国医大师王琦院士临床治疗前列腺增生症的组方挖掘及用药思路探究

Master of traditional Chinese medicine Academician WANG Qi's prescription excavation for clinical treatment of prostatic hyperplasia and exploration of medicine ideas

关键词:  前列腺增生症  组方挖掘  用药思路  王琦

Key words:  benign prostatic hyperplasia  prescriptions mining  medication idea  WANG Qi

摘要:

[目的] 探究并分析王琦院士临床治疗前列腺增生症的组方规律及用药特点，为中医临床治疗该病提供思路和参考。[方法] 收集并整理2016年9月—2019年6月期间王琦院士门诊收治前列腺增生症的临床病例，经过纳入和排除标准筛选及数据规范化处理后，由3人录进“中医传承辅助平台系统（V2.5）”软件并核对，采用平台大数据算法进行组方挖掘和分析。[结果] 共纳入方剂75首，涉及中药154味。统计前列腺增生症治疗药物的使用频次、性味归经、关键药物、药物组合关联规则及新方组合。使用频次居前8位的中药依次为水蛭、王不留行、乌药、桃仁、赤芍、桂枝、茯苓、牡丹皮，可见其为桂枝茯苓丸加味。四气频次由高到低依次为寒、平、温、凉、热。五味频次由高到低依次为苦、甘、辛、咸、涩、酸。挖掘出12组药物核心组合，在此基础上演变得到6首新处方。[结论] 王琦院士在临床治疗前列腺增生症时紧抓本虚标实的病机特点，提出“肾气亏虚、瘀血阻滞”的病机理论，灵活运用“主病主方”与分期论治的思想。王琦院士治疗前列腺增生症以“疏通”为治则，以散瘀血、消癥积、通水道三法并用为治法，用药以益气活血消癥、化痰软坚利水为主。

Abstract:

[Objective] To explore and analyze the regularity and characteristics of the prescriptions of Academician WANG Qi's clinical treatment of benign prostatic hyperplasia(BPH),and provide ideas and reference for clinical treatment of traditional Chinese medicine(TCM).[Methods] The clinical cases of BPH from Academician WANG Qi's outpatient clinic from September 2016 to June 2019 were collected and collated. After screening for inclusion and exclusion criteria and standardization of data,the cases were checked by three persons and entered into the "TCM Inheritance Support System(V2.5)" software,and finally the platform big data algorithm was used for prescriptions mining and analysis.[Results] A total of 75 prescriptions were included,involving 154 herbs. According to the statistics,the herbs of using frequency for the treatment of BPH,nature and flavour,channel tropism,key herbs,association rules of herb combinations and combinations of new prescriptions were obtained. Top 8 herbs with using frequency were whitmania pigra whitman,semen vaccariae,linderae radix,semen persicae,radix paeoniae rubra,cinnamomum cassia presl,poria,moutan cortex radicis,which can be seen to add herbs to Guizhi Fuling Pill. The frequency of four nature from high to low was cold,calm,warm,cool and hot. The frequency of five flavours from high to low was bitter,sweet,pungent,salty,astringent and sour. Twelve core herb combinations were excavated,and six new prescriptions were obtained based on the evolution.[Conclusion] In the clinical treatment of BPH,Academician WANG Qi focused on the pathogenesis characteristics of deficient root and excessive superficial,and proposes the pathogenesis theory of "kidney qi deficiency and blood stasis block". In addition,he also flexibly applied the idea of "main prescription for primary disease" and the concept of discussion on staging treatment. Academician WANG Qi believed that the treatment of BPH should be based on the principle of "dredge",the three methods of dissipating blood stasis,eliminating accumulation and dredging water channels should be combined as the treatment method. Moreover,the medication was mainly based on replenishing qi,activating blood and resolving aggregation,resolving phlegm,softening hard mass and promoting urination.