【摘要】：[目的]整理本人跟診時所搜集到的導師臨床運用桃紅四物湯的醫(yī)案,借助于數(shù)據(jù)挖掘技術(shù),系統(tǒng)性地總結(jié)導師臨床運用桃紅四物湯治療內(nèi)分泌疾病的經(jīng)驗,便于今后在臨床上更好地運用桃紅四物湯,充分體現(xiàn)其臨床價值。[方法]通過溫習和查閱相關(guān)文獻,深入了解桃紅四物湯來源、組成、功效、臨床運用及實驗室研究進展等方面的相關(guān)知識,收集、整理導師王旭教授2015年9月至2016年12月間運用桃紅四物湯的醫(yī)案,再根據(jù)納入標準和排除標準進行篩選,共獲得符合要求的155診次醫(yī)案。將所有醫(yī)案數(shù)據(jù)錄入MedcaseV3.2數(shù)據(jù)記錄挖掘系統(tǒng)中,構(gòu)建本次研究的數(shù)據(jù)專庫。先對醫(yī)案數(shù)據(jù)進行全面清洗,再用相關(guān)數(shù)據(jù)挖掘方法(包括頻數(shù)統(tǒng)計和關(guān)聯(lián)規(guī)則等)進行挖掘分析。將挖掘得到的臨床癥狀、舌苔、脈象、處方用藥及其中的關(guān)聯(lián)性等內(nèi)容分析、歸納并總結(jié)。[結(jié)果]本次研究共118例患者,其中男性5例,女性113例,分別占4.24%、95.76%,男女比例1:22.6�；颊咧心挲g最大的76歲,最小的16歲,平均為35歲。中醫(yī)診斷方面,以月經(jīng)不調(diào)、黧黑斑、癭病為主,頻率分別為33.55%、26.45%、14.84%。西醫(yī)診斷方面,以月經(jīng)病、黃褐斑為主,頻率分別為30.97%、26.45%。臨床表現(xiàn)方面,共有148個臨床癥狀,頻率較高的臨床表現(xiàn)有月經(jīng)色暗、有血塊、神疲乏力、月經(jīng)量少、經(jīng)前乳脹、月經(jīng)后期、面部色素沉著、怕冷、寐差、面色無華、脫發(fā)、經(jīng)行腰酸,頻率分別為49.03%、47.10%、45.81%、42.58%、31.61%、30.32%、29.03%、27.74%、23.87%、23.23%、21.94%、21.29%;舌象方面,較高頻的有質(zhì)淡紫(43.23%)、苔薄(38.71%)、質(zhì)紅(27.10%)、苔薄白(23.23%)、有瘀點(21.29%)、有紫氣(17.42%)、質(zhì)紫黯(14.84%)、邊有齒痕(13.55%)。脈象方面,頻率大于20%的脈象有:澀脈、細脈、弦脈,頻率分別為92.90%、72.29%、23.23%,以澀脈、細脈為主。用藥方面,高頻藥物有9味,分別為:桃仁、紅花、川芎、當歸、白芍、甘草、熟地、山藥、山茱萸,頻率分別為:100.00%、100.00%、97.42%、95.48%、92.26%、87.10%、85.81%、68.39%、67.10%。[結(jié)論]王旭教授臨證時常體現(xiàn)其異病同治的思維。導師臨床運用桃紅四物湯治療多種內(nèi)分泌疾病,尤其在女性月經(jīng)不調(diào)、黃褐斑、甲狀腺相關(guān)疾病中最為多見。雖然所治療的疾病種類不一,但這些疾病均在其發(fā)展變化中出現(xiàn)了血虛血瘀之證。當這些臨床表現(xiàn)、舌苔、脈象均與血虛血瘀證相符合時,可選用桃紅四物湯。導師常根據(jù)歸經(jīng)理論指導用藥。"經(jīng)脈所過,主治所及",桃紅四物湯主入肝經(jīng),王旭教授臨床運用桃紅四物湯時,常用其治療肝經(jīng)循行所過之處的疾患,諸如黃褐斑、月經(jīng)不調(diào)和甲狀腺相關(guān)疾病等。王旭教授臨證時常從肝腎論治,因肝腎同源,腎精與肝血互生互用,同盛同衰,故王旭教授臨床運用桃紅四物湯時常配伍使用六味地黃丸中"三補"(熟地、山藥、山茱萸),肝腎同調(diào)。并在調(diào)理女子月經(jīng)時,考慮到月經(jīng)的產(chǎn)生與調(diào)節(jié)與腎臟、肝臟、脾臟關(guān)系緊密,故臨床處方用藥時注意調(diào)養(yǎng)肝腎,且常常肝脾腎三臟同調(diào)。
[Abstract]:[objective] to sort out the medical records of clinical application of Taohong Siwu decoction, and systematically summarize the experience of using Taohong Siwu decoction in the treatment of endocrine diseases, with the help of data mining technology. It is convenient to use Taohong Siwu decoction better in clinic in the future and fully reflect its clinical value. [methods] by reviewing and consulting the relevant literature, we can deeply understand the source, composition, efficacy, clinical application and laboratory research progress of Taohong Siwu decoction. From September 2015 to December 2016, professor Wang Xu used Taohong Siwu Tang medical records and screened them according to the inclusion criteria and exclusion criteria. A total of 155 medical records were obtained. All medical records were input into Medcase V3.2 data mining system, and the data database of this study was constructed. Firstly, the data of medical records are cleaned completely, and then the related data mining methods (including frequency statistics and association rules) are used for mining and analysis. The clinical symptoms, tongue coating, pulse, prescription medication and its relevance were analyzed and summarized. [results] there were 118 patients in this study, including 5 males and 113 females, accounting for 4. 24% and 95. 76% respectively, the ratio of male to female was 1: 22. 6. The oldest and youngest were 76 and 16, with an average age of 35. In the diagnosis of traditional Chinese medicine, menstrual disorder, blackish spot and gall disease were the main ones with the frequency of 33.555.26.45 and 14.8445, respectively. Western medicine diagnosis, menstrual disease, chloasma, the frequency of 30.97, 26.45. In terms of clinical manifestations, there were 148 clinical symptoms with high frequency, including dark menstrual color, blood clot, fatigue, less menstrual volume, premenstrual distension, late menstrual period, pigmentation on the face, fear of cold, poor sleep, no color, hair loss, The frequencies were 49.03, 47.101and 45.81, respectively. The frequencies were 42.58 and 31.61and 30.323.32 and 29.320.32, respectively. They were: 27.747.23.8723.2323.2321.9421.292.The higher frequency of light purple (43.23%), thin coating (38.71%), red (27.10%), thin white (23.23%), bruising point (21.29%), purple qi (17.42%), dark purple (14.84%), and teeth marks (13.55%) were found in the tongue picture, and there were bruises (21.29%), purple qi (17.42%), dark purple (14.84%) and teeth marks (13.55%). In terms of pulse, the frequency of more than 20% pulse is: astringent vein, thin vein, chord pulse, frequency is 92.90, 72.29 and 23.23, mainly astringent vein and thin vein. In medicine, there are 9 kinds of high frequency drugs: peach kernel, safflower, Chuanxiong, angelica, Radix Paeoniae Alba, Glycyrrhiza, ripe ground, Chinese yam, Cornus officinalis, the frequency of which is 100.000. 000.97. 42Con 92.269.2697.100.85.81and 67.107.10. [conclusion] Professor Wang Xu's clinical symptoms often reflect his thinking of treating different diseases with the same treatment. Tutor clinical use of Taohong Siwu decoction to treat a variety of endocrine diseases, especially in women menstrual disorders, chloasma, thyroid-related diseases are most common. Although the kinds of diseases treated are different, these diseases have the syndrome of blood deficiency and blood stasis in their development. When these clinical manifestations, tongue coating and pulse are consistent with blood deficiency and blood stasis syndrome, Taohong Siwu decoction can be selected. Mentors often guide the use of drugs according to the theory of return to the Classics. " When Professor Wang Xu uses Taohong Siwu decoction clinically, it is commonly used to treat diseases along the meridian of the liver, such as chloasma, menstrual disorder and thyroid related diseases. Professor Wang Xu often treats the liver and kidney from the liver and kidney, because the liver and kidney are homologous, the kidney essence and the liver and blood are used mutually, the same prosperity is the same as the aging, so Professor Wang Xu often uses Taohong Siwu decoction in clinical use in combination with Liuwei Dihuang pills "three tonics" (cooked land, Chinese yam, Chinese yam). Cornus officinalis), liver and kidney are the same. When regulating the menstruation of women, it is considered that the production and regulation of menstruation are closely related to the kidney, liver and spleen, so the clinical prescriptions should pay attention to nourishing the liver and kidney, and the three viscera of liver, spleen and kidney are often in the same tune.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R249;R259

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