基于数据挖掘探讨黄文政教授治疗慢性肾小球肾炎用药规律

Discussion on the treatment of chronic glomerulonephritis by Professor HUANG Wenzheng based on data mining

关键词:  慢性肾小球肾炎  数据挖掘  用药特色  黄文政

Key words:  chronic glomerulonephritis  data mining  medication characteristic  HUANG Wenzheng

摘要:

[目的] 运用数据挖掘方法分析黄文政教授临床诊治慢性肾小球肾炎用药规律，初步探索黄教授治疗该病的思路与经验。[方法] 收集2017年1月—2018年12月黄文政教授门诊慢性肾小球肾炎患者的中药处方。运用SPSS 22.0软件分析中药使用频数、频率，运用SPSS Modeler 18.0软件分析药物关联规则，运用Gephi 0.9.2软件分析核心子网络、中药群。基于分析结果初步探讨黄教授治疗该病的思路与经验。[结果] 1）2017年1月—2018年12月就诊于黄文政教授门诊的慢性肾小球肾炎患者共197例，1 289诊次。2）黄教授诊治该病常用茯苓、黄芪、当归、丹参、白术、萆薢、芡实、金樱子、蝉蜕、生甘草等药物。3）黄教授诊治该病常用地锦草+荠菜花、蒲公英+白花蛇舌草、柴胡+黄芩、芡实+金樱子等对药，常用黄芪+生地黄+山药、黄芪+白术+防风+防己、黄芪+熟地黄+白术+山药+当归等组药。4）黄教授诊治该病常用中药的K-16核心网络共包含62味药物，大体可总结概括为4个模块。[结论] 结合数据挖掘结果以及黄教授临证经验，可初步探知黄文政教授常从脾肾亏虚、气阴不足、湿热内蕴3方面辨治慢性原发性肾小球肾炎，以“疏利少阳三焦”之法贯穿始终，同时重视虫类药，特别是蝉蜕、僵蚕、水蛭在治疗该病中的运用。方药常以防己黄芪汤、参芪地黄汤或黄芪、党参、白术、生地黄、当归、丹参、僵蚕为基础加减组方。此外，黄教授精确把握了扶正法与祛邪法在组方用药中的平衡，其一在于对某一味药物补益作用与祛邪作用的正确认识和精确把握。其二主张合理配伍，强调必须在足够扶正基础上应用祛邪法，并重视药物的互相作用，以收祛邪不伤正，扶正不恋邪之功。

Abstract:

[Objective] To analyze the clinical application of Professor HUANG Wenzheng in the diagnosis and treatment of chronic glomerulonephritis by data mining method, and to extract Professor HUANG's thinking and experience in treating this disease.[Methods] Chinese medicine prescriptions for patients with chronic glomerulonephritis in the outpatient clinic of Professor HUANG Wenzheng from January 2017 to December 2018 were collected. Using SPSS 22.0 software to analyze the frequency number and frequency of Chinese medicine use, SPSS Modeler 18.0 software was used to analyze drug association rules, and Gephi 0.9.2 software was used to analyze core sub-network and Chinese medicine group. Based on the analysis results, the main academic ideas of Professor HUANG's diagnosis and treatment of the disease were extracted.[Results] 1) From January 2017 to December 2018, a total of 197 patients with chronic glomerulonephritis were visited in the outpatient clinic of Professor HUANG Wenzheng, with 1 289 times. 2) Professor HUANG often uses Wolfiporia cocos, Astragalus mongholicus, Angelica sinensis, Salvia miltiorrhiza, Atractylodes macrocephala, Dioscorea tokoro Makino, Euryale ferox Salisb, Rosa laevigata, periostracum cicada, Glycyrrhizae and other drugs. 3) Professor HUANG is commonly used Euphorbia humifusa Willd and Capsella bursa-pastoris, Taraxacum mongolicum and Hedyotis diffusa, Bupleurum and Scutellaria baicalensis Georgi, Euryale ferox Salisb and Rosa laevigata, and other pairs of drugs, commonly used Astragalus mongholicus, Rehmannia glutinosa and Dioscorea oppositifolia, Astragalus mongholicus, Atractylodes macrocephala, Siler divaricatum Benth and Aristolochia fangchi, Astragalus mongholicus, Rehmannia glutinosa, Atractylodes macrocephala, Dioscorea oppositifolia, Angelica sinensis, and other groups of drugs. 4) The K-16 core network of traditional Chinese medicines commonly used by Professor HUANG for diagnosis and treatment of this disease contains 62 medicines, which can be summarized into 4 modules.[Conclusion] Combined with the data mining results and Professor HUANG's clinical experience, it can be preliminarily found that Professor HUANG Wenzheng often treats chronic primary glomerulonephritis from three aspects:deficiency of spleen and kidney, deficiency of qi and yin, and accumulation of damp heat, with the method of "dredging the triple energizer of shaoyang" throughout, and paying attention to the application of insect drugs, especially periostracum cicada, bombyx batryticatus and leech in treating this disease. Prescriptions are often based on Fangji Huangqi Decoction, Shenqi Dihuang Decoction or Astragalus mongholicus, radix codonopsis, Atractylodes macrocephala, Rehmannia glutinosa, Angelica sinensis, Salvia miltiorrhiza, and bombyx batryticatus. In addition, Professor HUANG accurately grasped the balance between strengthening the body and eliminating pathogenic factors in the prescription medication, one of which lies in the correct understanding and accurate grasp of the tonic and eliminating pathogenic factors of a certain drug. Secondly, it advocates reasonable compatibility, emphasizes that the method of eliminating pathogenic factors must be applied on the basis of strengthening the body, and attaches importance to the interaction of drugs, so as to achieve the functions of eliminating pathogenic factors without hurting body and strengthening the body without evil.