摘要
目的:对王新东诊治射血分数保留型心力衰竭(ejection fraction preserved heart failure,HFpEF)的医案进行数据分析,挖掘其诊治HFpEF的特色经验。方法:选取2020年9月至2023年1月王新东于江苏省中西医结合医院门诊与病房诊治的HFpEF病例共计340诊次,运用中医传承辅助平台,构建王新东治疗HFpEF医案信息平台,进行数据管理、频次统计、数据挖掘和数据分析,并进行分析和总结。结果:本研究纳入患者中男女占比分别为33.82%和66.17%,年龄为34~94岁,症状以胸闷、乏力、不寐等为主,舌象以舌质红、舌质淡红等为主,脉象以脉浮、脉弦滑等为主。对医案中出现的186味中药进行统计分析,中药四气统计依次为温、寒、平、凉;五味统计依次为苦、辛、甘、酸、咸;归经统计前5位为肺、脾、肝、胃、心;中药分类统计前5位为补虚药、利水渗湿药、活血化瘀药、化痰止咳平喘药、理气药;用药频次统计前5位的中药分别为半夏、茯苓、生白术、莪术、陈皮。基于规则分析及熵聚类算法分析得出治疗HFpEF的核心药物组合为香附-桔梗、五味子-麦冬、莪术-葶苈子-瓜蒌皮等,并凝练形成经验方剂“葶鹿益心饮”获国家发明专利授权。结论:王新东认为HFpEF病性属本虚标实,病因病机为气阴两虚,水瘀内停;临证时可宗以“味”统方、苦辛平逆理论治疗HFpEF,苦辛合用,一阳一阴,泄中寓开,通中有降,相反相成,分消和解水湿,宣通平逆肺气。
Objective:To analyze the medical cases of Professor Wang Xindong in the diagnosis and treatment of ejection fraction preserved heart failure(HFpEF),and to explore his characteristic experience in the diagnosis and treatment of HFpEF.Methods:A total of 340 cases of HFpEF were diagnosed and treated by Professor Wang Xindong in the outpatient and ward of Jiangsu Provincial Hospital of integrative Medicine from September 2020 to January 2023.Results:The male and female proportions of the patients included in this study were 33.82%and 66.17%,respectively,aged 34-94,and the symptoms were mainly chest tightness,fatigue,and insomnia,the tongue image was mainly red tongue and pale red tongue,and the pulse image was mainly floating and slippery.The statistical analysis of 186 flavors of traditional Chinese medicine in the medical case showed that the statistics of the Four Qi of traditional Chinese medicine were warm,cold,mild and cool.The statistics of the Five Flavors were bitter,pungent,sweet,sour,and salty;The top 5 meridian tropism are Lung,Spleen,Liver,Stomach and Heart;The top 5 in the classification statistics of traditional Chinese medicine are deficiency tonic drugs,relieving Water and Dampness drugs,blood circulation promoting and stasis removing drugs,relieving Phlegm,stop cough and asthma medicines as well as Qi regulating drugs;The top 5 traditional Chinese medicines in terms of drug frequency were Banxia(Pinellia ternata),Fuling(Poria cocos),Shengbaizhu(Bighead atractylodes rhizome),Ezhu(Curcuma zedoary)and Chenpi(Tangerine peel).Based on the rule analysis and entropy clustering algorithm analysis,it was concluded that the core drug combinations for the treatment of HFpEF were Xiangfu-Jiegeng(Cyperus rotundus-Platycodon,Wuweizi-Maidong(Schisandra chinensis-Ophiopogon japonicus),Ezhu-Tinglizi-Gualoupi(Curcuma zedoary-Semen lepidii-trichosanthes peel),etc.,and the empirical formula"Tinglu Yixin Drink"was created,which was authorized by the national invention patent.Conclusion:Professor Wang Xindong believes that the pathology of HFpEF is a deficiency in root and excess in symptom and the pathogenesis is Qi and Yin deficiency as well as Water and stasis stagnation.In clinical practice,the theory and method of"Taste unifying formula"and"Ku Xin Ping Ni"in treatment of HFpEF.Bitter and pungent drugs,with one Yang and one Yin,the opposite,can dissipate and dissolve Water and Dampness,and can calm the reversed Lung Qi.
作者
张蒙
王新东
ZHANG Meng;WANG Xindong(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai China 201203;Integrative Hospital Affiliated to Nanjing University of Chinese Medicine/Integrative Hospital of Jiangsu Province,Nanjing Jiangsu China 210028)
出处
《中医学报》
2025年第8期1748-1756,共9页
Acta Chinese Medicine
基金
国家自然科学基金项目(81973766)
董其美全国名老中医药专家传承工作室建设项目{国中医药人教函〔2022〕75号}
江苏省自然科学基金项目(BK20211387)。
关键词
射血分数保留型心力衰竭
以“味”统方、苦辛平逆法
葶鹿益心饮
王新东
heart failure with preserved ejection fraction
"taste"unifying formula,Ku Xin Ping Ni method
Tinglu Yixin Drink
Wang Xindong
作者简介
张蒙(1998-),女,江苏宿迁人,博士研究生,研究方向:中医药防治心血管疾病;通信作者:王新东,男,主任医师,研究方向:中医药防治心系疾病。E-mail:wangxindong@jsatcm.com。
