基于R语言数据挖掘叶天士《临证指南医案》治疗肾系疾病的用药规律

Drug Use Rules for Treating Renal Diseases Based on R Language Data Mining Ye Tianshi’s “Case Records as a Guide to Clinical Practice”

摘要: 目的：本文通过查阅清代著名医家叶天士所著《临证指南医案》，对叶天士治疗肾系病证的医案进行归纳总结、统计分析，探寻叶天士辨治肾系疾病的核心理论思想、特色药物组合；为临床辨治肾系疾病提供启发与思路。方法：将《临证指南医案》中治疗肾系疾病的方剂录入Excel表格建立数据库，运用Excel对录入数据的中药味数、四气、五味、归经进行频次、频率分析并运用RStudio、SPSS Modeler 18.0结合Cytoscape探索核心中药，进行核心中药关联规则及聚类分析，并进行可视化展示。结果：本研究共纳入医案135例，共计中药188味，使用最多的药物依次为茯苓、熟地黄、茯神、泽泻、远志；所用药物性温、性平、性寒者所占比例最大，药味以甘、苦、辛为主，多归肾经、心经、肝经、脾经、肺经；以DC值大于40为依据，筛选出26味核心中药，以支持度大于0.06，置信度大于0.8为条件，得出39条核心关联规则；26味核心药物网络共现图，共涉及26个节点，240条边；确定最佳聚类数为3类。结论：叶天士辨治肾系疾病时仍重视脾胃；善于交通心肾；多滋阴补血活血而兼行气，补而不滞；常以五苓散为底方畅气机、清肾火而利水。

Abstract: Objective: By referring to the Case Records as a Guide to Clinical Practice written by Ye Tianshi, a famous doctor in Qing Dynasty, this paper summarized and analyzed the medical records of Ye Tianshi’s treatment of renal diseases, and explored the core theoretical ideas and characteristic drug combinations of Ye Tianshi’s differentiation and treatment of renal diseases. It provides inspiration and thought for clinical differentiation and treatment of renal diseases. Methods: The prescriptions for the treatment of renal diseases in Case Records as a Guide to Clinical Practice were recorded in Excel to establish a database. Excel was used to analyze the frequency and frequency of TCM flavor number, four Qi, five taste and channel reduction in the data. RStudio, SPSSModeler18.0 combined with Cytoscape were used to explore core TCM. Core traditional Chinese medicine association rules and cluster analysis were carried out, and visualized. Results: A total of 135 cases of medical records were included in this study, with a total of 188 TCM flavors. The most commonly used drugs were poria, cooked rehmannia, Fuzhuan, alisma and polygala. The proportion of warm, flat and cold drugs used was the largest, and the taste of drugs was mainly sweet, bitter and xin, mostly kidney channel, heart channel, liver channel, spleen channel and lung channel. Based on DC value greater than 40, 26 core Chinese medicines were screened, and 39 core association rules were obtained with support degree greater than 0.06 and confidence degree greater than 0.8. The cooccurrence diagram of the 26 flavor core drug network involved 26 nodes and 240 edges. The optimal cluster number was determined to be 3 categories. Conclusion: Ye Tianshi still paid attention to spleen and stomach when differentiating and treating renal diseases. Good at communicating heart and kidney; nourishing Yin and invigorating blood and activating blood, reinforcing qi without stagnation; Wuling powder is often used as the base to smooth qi, clear kidney fire and benefit water.