Abstract:

Objective　To analyzed the medication rules of differentiation and treatment of rheumatoid arthritis (RA) by Zhang Minghe and Fan Yongsheng. Methods　The data mining method was used. One hundred and fifty-two patients with RA treated at Zhang Minghe Clinic and 125 patients at Fan Yongzhen Clinic from April 2018 to December 2019 were selected; each patient's information was collected more than 3 times; among which, the 1-3 treatment times with good efficacy were selected, and 217 effective treatment times were obtained from Zhang, and 201 from Fan. With the help of "Ancient and Modern Medical Records Cloud Platform (V2.1)", the data of the two professors' cases were sorted out, the similarities and differences of the cases were compared and analyzed, and the rules and characteristics of the differentiation and treatment of RA were summarized. Results　Among the 217 treatment times by Zhang, the top 2 Zhengsu were phlegm dampness [56.68% (123/217)] and cold[50.69% (110/217)], and the tope 2 syndrome types were cold-dampness obstruction [43.78% (95/217)] and damp-heat obstruction [21.20% (46/217)]. The categories of commonly used Chinese medicine were wind-dampness drugs, heat-clearing drugs, blood-activating drugs for removing blood stasis, etc. According to association rule analysis, there was no correlation between the efficacy of commonly used Chinese medicine and its highly correlated Zhengsu and syndrome types. The core prescriptions were obtained through complex network analysis. The common treatment methods in the 201 treatment times by Fan were Tongluo, dispelling wind, dispelling dampness, Yiyin, and so on. The categories of commonly used Chinese medicine were deficiency tonifying drugs, wind-dampness dispelling drugs, surface relieving drugs, etc. Through the analysis of association rules, it found that the treatment method was consistent with the efficacy of traditional Chinese medicine with high correlation. Through complex network analysis, it found that the Tongluo method was highly correlated with other treatment methods. Conclusion　Zhang pays attention to disease differentiation and drug use, and takes the "clearing heat and detoxifying method" as the basic treatment; Fan pays attention to syndrome differentiation and treatment, and often makes flexible differentiation and treatment according to the syndrome types. The common rules of the two for RA are dispelling wind and removing dampness, Tongluo, clearing heat and detoxifying, activating blood circulation and removing blood stasis, and Fuzheng and protecting the stomach.

Key words:

Rheumatoid arthritis, Disease differentiation and treatment, Combination of disease and syndrome

摘要：

目的　分析张鸣鹤、范永升教授辨治类风湿关节炎的用药规律。方法　采用数据挖掘方法，选取2018年4月至2019年12月就诊于张鸣鹤教授门诊的类风湿关节炎患者152例，其中男9例、女143例，年龄25～76岁；选取同时间就诊于范永升教授门诊的类风湿关节炎患者125例，其中男15例、女110例，年龄23～89岁。每名患者收集3次以上信息，从中选取疗效较好诊次1～3次，获得张鸣鹤教授有效诊次217次，范教授有效诊次201次。以“古今医案云平台（V2.1）”为工具，分别对两位教授验案进行数据整理，对比验案异同点，总结辨治类风湿关节炎的规律和特色。结果　张鸣鹤教授验案217诊次中证素分布频率前2位分别为痰湿［56.68%（123/217）］、寒［50.69%（110/217）］，证型分布频率前2位分别为寒湿痹阻证［43.78%（95/217）］、湿热痹阻证［21.20%（46/217）］；常用中药类别为祛风湿药、清热药、活血化瘀药等；通过关联规则分析得知，常用中药功效与其高关联度证素、证型无相关性；通过复杂网络分析获得核心处方为金银花、大血藤、雷公藤、虎杖、板蓝根、羌活、独活、地枫皮、川芎、川牛膝、桂枝。范永升教授验案201诊次中常用治法有通络、祛风、利湿、益阴等；常用中药类别为补虚药、祛风湿药、解表药等；通过关联规则分析得知，治法与其高关联度中药功效相吻合；通过复杂网络分析得知，“通络法”与其他治法均有高度关联。结论　张鸣鹤教授重视辨病用药，以“清热解毒法”为基础治疗，范永升教授重视辨证论治，常根据证型差异灵活辨治，两位教授对类风湿关节炎共有规律为祛风除湿、通络、清热解毒、活血化瘀、扶正护胃。

关键词:

类风湿关节炎, 辨病论治, 病证结合