| 摘要: |
| 目的：基于“五脏依时渐衰”理论，探讨冠心病患者不同就诊年龄阶段的用药规律，为临床据龄辨治提供参考。方法：检索中国知网、万方数据、维普中文科技期刊数据库及《国家级名老中医 冠心病验案良方》中治疗冠心病的医案，依据纳入与排除标准筛选后，以患者就诊年龄为依据，每10岁为一个年龄组进行分层，构建各年龄组处方数据库。采用药物频次分析、药物功效与性味归经分析、关联规则分析及系统聚类分析等方法，挖掘不同年龄段的用药特点。结果：共纳入冠心病医案390例，其中40～49岁组52例、50～59岁组109例、60～69岁组149例、70～79岁组67例，≥80岁组因样本量过少予以剔除。40～49岁、50～59岁、60～69岁和70～79岁组分别涉及中药146、199、234、167味，筛得高频药物22、29、33、28味。各年龄组用药功效均以补虚药为首，药性多温，药味多甘、苦，归经均以肝经为首。关联规则分析显示，各年龄组核心关联药物主要包括丹参、半夏、甘草、茯苓、川芎、瓜蒌等，不同年龄组药物关联组合存在差异。聚类分析显示，40～49岁组药物组合以化痰理气、疏肝活血为主；50～59岁组以化痰活血为主，兼见益气养阴、疏肝泻火；60～69岁组益气养阴、通阳泄浊、健脾益气、破血化瘀等治法并见；70～79岁组治法较为多元，补虚力度增强，健脾化湿、益气养阴、补气活血与温阳散结等法并见。结论：冠心病患者不同就诊年龄阶段的处方用药呈现一定差异，其用药规律随增龄呈现从“理气化痰”向“活血化瘀”，再向“益气养阴、健脾化湿”的阶段性迁移。肝木条达贯穿治疗始终，是消散阴浊、修复脏衰的关键枢纽。本研究从就诊年龄分层角度揭示的据龄用药规律，可为冠心病分龄论治及延缓病理性衰老提供参考。 |
| 关键词: 冠心病 五脏依时渐衰 年龄 用药规律 数据挖掘 |
| DOI： |
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| Age-based medication rules for coronary heart disease based on the theory of “age-related gradual decline of the five viscera” |
| ZHANG Chun,ZHANG Shumeng,MAO Yan |
| (Hunan University of Chinese Medicine, Changsha 410208, Hunan, China) |
| Abstract: |
| Objective： To investigate the medication rules for coronary heart disease （CHD） patients with different ages at the time of consultation based on the theory of “age-related gradual decline of the five viscera”, and to provide a reference for age-based syndrome differentiation and treatment in clinical practice. Methods： CNKI, Wanfang Data, VIP, and the book Proven Cases and Prescriptions for Coronary Heart Disease by National Famous Old TCM doctors were searched for the medical records of CHD. After screening according to inclusion and exclusion criteria, the records were stratified by patient age at the time of consultation, with each 10-year interval as one age group, and prescription databases were constructed for each age group. Methods including drug frequency analysis, the analysis of drug function/nature/taste/meridian tropism, association rule analysis, and hierarchical cluster analysis were used to explore the medication characteristics of different age groups. Results： A total of 390 CHD medical records were included, with 52 cases in the 40-49 age group, 109 cases in the 50-59 age group, 149 cases in the 60-69 age group, and 67 cases in the 70-79 age group, and the ≥80 age group was excluded due to insufficient sample size. The 40-49, 50-59, 60-69, and 70-79 age groups involved 146, 199, 234, and 167 TCM drugs, respectively, among which 22, 29, 33, and 28 high-frequency drugs were identified. Deficiency-tonifying herbs were mainly used in each age group, and most drugs had a warm nature and a sweet or bitter taste and mainly entered the liver meridian. The association rule analysis showed that the core drugs in each age group mainly included Salvia miltiorrhiza, Pinellia ternata, Radix Glycyrrhizae, Poria cocos, Rhizoma Chuanxiong, and Fructus Trichosanthis, and there were differences in drug association and combinations across different age groups. The cluster analysis showed that the drug combinations in the 40-49 age group mainly focused on resolving phlegm and regulating Qi and soothing the liver and activating blood; in the 50-59 age group, they mainly focused on resolving phlegm and activating blood, with additional functions of benefiting Qi and nourishing Yin and soothing the liver and purging fire; in the 60-69 age group, there were therapies such as benefiting Qi and nourishing Yin, unblocking Yang and eliminating turbidity, strengthening the spleen and benefiting Qi, and breaking blood and resolving stasis; in the 70-79 age group, the treatment methods were more diverse with an increased emphasis on tonifying deficiency, and there were therapies such as strengthening the spleen and removing dampness, benefiting Qi and nourishing Yin, tonifying Qi and activating blood, and warming Yang and resolving static blood. Conclusion： There are certain differences in the prescriptions for CHD patients with different ages at the time of consultation, and their medication rules gradually shift from “regulating Qi and resolving phlegm” to “activating blood and resolving stasis” and then to “benefiting Qi, nourishing Yin, strengthening the spleen, and removing dampness” with the increase in age. Maintaining the smooth flow of liver Qi throughout treatment is key to dissipating Yin turbidity and restoring declining visceral function. This study reveals the age-based medication rules from the perspective of age stratification at the time of consultation, which can provide a reference for developing age-based therapies for CHD and delaying pathological aging. |
| Key words: coronary heart disease age-related gradual decline of the five viscera age medication rules data mining |
