近現(xiàn)代醫(yī)家治療癲狂的用藥規(guī)律分析

張毅杰　李晶晶　杭曉屹　孫文軍

摘要 目的：通過對近現(xiàn)代醫(yī)家治療癲狂醫(yī)案的數(shù)據(jù)挖掘分析，總結(jié)近現(xiàn)代醫(yī)家治療癲狂的用藥規(guī)律。方法：檢索、收集、整理古今醫(yī)案云平臺病案庫、國家知識基礎(chǔ)設(shè)施數(shù)據(jù)庫（CNKI）和《名老中醫(yī)經(jīng)驗(yàn)全編》《中國名老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗(yàn)集》《中國近現(xiàn)代名中醫(yī)醫(yī)案精華》等醫(yī)案類書籍中有關(guān)癲狂的醫(yī)案，建立近現(xiàn)代醫(yī)家治療癲狂的醫(yī)案數(shù)據(jù)庫，提取中藥處方數(shù)據(jù)。利用古今醫(yī)案云平臺和SPSS軟件進(jìn)行頻次統(tǒng)計(jì)、關(guān)聯(lián)分析、聚類分析，利用Gephi進(jìn)行復(fù)雜網(wǎng)絡(luò)分析，分析近現(xiàn)代醫(yī)家治療癲狂的高頻藥物、關(guān)鍵藥對、常用方劑、核心處方。結(jié)果：本研究共納入228篇病案，363首中藥方劑，包含276味中藥。高頻中藥為甘草、半夏、石菖蒲、大黃、遠(yuǎn)志、郁金、柴胡、茯苓、陳皮、黃芩等，常用藥物配伍包括半夏-陳皮、石菖蒲-遠(yuǎn)志、龍骨-牡蠣等，聚類結(jié)果分為8類，包含了癲狂夢醒湯、溫膽湯、礞石滾痰丸等方劑，核心處方為柴胡加龍骨牡蠣湯、甘麥大棗湯和十味溫膽湯加減。結(jié)論：數(shù)據(jù)分析顯示近現(xiàn)代醫(yī)家治療癲狂時(shí)，認(rèn)識全面，明辨氣血虛實(shí)，辨證選擇理氣、活血、治痰、解郁、降火、安神等不同治法。

關(guān)鍵詞 癲狂;癲狂夢醒湯;柴胡加龍骨牡蠣湯;精神分裂癥;甘麥大棗湯;痰;醫(yī)案;王清任

Medication Regularity by Modern Physicians in Treatment of Manic-depressive Psychosis

ZHANG Yijie，LI Jingjing，HANG Xiaoyi，SUN Wenjun

（1 Beijing University of Chinese Medicine，Beijing 100029，China; 2 The Third Affiliated Hospital

of Beijing University of Chinese Medicine，Beijing 100029，China）

Abstract Objective：To summarize the medication regularity by modern physicians in the treatment of manic-depressive psychosis based on relevant medical records.Methods：The medical records in the Ancient and Modern Medical Records Cloud Platform，CNKI，Collection of Famous TCM Doctors′ Experience，Academic Experience Collection of Prestigious TCM Experts in China，and Essence of Modern Chinese Medical Records were retrieved，collected，and sorted out to establish a database of medical records of manic-depressive psychosis treatment by modern physicians.The data of Chinese medicinal prescriptions were extracted.The Ancient and Modern Medical Records Cloud Platform and SPSS were used for frequency statistics，association analysis，and cluster analysis，and Gephi for complex network analysis to analyze the high-frequency drugs，key drug pairs，commonly used prescriptions，and core prescriptions used by modern physicians in the treatment of manic-depressive psychosis.Results：A total of 228 medical records were included，involving 363 Chinese medicinal prescriptions and 276 drugs.The high-frequency drugs included Glycyrrhizae Radix et Rhizoma，Pinelliae Rhizoma，Acori Tatarinowii Rhizoma，Rhei Radix et Rhizoma，Polygalae Radix，Curcumae Radix，Bupleuri Radix，Poria，Citri Reticulatae Pericarpium，and Scutellariae Radix.The commonly used drug pairs included Pinelliae Rhizoma-Citri Reticulatae Pericarpium，Acori Tatarinowii Rhizoma-Polygalae Radix，and Ossa Draconis-Ostreae Concha.As revealed by cluster analysis，the common prescriptions were classified into eight categories，including Diankuang Mengxing Decoction，Wendan Decoction，and Mengshi Guntan Pills.The core prescriptions were Longgu Muli Decoction modified with Bupleuri Radix，Ganmai Dazao Decoction，and modified Shiwei Wendan Decoction.Conclusion：Data analysis demonstrated that when treating manic-depressive psychosis，modern physicians explicitly clarified qi and blood，and asthenia and sthenia，and determined the therapeutic methods of regulating qi，promoting blood circulation，resolving phlegm，relieving depression，reducing fire，and soothing the nerves based on syndrome differentiation.

Keywords Manic-depressive psychosis; Diankuang Mengxing Decoction; Longgu Muli Decoction modified with Bupleuri Radix; Schizophrenia; Ganmai Dazao Decoction; Phlegm; Medical records; Wang Qingren

中圖分類號：R256.29文獻(xiàn)標(biāo)識碼：Adoi：10.3969/j.issn.1673-7202.2022.06.021

癲狂為精神失常的疾病，包含了近現(xiàn)代醫(yī)學(xué)中精神分裂癥、躁狂型分裂情感性障礙等多種疾病，癲者多語無倫次、沉默癡呆，或見靜而多笑，狂者則狂言妄語、喧擾不寧、甚者打人毀物。……