 18 次(17.31%)、茺蔚子 17 次(16.35%)、菟絲子 17 次(16.35%)、龍骨 16 次(15.38%)、黃柏 16 次(15.38%)、杜仲 16 次(15.38%)、龜板 15 次(14.42%)、椿根皮 13 次(12.50%)、黨參 13 次(12.50%)、黃芪 13 次(12.50%)、丹參 13 次(12.50%)、車前子 13 次(12.50%)、山藥 13 次(12.50%)、生地 13 次(12.50%)、白薇 11 次(10.58%)、決明子 11 次(10.58%)、延胡索 11 次(10.58%)、遠(yuǎn)志 11 次(10.58%)。通過癥狀頻數(shù)統(tǒng)計(jì)結(jié)果,可以看出,新安醫(yī)家治療帶下病的醫(yī)案中,高頻癥狀是:除脈濡、脈弦、脈滑、脈澀、脈數(shù)、苔黃、苔白之外,白帶量多71次(68.27%)、小腹痛 30 次(28.85%)、頭暈 26 次(25.00%)、腰酸 25 次(24.04%)、黃帶 24 次(23.08%)、腰痛 16 次(15.38%)、納呆 13 次(12.50%)、胸悶 12 次(11.54%)、身痛 9 次(8.65%)、肢酸9次(8.65%)、耳鳴8次(7.69%)、乏力8次(7.69%)、帶下清晰8次(7.69%)、陰癢7次(6.73%)、肢冷7次(6.73%)、惡寒7次(6.73%)。根據(jù)關(guān)聯(lián)規(guī)則統(tǒng)計(jì)結(jié)果,帶下病醫(yī)案中常用藥物配伍如下:(1)常用藥對配伍:黨參=甘草;陳皮=甘草;柴胡=甘草;椿根皮=白芍;車前子=甘草;決明子=石斛;黨參=陳皮;黨參=柴胡;丹參=石斛;決明子=龜板;白薇=牡蠣;龜板=石斛;枸杞=沙苑子;白蒺藜=雞冠花;雞冠花=烏賊骨;黃芪=當(dāng)歸;生地=丹皮;菟絲子=牡蠣;茺蔚子=烏賊骨;龍骨=牡蠣;杜仲=沙苑子;白術(shù)=甘草;決明子=白蒺藜;白薇=沙苑子;陳皮=白術(shù);茯神=石斛;白蒺藜=石斛;沙苑子=續(xù)斷。(2)常用三味藥團(tuán)配伍:黨參+陳皮=甘草;黨參+柴胡=甘草;柴胡+白術(shù)=陳皮;陳皮+柴胡=甘草;陳皮+白術(shù)=甘草;陳皮+茯苓=甘草;柴胡+白術(shù)=甘草;白蒺藜+烏賊骨=雞冠花;沙苑子+牡蠣=續(xù)斷;茺蔚子+雞冠花=烏賊骨;黃芩+當(dāng)歸=白芍;雞冠花+續(xù)斷=烏賊骨;沙苑子+續(xù)斷=牡蠣;杜仲+枸杞=沙苑子;枸杞+續(xù)斷=沙苑子;枸杞+續(xù)斷=牡蠣。(3)常用四味藥團(tuán)配伍:陳皮+柴胡+白術(shù)=甘草;白術(shù)+當(dāng)歸+茯苓=甘草;甘草+茯苓+白芍=當(dāng)歸;黨參+陳皮+甘草=柴胡。結(jié)論:通過對納入的338則新安醫(yī)家治療月經(jīng)病及帶下病的醫(yī)案進(jìn)行統(tǒng)計(jì)分析,得出的結(jié)論多數(shù)都是臨床常用或者是既存的傳統(tǒng)知識(shí)和理論符合的,反推證明應(yīng)用數(shù)據(jù)挖掘進(jìn)行醫(yī)案分析是有效的。通過描述性分析、關(guān)聯(lián)規(guī)則分析、聚類分析,可以得出高頻藥物、高頻癥狀、常見二味、三味、四味中藥配伍,并通過以方測證,反推新安醫(yī)家對于婦科疾病的辨治特色。將分析結(jié)果與原著文獻(xiàn)相結(jié)合,并與中醫(yī)傳統(tǒng)理論知識(shí)對比,得到了 一些新安醫(yī)家對于常見婦科病的辨治特色與用藥規(guī)律。
[Abstract]:OBJECTIVE: Considering the increasing incidence of gynecological diseases and the advantages of traditional Chinese medicine in the treatment of gynecological diseases, the author thinks that it is urgent to systematically arrange the syndrome differentiation characteristics and medication rules of Xin'an Medical Department of gynecology. By using modern data mining methods, the author makes a thorough analysis of the gynecological works of Xin'an Medical Department and makes them on the original basis. Further carry forward, combine the original text, medical records and data mining results, analyze, refine and summarize the syndrome characteristics, treatment characteristics, prescription principles and medication styles of the gynecological treatment of Xin'an physicians. Compare with other schools of gynecology in the way of differentiation and treatment and medication characteristics, so as to further understand the differentiation and treatment characteristics and medication of Xin'an gynecology. METHODS: Data mining method was adopted in this study. On the platform of Windows 7, Excel was used to input the gynecological prescriptions and symptoms involved in the works of Xin'an physicians into the database, establish the gynecological prescriptions database of Xin'an physicians, export the data, and dig the data with the statistical software SPSS 17.0 and SPSS Modeler 14.1. Results: (1) When menstrual diseases were treated by Xin'an physician, the medicines used frequently were Angelica sinensis 159 (67.95%), Paeonia lactiflora 119 (50.85%), Poria cocos 76 (32.48%), Ligusticum Chuanxiong 58 (24.79%), Atractylodes macrocephala macrocephala 55 (23.50%), Glycyrrhiza uralensis 50 (21.37%) and cooked land. 49 (20.94%), Salvia miltiorrhiza 46 (20.94%), Salvia miltiorrhiza 46 (19.66%), Xian-Fu 44 (18.80%), oy42 (17.95%), oy42 (17.95%), habitat 39 (16.67%), cuttlebone 38 (16.24%), cuttlebone 38 (16.24%),, paeoony 36 (15.38%),, Zelan35 (14.96%), Zelan35 (14.96%), Bai-Qin34 (14.53%), tribtribtribtribulus 34 (14.53%), saflower 33 (14.10%), Bai-zikernel 30 (12.82.82%), coryyan-fu29 (12.39%), Shen-Shen-29%, 12.39%, pilpilpilpilpilpilpilpilpilpilpilpil11.97%, human Shen 26 (11.11%). In addition to "pulse string, white fur, pale tongue, thin fur, fine pulse, pulse number", the symptoms of high frequency (frequency > 20) were as follows: avalanche 71 (30.34%), abdominal pain 58 (24.79%), dizziness 56 (19.66%), amenorrhea 46 (19.66%), abdominal distention 37 (15.81%), menstrual volume 34 (14.53%), lumbar acid 33 (14.10%), dysmenorrhea 31 (13.25%), dysmenorrhea. Menstrual volume was 31 (13.25%) less, stasis was 30 (12.82%), palpitation was 27 (11.54%), menstrual blood clots were 25 (10.68%), late menstruation was 23 (9.83%), menstrual paleness was 23 (9.83%), facial yellowness was 23 (9.83%) and premenstrual menstruation was 21 (8.97%). Glycyrrhiza = white peony; Glycyrrhiza = white peony; Glycyrrhiza = white peony; Glycyrrhiza = angeangeangeangelic =; Glycyrrhiza = white peony; Glycyrrhiza = white peony; Glycyrrhiza = white peony = angeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangelica; ripland = Sichuan = Sichuan bend; ripland = Sichuan = Sichuan bend; ripland = angeangeangeangeangeangeangeangeangeangelic; ripland = ripland; Salvia root = angeangeangeangeangeangelica; Salvia root = Angelica root; Salvia root = angeangeangelica root = angeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangelica; Rhizoma Angelica sinensis Flowers = angelica; cypress kernel = white peony; cypress kernel = white peony; cypress kernel = white peony; yanhusuo = ange; yanhusuo = ange; ShenShenShen = white peony; FuShen = angeange; Chen peel = ange; Chenpeel = angeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangelica; Chenssensensenseng = angeangeangeangeangelica; chickchickchicken crocrocrocrowflower = squibone; chickcrocrocrocrocrown flower = oyoyoyoy; chickchickchickchicken crocrocrocrocrocrocrown flower = interrupte; CiCiCiCiCiCinnamoamon; cincincincincincincincincincincincincincincinna; wowowowowowowowolfberrberrberrberrberrberrberrberr+Angelica sinensis Peony = white peony; ripe land + angeangelic = ligugugugugugugugugugugugugugugugu = white peony; Baishsh + angeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeangeAngelica sinensis; Shu Di + Chuanxiong = Bai Peony; Peony; Baishu + FuDao = angeangeangelic; Danshu + Angelica = white peony; Baishu + white peony = white peony = ange; Baishu + white peony = ange; Baishu + white peony = angeangeangeangeangeangeangeangeangeangeangeange; Dipsacacacacacacacus + white peony = angeangeangeangeangelic; Dipsacacus + white peony = white peony = angeangeangeangeangelic; Dipsacus + white peony = white peony = angeangeangeangelic; Dipsacacacacus + white peony + white Peony = angeangeangelica; Dipsacacacacacus + white peony + white peony = angeangeangeangeangeangeangeangeangeangeangeangeangeangeangelic; DipsacacacRadix Angelicae Sinensis (3) commonly used four herbs compatibility: ripe ground + white peony + Angelica = Chuanxiong; liquorice + white peony + Angelica = Chuanxiong; liquorice + white peony + Angelica = Chuanxiong; liquorice + white peony + Angelica = Baishsh; white Shu + white peony + Angelica = ripground; white white white white peony + Angelica = ripground; white shshrub + white peony + Angelica = Poriariariaria; frafrafragrant + ChuChuanxiong + angeangeangeangeangelica = angeangeangeangeangeangeangelica; (3) the common four herbherbs compatibility: ripe + white peony + white peony + white peony + white peony + white peony; (3) Basis of disease Frequency statistics showed that 198 Chinese herbs were involved in the treatment of menstrual diseases by Xin'an physicians. Among them, 43 times of Angelica sinensis (41.35%), 43 times of Paeonia lactiflora (41.35%), 43 times of Poria Cocos (41.35%), 38 times of Glycyrrhiza uralensis (36.54%), 33 times of oysters (31.73%), 27 times of intermittent (25.95%), 27 times of Dendrobium (25.96%) 24 times of Atractylodes macrocephala (2.96%) were used more frequently. Scutellaria baicalensis 22 times (21.15%), cuttlebone 22 times (21.15%), cockscomb 22 times (21.15%), asparagus 21 times (20.19%), red peel 21 times (20.19%), Chinese wolfberry 20 times (19.23%), Bupleurum 19 times (18.27%), Tribulus terrestris 18 times (17.31%), orange peel 18 times (17.31%), Fushen 18 times (17.31%), Ramulus Azi 17 times (16.35%), Chinese wolfberry seed 17 times (16.35%), Chinese carp silk seed 17 times (16.35%) Dragon bone 17 times (16.35%). There were 16 times (15.38%), 16 times (15.38%) of Cortex Phellodendri, 16 times (15.38%) of Eucommia ulmoides, 15 times (14.42%) of turtle board, 13 times (12.50%), 13 times (12.50%) of Codonopsis pilosula, 13 times (12.50%) of Radix astragali, 13 times (12.50%) of Salvia miltiorrhiza, 13 times (12.50%) of plantain, 13 times (12.50%) of yam, 13 times (12.50%) of habitat, 11 times (10.58%) of Cassia obtusifolia, 11 times (10.58%) of Semen Cassiae According to the statistics of symptoms frequency, the high frequency symptoms of Xin'an doctor were as follows: besides pulse moistening, pulse strings, pulse smoothness, pulse astringency, pulse number, mossy yellow and mossy white, the amount of leucorrhea was 71 times (68.27%), abdominal pain 30 times (28.85%), dizziness 26 times (25.00%), lumbar acid 25 times (24.04%), yellow belt 24 times. Sixteen times (23.08%), 16 times (15.38%) of low back pain, 13 times (12.50%), chest tightness 12 times (11.54%), body pain 9 times (8.65%), limb acid 9 times (8.65%), tinnitus 8 times (7.69%), fatigue 8 times (7.69%), clear 8 times (7.69%), pruritus 7 times (6.73%), cold 7 times (6.73%) and cold 7 times (6.73%). The following: (1) Common medicinal pairs are as follows: (1) compatibility: Codonopsis root = licoriorice; Tangshen = licorice; tangpeel = licorice; Buplepleurum = liquorice; Bupleurum = liquorice; tootootootooroot skin = white peony; Plantago seed = licorice; Cassia seed = Dendrobium; Codonopsis root = chenskin; Codonopsis root = Chen skin; Codonopsis root = Bupleurum = Checkberrberry; Castanshesheshesheshesheshesheshesheshesheshesheshesheshesheshen = Dendrobium; Cassia root = turturtleoyoyoyoyoyoyoyoyoyoyoyoyoyoyoywowowowowowowolfberrberrberrberrberrberrberrberry = sand garden; A dodder. Silk seed = oyster; Cartilage = squid bone; keel = oyoyster; Eucommia = asasparagus = oyoyoy; Eucommia = asasparagus = Astragalgalgalgalgalgalgalgalgalgalgalgalgalus; BaiWei = asparagalgalgalgalgalgalgalus; Cassia fruit = Tribulus terterterrestris; BaiWei = asparagalgalgalgalgalgalgalgalgalus; Pericarpcarp Chen = white atratratractylodes; Pericarpcarpcarp = white atratractylodes; Pericarpcarp = white atractylodes rhizoma; FuShen = DenDendrobifolia FuShen = Dendrobiflora; Triterus terrestris terrestris terrestris terrestris terrestris terrestris terrestris terrestris terrestris; Orange peel+ Atractylodes macrocephala = licorice; tangerine peel + Poria cocos = liquorice; Bupleurum + Atractylodes macrocephala = licorice; Tribulus terrestris + squid bone = cockscomb flower; asparagus + oyster = dipper; azalea latifolia + cockscomb flower = sepia bone; Radix Scutellariae Scutellariae + Angelica sinensis = white peony; cockscomb + dipper = oyster; Eucommia ulmoides + wolfberry = asparagus; wolfberry + dipper = asparagus; wolfberry + dipper = asparagus; wolfberry + dipper = asparagus. (3) Oyst Group compatibility: tangpi + Bupleurum + Atractylodes macrocephala = licorice; Atractylodes macrocephala + Angelica + Poria cocos = licorice; licorice + Poria + paeony = angelica; Codonopsis pilosula + tangpi + licorice = bupleurum. Conclusion: Through statistical analysis of 338 cases of Xin'an physicians treating menstrual disorders and underlying diseases, most of the conclusions are commonly used or existing traditional knowledge and theory. By descriptive analysis, association rule analysis and clustering analysis, we can get the compatibility of high-frequency drugs, high-frequency symptoms, common two flavors, three flavors and four traditional Chinese medicines, and then we can deduce the differentiation and treatment characteristics of new peace physicians for gynecological diseases by using prescriptions. By combining the literature and comparing it with the traditional theory of traditional Chinese medicine, the characteristics of differentiation and treatment of common gynecological diseases and the law of medication of some Xin'an doctors were obtained.
【學(xué)位授予單位】：北京中醫(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)】：R271.1

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