关键词: 慢性心力衰竭, 数据挖掘, 关联规则, 用药规律

Abstract: Objective To explore the characteristics of TCM prescriptions for chronic heart failure (CHF) in the recent 20 years. Methods After screening, 206 formulae were collected, involving 210 medicinal herbs. After data standardization of all included prescriptions, a database of formulae for chronic heart failure was established using Microsoft Excel software. SPSS 17.0 and clementine 12.0 software were used on Windows 7 platform for descriptive analysis and association analysis (Apriori algorithm). Results Statistics showed that qi deficiency was the most commonly seen pattern element of CHF, appearing 158 times in the database of prescriptions, followed by blood stasis (142 times), water and fluid retention (86), yin deficiency (75), phlegm turbidity (68) and yang deficiency (63). The CHF affected zang-fu organs were mainly heart, kidney and lung. The top 10 medicinal herbs frequently prescribed for CHF were Huangqi (Astragalus Root, Radix Astragali) (170), Danshen (Danshen Root, Radix et Rhizoma Salviae Miltiorrhizae) (140), Fuling (Poria, Poria) (128), Fuzi (Monkshood, Radix Aconiti) (108), Baizhu (White Atractylodes Rhizome, Rhizoma Atractylodis Macrocephalae) (104), Tinglizi (Pepperweed Seed, Semen Descurainiae seu Lepidii) (86), Guizhi (Cinnamon Twig, Ramulus Cinnamomi) (84), Gancao (Licorice Root, Radix et Rhizoma Glycyrrhizae) (78), Renshen (Ginseng, Radix et Rhizoma Ginseng) (76) and Zexie (Water Plantain Rhizome, Rhizoma Alismatis) (66). Association analysis identified the medicinal herbs and their combinations that were highly correlated with qi deficiency, blood stasis, water and fluid retention, yin deficiency and phlegm turbidity. Further analysis of pairs of highly correlated medicinal herbs demonstrated that CHF treatment incorporated methods of boosting qi, invigorating blood, promoting urination, dissolving phlegm and warming yang, which complemented each other and treated the root and branch simultaneously. Conclusion During the onset, progression and prognosis of CHF, its TCM pattern is in constant change. Its pathogenesis is the root in deficiency with the branch in excess, i.e. the root is heart yang qi (and sometimes yin) deficiency while the branch is blood stasis, water dampness and phlegm rheum. In addition, through analysis, we found a high correlation between pattern elements and medicinal herbs used in treatment. Commonly used herbal combinations were mainly conducive to boosting qi, invigorating blood, promoting urination, nourishing yin, dissolving phlegm and warming yang. Clinically, the physician should, on the basis of thorough understanding of the relation between pathogenic factors and healthy qi, treat the branch in acute cases, and treat the root or the root and the branch simultaneously in mild cases.

Key words: chronic heart failure, data mining, association rules, pattern of prescription