主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2020, Vol. 43 ›› Issue (10): 841-848.doi: 10.3969/j.issn.1006-2157.2020.10.008

• 循证医学 • 上一篇    下一篇

近20年慢性心力衰竭中医现代临床用药规律分析*

史君1, 王星1, 赵慧辉2, 王伟2#   

  1. 1 内蒙古医科大学基础医学院 内蒙古 010010;
    2 北京中医药大学中医学院
  • 收稿日期:2019-12-06 出版日期:2020-10-30 发布日期:2020-11-04
  • 通讯作者: #王伟,男,博士,教授,博士生导师,主要研究方向: 中西医结合治疗心血管病、糖尿病并发症的作用机制与新药研究、心血管病的证治规律研究,E-mail:wangwei@bucm.edu.cn
  • 作者简介:史君,女,博士,副教授
  • 基金资助:
    *国家自然科学基金项目(No. 81973697)

Analysis of TCM prescriptions for chronic heart failure in recent 20 years*

Shi Jun1, Wang Xing1, Zhao Huihui2, Wang Wei2#   

  1. 1 School of Basic Medicine, Inner Mongolia Medical University, Inner Mongolian 010110, China;
    2 School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
  • Received:2019-12-06 Online:2020-10-30 Published:2020-11-04
  • Contact: Prof. Wang Wei, Ph.D., Doctoral Supervisor. Beijing University of Chinese Medicine. No. 11 Beisanhuan Donglu Road, Chaoyang District, Beijing 100029. E-mail: wangwei@bucm.edu.cn
  • Supported by:
    National Natural Science Foundation of China (No. 81973697)

摘要: 目的 探讨近20年慢性心力衰竭(CHF)现代中医临床用药规律。方法 经过筛选,共收集到符合纳入标准的方剂206个,涉及中药210种。对所有纳入的方剂进行数据标准化之后,利用excel软件建立慢性心力衰竭方药数据库,并在Windows 7平台采用SPSS17.0和clementine12.0软件对数据进行描述性分析和关联规则分析(Apriori算法)。结果 数据统计显示,CHF证候要素中气虚出现频率最高158次,其次是血瘀142次、水饮86次、阴虚75次、痰浊68次、阳虚63次等;其病位以心、肾、肺为主;使用频率最高的前10位中药依次为:黄芪(170),丹参(140),茯苓(128),附子(108),白术(104),葶苈子(86),桂枝(84),甘草(78),人参(76),泽泻(66);关联规则结果显示了与气虚、血瘀,水饮、阴虚、痰浊关联度最高的中药及中药组合,并且通过进一步分析各中药之间关联度最高的药对配伍,显示出益气、活血、利水、化痰、温阳相互补充、标本兼顾的治法。结论 慢性心力衰竭的发生、发展、转归,其证候始终处于动态变化过程中。其病机为本虚标实,以心之阳气(或兼心阴)亏虚为本,瘀血水湿痰饮为标。此外,在分析中我们发现证候要素与中药之间具有高度关联性,临床常用组合主要是以益气、活血、利水、养阴,化痰,温阳为主。临证时,应把握住邪正之间的关系,急则治其标,缓则治其本或标本兼治。

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

中图分类号: 

  • R256.2