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1.中国中医科学院 中医临床基础医学研究所,北京 100700
2.中国中医科学院,北京 100700
张妮楠,博士,从事中医临床疗效评价研究,Tel:010-64089654,E-mail:znnzhangninan@163.com
* 谢琪,博士,研究员,从事中医临床疗效评价研究,Tel:010-64089654,E-mail:xieqixieqi@139.com
收稿日期:2020-06-14,
网络出版日期:2020-08-31,
纸质出版日期:2020-12-20
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张妮楠,周洪伟,林睿凡等.基于临床诊疗数据的余瀛鳌先生治疗癫痫的通治方分析[J].中国实验方剂学杂志,2020,26(24):96-102.
ZHANG Ni-nan,ZHOU Hong-wei,LIN Rui-fan,et al.Effect of YU Ying-ao's Tongzhifang in Treatment of Epilepsy Based on Clinical Diagnosis and Treatment Data[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(24):96-102.
张妮楠,周洪伟,林睿凡等.基于临床诊疗数据的余瀛鳌先生治疗癫痫的通治方分析[J].中国实验方剂学杂志,2020,26(24):96-102. DOI: 10.13422/j.cnki.syfjx.20202073.
ZHANG Ni-nan,ZHOU Hong-wei,LIN Rui-fan,et al.Effect of YU Ying-ao's Tongzhifang in Treatment of Epilepsy Based on Clinical Diagnosis and Treatment Data[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(24):96-102. DOI: 10.13422/j.cnki.syfjx.20202073.
目的
2
该研究以全国名中医余瀛鳌先生诊治癫痫的门诊病历数据为基础结合数据挖掘,分析其通治方的组成、用药加减规律,总结全国名中医余瀛鳌先生治疗癫痫的临证经验,为中医药治疗癫痫提供可参考的依据。
方法
2
根据余瀛鳌先生诊治癫痫的门诊病历数据为基础,进行了规范的患者随访、临床诊疗数据采集、预处理与挖掘分析,并与专家访谈相印证,基Liquorice 2.3数据挖掘平台和SPSS 17.0进行数据管理和统计分析。
结果
2
完整采集了243诊例1 219诊次病例数据,得到了余瀛鳌先生癫痫通治方的组成以古方白金丸为雏形,以生龙齿和生牡蛎增强潜镇之功,以陈皮、杏仁、胆南星、竹茹化痰通络,以丹参和桃仁活血化瘀,十味药物组方缜密、配伍严谨;通过小样本数据得到强直痉挛型癫痫患者服用该方3个月和6个月的总有效率均为80%(
P<
0.01,
P<
0.01)且均未见不良反应;关于通治方剂量成人丸药处方的剂量一般为汤药处方的3~6倍,儿童丸药处方的剂量一般为汤药处方的5~10倍;在辨病与辨证相结合为指导下癫痫急性期加琥珀末1.5~3 g,郁金和白矾用量之比通常为4∶1,抽搐较甚药用钩藤、僵蚕、地龙,癫痫因外伤所致药用生蒲黄、土鳖虫、红花、赤芍,便干药用火麻仁、乏力药用黄芪、食积不消药用鸡内金、易怒药用龙胆草等。
结论
2
余瀛鳌先生以潜镇止痫化痰通络法治疗癫痫的通治方药物组成相对固定,随证加减规律可循。成人和儿童汤药组方和丸药组方剂量范围以及临证经验可供。
Objective
2
Analyze the composition of Tongzhifang,regularity of modified prescriptions based on outpatient medical records of national famous Chinese medicine practitioner Professor YU Ying-ao for the treatment of epilepsy as well as data mining, and summarize the clinical experience of Professor YU in diagnosis and treatment of epilepsy, in order to provide the reference basis for the traditional Chinese medicine treatment epilepsy.
Method
2
Based on the data of outpatient medical records of Professor YU for epilepsy diagnosis and treatment,this study conducted standard patient follow-up,clinical data collection,pretreatment and mining analysis,and was confirmed through expert interviews. Liquorice 2.3 data mining platform and SPSS 17.0 were used for data management and statistical analysis.
Result
2
A total of 1 219 medical records of 243 cases were completely collected. As a result, Professor YU Ying-ao's Tongzhifang for epilepsy was based on ancient prescription Baijinwan,in which Shenglongchi and Ostreae Concha enhance tranquilizing and hyperactivity-subduing effects,Citri Reticulatae Pericarpium,Armeniacae Semen Amarum,Arisaema Cum Bile and Bambusae Caulis in Taenias eliminate phlegm and free channels, Salviae Miltiorrhizae Radix et Rhizoma and Persicae Semen promote blood circulation to remove blood stasis, and the 10 herbs were meticulously composed and well compatible. According to the small sample data,the total effective rate of patients with tetany type epilepsy taking this prescription for 3 months and 6 months was 80% (
P
<
0.01), with no adverse reactions. As for the dosage of Tongzhifang,the dosage for adult pills is generally 3-6 times that of decoction prescriptions,and the dosage for children's pills is generally 5-10 times that of decoction prescriptions. Under the guidance of the combination of disease differentiation and syndrome differentiation,epilepsy at the acute phase was treated with additionally Hupomo 1.5-3 g,the ratio of Curcumae Radix to Alumen is usually 4∶1, severe convulsion was treated with additionally Uncariae Ramulus Cum Uncis, Bombyx Batryticatus and Pheretima, epilepsy due to trauma was treated with additionally Typhae Pollen, Eupolyphaga Steleophaga, Carthami Flos and Radix Paeoniae Rubra; constipation was treated with additionally Cannabis Fructus; fatigue was treated with additionally Astragali Radix; dyspepsia was treated with additionally Galli Gigerii Endothelium Corneum; and irritability treated with additionally Gentiana scabra Bunge.
Conclusion
2
The composition of Professor YU's Tongzhifang for treating epilepsy with Qianzhen Zhixian Huatan Tongluo method is relatively stable. Modified prescriptions are based on syndrome differentiation. Clinical experience and dosage range of decoction prescription and pill prescription for adults and children are available.
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