基于数据挖掘探析张锡纯《医学衷中参西录》舌诊特色

Exploring the thought of tongue diagnosis in ZHANG Xichun’s Integrating Chinese and Western Medicine based on data mining

关键词:  张锡纯  《医学衷中参西录》  舌诊

Key words:  ZHANG Xichun  Intergrating Chinese and Western Medicine  tongue diagnosis

摘要:

[目的] 梳理《医学衷中参西录》中有舌诊记载的医案，探索张锡纯舌诊的应用思路和临床意义。[方法] 搜集整理《医学衷中参西录》有关舌象记载的医案，建立数据库，运用Microsoft Excel 2021进行舌象、疾病分类和用药频数统计，通过SPSS Modeler 18.0软件所提供的Apriori算法进行关联规则分析，利用Cytoscape3.7.1软件进行可视化分析。[结果] 共纳入医案138则，高频舌象为黄苔、厚苔、白苔、干苔、灰黑苔等，舌苔之间关联性较强；高频疾病为温病、伤寒类疾病等外感类疾病，黄苔与温病、伤寒、瘟疫、内伤杂病同时出现的频率较其他舌象高；高频药物为石膏、甘草、山药、知母、玄参等，黄、厚、白、干苔均与石膏关联性较强，其次是甘草、山药和知母。[结论] 张锡纯尤重视舌苔在外感病中的动态变化，并指出舌干可能提示气虚下陷，灰黑苔需注重调和脾胃、补养气阴。此外，石膏用量决定其清热之力，不用局限于黄苔等明显热象。

Abstract:

[Objective] To sort out the medical cases with tongue diagnosis recorded in Integrating Chinese and Western Medicine，and to explore the application of ZHANG Xichun’s tongue diagnosis and its clinical significance. [Methods] The medical cases related to the record of tongue image in Integrating Chinese and Western Medicine were collected，a database was established，Microsoft Excel 2021 was used to carry out the statistics of tongue image，disease classification and medication frequency，the association rule analysis was carried out by the Apriori algorithm provided by SPSS Modeler 18.0 software，and the visual analysis was carried out by Cytoscape 3.7.1 software. [Results] A total of 138 medical cases were included，and the high-frequency tongue signs were yellow moss，thick moss，white moss，dry moss，gray-black moss，etc.，with strong correlation between the tongue signs；the high-frequency illnesses were exogenous illnesses such as warm febrile disease and febrile diseases，and yellow moss appeared with warm febrile disease，febrile diseases，plague，and internal injuries at the same time with a higher frequency than the other signs；and the high-frequency medicines were gypsum，licorice，yam，Anemarrhenae Rhizoma，and Scrophulariae，etc.，and the yellow，thick，white，dry moss were all strongly associated with gypsum，followed by licorice，yam and Anemarrhenae Rhizoma. [Conclusion] ZHANG Xichun paid special attention to the dynamic changes of tongue moss in exogenous diseases，and pointed out that dry tongue may indicate qi insufficiency and subsidence，and gray-black moss needs to focus on reconciling the spleen and stomach and nourishing qi and yin. In addition，the dosage of gypsum determines its heat-clearing power，which need not be limited to obvious signs of heat such as yellow moss.