【摘要】：目的：以承氣湯類方古代醫(yī)案為對象運(yùn)用數(shù)據(jù)挖掘手段探究其臨床應(yīng)用的價(jià)值。方法：以承氣湯類方各方劑名為關(guān)鍵詞,搜索《中華醫(yī)典》醫(yī)論醫(yī)案部分,制訂適合本研究的古代醫(yī)案納入標(biāo)準(zhǔn),對納入的醫(yī)案進(jìn)行整理歸納,建立承氣湯類方古代醫(yī)案數(shù)據(jù)庫,運(yùn)用統(tǒng)計(jì)學(xué)方法及數(shù)據(jù)挖掘手段,如頻數(shù)分析、因子分析、聚類分析等一系列方法對該數(shù)據(jù)庫中醫(yī)案的癥狀、處方用藥等內(nèi)容進(jìn)行分析、挖掘,探究承氣湯類方的證候及藥物使用特點(diǎn),從而印證其臨床應(yīng)用的適應(yīng)性及價(jià)值。結(jié)果：搜索得承氣湯類方古代醫(yī)案共155則,納入古代醫(yī)案96則。對醫(yī)案進(jìn)行統(tǒng)計(jì)、數(shù)據(jù)挖掘可得： (1)在古代醫(yī)案中,承氣湯類方可以治療內(nèi)、外、婦、五官、骨傷等多種疾病。其中應(yīng)用最多的還要屬脾胃疾病、神志病以及外感熱病,其所占百分比分別為45.83%、13.54%、12.50%。 (2)古代醫(yī)案承氣湯類方所治療的癥狀按頻次高低順序排在前五的依次為大便閉、發(fā)熱、腹痛、腹脹、煩躁譫語。(3)承氣湯類方常用藥物中除構(gòu)成承氣湯類方的藥物如厚樸、枳實(shí)、芒硝、桃仁、甘草等使用頻次較高外,其余運(yùn)用較多的種類有清熱藥如犀角、生地,活血藥如五靈脂、生蒲黃。結(jié)論： (1)承氣湯類方起源于東漢時(shí)期的《傷寒論》,并于唐宋時(shí)期有了初步發(fā)展,金元時(shí)期為該類方的發(fā)展中期,直至明清,伴隨溫病學(xué)派的興起,帶動了承氣湯類方的發(fā)展與創(chuàng)新,從而進(jìn)入類方發(fā)展的高峰期。 (2)后世發(fā)展出的承氣湯變證方與原方證治相比主要區(qū)別體現(xiàn)在病理因素不同、病位不同、兼證不同以及病性虛實(shí)不同。 (3)承氣湯類方在臨床應(yīng)用中可以治療內(nèi)、外、婦、兒、五官、骨傷等多學(xué)科的多種疾病,但主要的還是運(yùn)用于脾胃疾病、神志病以及外感熱病這三大類疾病之中。 (4)其主治癥狀除了現(xiàn)代臨床經(jīng)常適用的便秘、腹痛、腹脹、發(fā)熱外,煩躁、譫語、頭痛幾赤等神志及頭而部癥狀亦表現(xiàn)得十分突出。 (5)承氣湯類方之基礎(chǔ)藥物如大黃、芒硝、厚樸、甘草外,常用加減藥類還包括清熱藥如犀角、生地,活血藥如五靈脂、生蒲黃。
[Abstract]:Objective: to explore the clinical value of Chengqi decoction by data mining. Methods: according to the names of various prescriptions of Chengqi decoction as the key words, we searched the part of the medical records of the Chinese Medical Code, worked out the standard for the inclusion of the ancient medical cases suitable for this study, and summarized the included medical cases. The database of ancient medical records of Chengqi decoction was established, and a series of methods, such as frequency analysis, factor analysis and cluster analysis, were used to analyze the symptoms of medical records and prescription drug use in the database by means of statistical methods and data mining methods, such as frequency analysis, factor analysis, cluster analysis and so on. To explore the syndromes and drug use characteristics of Chengqi decoction, so as to confirm the adaptability and value of its clinical application. Results: a total of 155 ancient medical records of Chengqi decoction were searched and included in 96 ancient medical cases. Statistics of medical records, data mining can be obtained: (1) in ancient medical cases, Chengqi decoction can treat many diseases, such as internal, external, female, facial, bone injury and so on. The most commonly used diseases were spleen and stomach disease, mind disease and exogenous fever, which accounted for 45.83% and 13.54% 12.50%, respectively. (2) the symptoms treated by Chengqi decoction in ancient medical records were in order of defecation closure, fever, abdominal pain, abdominal distension, irritability and delirium according to the order of frequency. (3) in the common medicine of Chengqi decoction, except for the medicine of Chengqi decoction such as Magnolia officinalis and Fructus Aurantii, The use frequency of mirabilite, peach kernel, licorice and so on is higher, and the other more kinds of heat-clearing medicine such as rhinoceros horn, raw land, blood activating medicine such as five Lingli, fuhuang. Conclusion: (1) Chengqi Tang decoction originated from the Eastern Han Dynasty, and had a preliminary development in Tang and Song dynasties. The Jin and Yuan dynasties were the middle period of its development, until the Ming and Qing dynasties, accompanied by the rise of febrile disease school. It drives the development and innovation of Chengqi decoction, thus entering the peak period of development. (2) the main difference between Chengqi decoction and the original prescription is that the pathological factors are different, the disease position is different, the syndromes are different, and the deficiency and reality of the disease are different. (3) Chengqi decoction can be used to treat many kinds of diseases, such as internal, external, female, infant, facial, bone injury and so on, but it is mainly used in the diseases of spleen and stomach, mind disease and external febrile disease. (4) in addition to constipation, abdominal pain, abdominal distension, fever, irritability, delirium, headache, etc. (5) besides rhubarb, mirabilite, Magnolia officinalis, Glycyrrhiza uralensis, Fang Zhi basic drugs of Chengqi decoction include heat-clearing drugs such as rhino horn, raw land, blood activating drugs such as five Lingli, and fuhuang.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249

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