基于数据挖掘的国医大师干祖望治疗慢性化脓性中耳炎用药规律研究

乔植 史军 陈晨 朱慧兰 刘玉

〔摘要〕 目的 探討国医大师干祖望治疗慢性化脓性中耳炎的用药规律，以期指导临床实践和新药开发。方法 收集整理干祖望教授治疗慢性化脓性中耳炎的医案，应用中医传承计算平台（V3.0），分析慢性化脓性中耳炎症状分布、证型分布、处方药物频次、核心组合及药物关联规则。结果 筛选出的101则医案中，辨证分型以脾虚湿困证最多（53.47%），其中耳道渗液流脓、听力下降、鼓膜穿孔为最常见症状。中药使用频次共664次，单味用药频次较高的有甘草（60次）、茯苓（53次）、白术（45次）等。用药以寒（35.79%）、平（30.16%）、温（27.74%）性药居多，药味多甘（46.27%）、苦（29.96%）。药物归经以脾、肺、肝、胃、肾经为主。对处方用药进行关联规则分析，演化出核心组合19组，得到常用药对“白术-党参”“茯苓-白术”“茯苓-党参”等。基于k-means算法进行用药聚类分析，进一步演化出5组核心组合，分别为参苓白术散合逍遥散、补中益气汤合参苓白术散、五味消毒饮合二妙丸、龙胆泻肝汤合三妙丸、益气聪明汤基础方。结论 国医大师干祖望治疗慢性化脓性中耳炎多采用健脾补土、益气升阳的方法，从脾胃论治，坚持整体辨证与局部辨证相结合，用药轻灵，灵活多变。

〔关键词〕 慢性化脓性中耳炎;干祖望;数据挖掘;健脾补土;益气升阳;中医传承计算平台

〔中图分类号〕R276.1       〔文献标志码〕A        〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.12.003

Study on Medication Law of Chinese Medical Master Gan Zuwang in the Treatment of

Chronic Suppurative Otitis Media Based on Data Mining

QIAO Zhi1， SHI Jun2， CHEN Chen1， ZHU Huilan1， LIU Yu1*

（1. Nanjing Hospital of Integrated Traditional Chinese and Western Medicine， Nanjing University of Chinese Medicine， Nanjing， Jiangsu 210014， China; 2. Jiangsu Hospital of Traditional Chinese Medicine， Nanjing， Jiangsu 210029， China）

〔Abstract〕 Objective To discuss the medication rule of the master of traditional Chinese medicine Gan Zuwang in the treatment of chronic suppurative otitis media， and to guide clinical practice and new drug development. Methods The medical records of professor Gan Zuwang’s treatment of chronic suppurative otitis media were collected and sorted out， the traditional Chinese medicine inheritance computing platform （V3.0） was used to analyze the symptoms， syndrome type distribution， prescription drug frequency， and core combination and drug association rule of chronic suppurative otitis media. Results Among the 101 medical cases screened， the most common symptoms were the syndrome of spleen deficiency and dampness and sleepiness. Among them， ear canal leakage and pus， hearing loss， and tympanic membrane perforation were the most common symptoms. The frequency of use of traditional Chinese medicine was 664 times， and the higher frequency of single medicine was Gancao （Glycyrrhizae Radix Et Rhizoma） （60 times）， Fuling （Poria） （53 times）， Baizhu （Atractylodis Macrocephalae Rhizoma） （45 times） and so on. The drug properties were mostly cold （35.79%）， flat （30.16%）， warm （27.74%）， the medicine tastes were mainly sweet （46.27%）， bitter （29.96%）. The meridians of the drugs were mainly the spleen， lung， liver， stomach， and kidney meridians. The association rules of prescription drugs were analyzed， and 19 core combinations were evolved， and commonly used drug pairs were “Baizhu （Atractylodis Macrocephalae Rhizoma）-Dangshen （Codonopsis Radix）”， “Fuling （Poria）-Baizhu （Atractylodis Macrocephalae Rhizoma）”， “Fuling （Poria）-Dangshen （Codonopsis Radix）” and so on. Based on the k-means algorithm for medication cluster analysis， 5 core combinations were further evolved. They were the basic prescriptions of Shenling Baizhu Powder and Xiaoyao Powder， Buzhong Yiqi Decoction and Shenling Baizhu Powder， Wuwei Xiaodu Decoction and Ermiao Pill， Longdan Xiegan Decoction and Sanmiao Pill， Yiqi Congming Decoction. Conclusion Master of traditional Chinese medicine Gan Zuwang mostly uses the method of invigorating the spleen and replenishing soil; replenishing Qi and promoting Yang in the treatment of chronic suppurative otitis media. He treats it from the spleen and stomach， adheres to the combination of overall syndrome differentiation and local syndrome differentiation， and the medication is light， flexible and changeable.

〔Keywords〕 chronic suppurative otitis media; Gan Zuwang; data mining; invigorating the spleen and replenishing soil; replenishing Qi and promoting Yang; traditional Chinese medicine inheritance computing platform

慢性化脓性中耳炎是耳科常见疾病之一，多由急性化脓性中耳炎迁延而发，主要累及中耳腔黏膜和骨膜，使患者出现鼓膜穿孔，导致患者听力下降[1]。……