中医古籍中治疗嗅觉障碍的用药规律分析

doi:10.6040/j.issn.1673-3770.0.2022.203

摘要/Abstract

摘要： 目的采用数据挖掘方法对中医古籍中记载治疗嗅觉障碍的复方用药规律进行分析,提供一定的遣方用药参考来探讨治疗嗅觉障碍的方法。方法检索中医典海软件中治疗嗅觉障碍的中药(TCM)处方,导入Excel 2016软件中形成嗅觉障碍方剂数据库,将数据导入古今医案云平台进行方剂频次、TCM频次、TCM属性、TCM聚类分析、关联分析及复杂网络分析。结果共得到明确记载有方剂名称的方剂115首,其中辛夷散频次最高。TCM频次统计中,排前13味的中药包括细辛、防风、川芎、升麻、木通、瓜蒂、白芷、羌活、甘草、炙甘草、黄芪、麻黄、人参。中药四气统计中以温性、微温、寒性的中药为主。五味以辛、甘、苦为主。肺脾两经为归经统计中频次最高的经脉。祛风止痛、温肺化饮、祛风散寒、通窍等为功效统计中前几位的功效。对前10味TCM进行聚类分析可得到3组中药(Ⅰ:细辛、瓜蒂;Ⅱ:木通,川芎,炙甘草;Ⅲ:升麻、防风、羌活、白芷、甘草)。调整置信度和支持度进行关联分析筛选出13组关联性最强的TCM配伍,其中升麻-防风、川芎-细辛为最核心的配伍。复杂网络分析可以得到核心的9味TCM(川芎、细辛、升麻、防风、木通、白芷、羌活、瓜蒂、甘草),主要为具有发散外邪、宣通鼻窍的中药,其组成与辛夷散最相似。结论中医古籍治疗嗅觉障碍的TCM主要以归于手太阴肺经、足太阴脾经的解表药为主,同时也需注意,如结合患者病因病机,为机体虚弱(气血阴阳不足、宗气虚损)引起的嗅觉障碍,亦可施以补虚药。

关键词: 嗅觉障碍, 古籍, 数据挖掘, 用药规律, 古今医案云平台

Abstract: Objective Data mining method was used to analyze the prescription regularity of olfactory dysfunction recorded in ancient Chinese medicine literature. We aimed to provide a prescription reference for the way for treating olfactory dysfunction. Methods Traditional Chinese medicine(TCM)prescriptions from the Zhong Yi Dian Hai software for the treatment of olfactory dysfunction were retrieved, and the Excel 2016 software was utilized to form an olfactory dysfunction prescription database by importing the original data. Data were imported into the ancient and modern medical case cloud platform for prescription frequency, TCM frequency, TCM attributes, and TCM cluster, correlation, and complex network analyses. Results A total of 115 clearly recorded prescriptions were obtained, among which Xinyi San had the highest recorded frequency. In the TCM frequency statistics, the top 13 herbs included Asarum, Saposhnikovia divaricata, Ligusticum wallichii, Rattletop, Akebia quinata, Muskmelon pedicel, Radix angelicae dahuricae, Notopterygium root, liquorice, Prepared radix glycyrrhizae, Astragalus membranaceus, Ephedra, and Ginseng. It was found that warm, mild warm, and cold were the main characteristics among the four natures of herbs. Spicy, sweet, and bitter are the most common flavors among the five flavors of herbs. Lung and spleen meridians were the predominant meridians. According to data statistics, the most common uses for TCM include the following: dispelling wind and relieving pain, warming lungto reduce watery phlegm, dispelling wind and dispersing cold, and relieving stuffy nose. Three groups of TCM were obtained by conducting a cluster analysis of the top 10 TCM(I: Asarum and Muskmelon pedicel; II: Akebia quinata, Ligusticum wallichii, and Prepared radix glycyrrhizae; III: Rattletop, Saposhnikovia divaricate, Notopterygium root, Radix angelicae dahuricae, and liquorice). Correlation analysis was conducted by adjusting the confidence and support degrees to select 13 groups with the most relevant TCM compatibility, among which Rattletop, Saposhnikovia divaricata, Ligusticum wallichii, and Asarum were the most compatible. Based on the complex network analysis, nine core TCMs were obtained(Ligusticum wallichii, Asarum, Rattletop, Saposhnikovia divaricata, Akebia quinata, Radix angelicae dahuricae, Notopterygium root, Muskmelon pedicel, and liquorice), which functions in dispersing external evil and promoting clearance of nasal passages, the composition of which is similar to Xinyi San. Conclusion The ancient TCM treatments used for olfactory dysfunction are drugs for the diaphoretic drug, which is represented by the lung meridian of hand-taiyin and the spleen meridian of foot-taiyin. Moreover, attention should be paid to the etiology and pathogenesis of the disease and it should be determined whether the olfactory dysfunction was caused by the deficiency of Qi-Xue-Yin-Yang and qi deficiency so that treatment can be administered accordingly.

Key words: Olfactory dysfunction, Ancient Chinese medical literature, Data mining, Prescription regularity, Ancient and modern medical case cloud platform

中图分类号:

R276.1

朱锦祥,周敏,王睿智,李丹,方彩珊,陈腾宇,林曼青,阮岩. 中医古籍中治疗嗅觉障碍的用药规律分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 86-95.

ZHU Jinxiang, ZHOU Min, WANG Ruizhi, LI Dan, FANG Caishan, CHEN Tengyu, LIN Manqing, RUAN Yan. Prescription regularity analysis in treating olfactory dysfunction from ancient Chinese medicine literature[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(4): 86-95.

参考文献

[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 嗅觉障碍诊断和治疗专家共识(2017年)[J]. 中华耳鼻咽喉头颈外科杂志, 2018,53(7): 484-494
[2] Sedaghat AR, Gengler I, Speth MM. Olfactory dysfunction: a highly prevalent symptom of COVID-19 with public health significance[J]. Otolaryngol Head Neck Surg, 2020,163(1): 12-15. doi:10.1177/0194599820926464
[3] Whitcroft KL, Hummel T. Olfactory dysfunction in COVID-19: diagnosis and management[J]. JAMA, 2020, 323(24): 2512-2514. doi:10.1001/jama.2020.8391
[4] Huang Z, Huang SE, Cong HL, et al. Smell and taste dysfunction is associated with higher serum total cholesterol concentrations in Chinese adults[J]. J Nutr, 2017, 147(8): 1546-1551. doi:10.3945/jn.117.250480
[5] 姜彦, 张增潇. 嗅觉功能障碍诊治研究进展[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(3): 165-169. doi:10.16542/j.cnki.issn.1007-4856.2020.03.002 JIANG Yan, ZHANG Zengxiao. The diagnosis and treatment of olfactory dysfunction[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2020, 28(3): 165-169. doi:10.16542/j.cnki.issn.1007-4856.2020.03.002
[6] Doty RL. Age-related deficits in taste and smell[J]. Otolaryngol Clin North Am, 2018, 51(4): 815-825. doi:10.1016/j.otc.2018.03.014
[7] Hummel T, Whitcroft KL, Andrews P, et al. Position paper on olfactory dysfunction[J]. Rhinology, 2016, 56(1): 1-30. doi:10.4193/rhino16.248
[8] Croy I, Negoias S, Novakova L, et al. Learning about the functions of the olfactory system from people without a sense of smell[J]. PLoS One, 2012, 7(3): e33365. doi:10.1371/journal.pone.0033365
[9] 魏宏权. 嗅觉功能障碍的分类、评估和治疗[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(3): 161-164, 173. doi:10.16542/j.cnki.issn.1007-4856.2020.03.001
[10] 胡原, 施磊, 张守杰. 嗅觉障碍的中医古典文献解读[J]. 医学信息, 2018, 31(20): 150-151. doi:10.3969/j.issn.1006-1959.2018.20.046
[11] 巢元方. 诸病源候论[M]. 太原: 山西科学技术出版社, 2015: 348
[12] 邢汝雯. 黄帝内经灵枢篇[M]. 武汉: 华中科技大学出版社, 2017: 364
[13] 楼英明. 医学纲目[M]. 北京: 学苑出版社, 2021: 4480
[14] 朱棣. 普济方[M]. 北京: 人民卫生出版社, 1960: 1306
[15] 国家药典委员会. 中华人民共和国药典——一部2020年版[M]. 北京: 中国医药科技出版社, 2020
[16] 钟赣生. 中药学新世纪第4版[M]. 北京: 中国中医药出版社, 2016: 485
[17] 王肯堂. 证治准绳上[M]. 北京: 人民卫生出版社, 1991: 862
[18] 李冀, 连建伟. 方剂学[M]. 4版. 北京: 中国中医药出版社, 2016: 318
[19] 彭怀仁. 中医方剂大辞典-第七册[M]. 2版. 北京: 人民卫生出版社, 2017: 939
[20] 王领弟, 林映雪, 王莹, 等. 经典名方辛夷散的古今文献分析与考证[J]. 中国药房, 2021, 32(18): 2300-2304. doi:10.6039/j.issn.1001-0408.2021.18.20 WANG Lingdi, LIN Yingxue, WANG Ying, et al. Ancient and modern literature analysis and textual research on the classical prescription Xinyi Powder[J]. China Pharmacy, 2021, 32(18): 2300-2304. doi:10.6039/j.issn.1001-0408.2021.18.20
[21] 禄浩, 吴丽萍, 耿乃志, 等. 《普济方·针灸门》治疗胸痹心痛处方的选穴规律研究[J]. 中西医结合心脑血管病杂志, 2022, 20(5): 831-834 LU Hao, WU Liping, GENG Naizhi, et al. Study on the law of acupoint selection in the prescription of Puji Fang Acupuncture Gate for treating chest pain and heartache[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2022, 20(5): 831-834
[22] 张璐, 刘源香. 《普济方》治疗癫痫用药规律分析[J]. 中医药导报, 2022, 28(3): 119-123 ZHANG Lu, LIU Yuanxiang. Analysis on medication regularity of Puji Fang in the treatment of epilepsy[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy, 2022, 28(3): 119-123
[23] 刘泽芳. 名医类编[M]. 海口: 海南出版社, 2002
[24] 王倩倩, 陈豪, 辛泰然, 等. 基于数据挖掘的葶苈大枣泻肺汤“泻肺”内涵及临床配伍规律探析[J]. 世界科学技术—中医药现代化, 2021, 23(7): 2434-2439. doi:10.11842/wst.20200907005 WANG Qianqian, CHEN Hao, XIN Tairan, et al. Analysis on the connotation and clinical compatibility of Tingli Dazao Xiefei Decoction based on data mining[J]. Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology, 2021, 23(7): 2434-2439. doi:10.11842/wst.20200907005
[25] 赵佶. 圣济总录[M]. 北京:人民卫生出版社, 2013: 1427
[26] 周学霆. 三指禅[M]. 北京: 中国医药科技出版社, 2020: 140
[27] 史珍, 刘玉霞, 蔡成森, 等. 免疫检查点抑制剂相关性肺炎的中医诊治探索[J]. 实用心脑肺血管病杂志, 2021, 29(11): 120-124 SHI Zhen, LIU Yuxia, CAI Chengsen, et al. TCM diagnosis and treatment of immune checkpoint inhibitors associated with pneumonia[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2021, 29(11): 120-124
[28] 赵政, 色佳鸿, 石光. 偏头痛非头痛症状的中医辨证[J]. 中医药导报, 2021, 27(1): 207-210 ZHAO Zheng, SHAI Jiahong, SHI Guang. TCM syndrome differentiation of migraine non-headache symptoms[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy, 2021, 27(1): 207-210
[29] 吴普. 神农本草经[M]. 上海: 第二军医大学出版社, 2012: 293
[30] 郭君双, 魏启亮, 程英, 等. 食物本草点校本[M]. 北京: 人民卫生出版社, 2018: 567
[31] 李时珍. 本草纲目[M]. 呼和浩特: 内蒙古人民出版社, 2008: 338
[32] 李亚敏, 周祯祥, 韩林涛, 等. 细辛启动大鼠嗅觉识别体系与归肺经相关性研究[J]. 中华中医药杂志, 2019, 34(12): 5911-5914
[33] PATEL Z M, HOLBROOK E H, TURNER J H, et al. International consensus statement on allergy and rhinology: Olfaction[J]. Int Forum Allergy Rhinol, 2022, 12(4): 327-680
[34] Zendehbad AS, Noroozian M, Shakiba A, et al. Validation of Iranian Smell Identification Test for screening of mild cognitive impairment and Alzheimer's disease[J]. Appl Neuropsychol Adult, 2022, 29(1): 77-82. doi:10.1080/23279095.2019.1710508
[35] 代丽丽, 汤维, 解道宇, 等. 慢性鼻窦炎患者鼻内窥镜术后嗅觉改善不佳的预测模型构建分析[J]. 中华全科医学, 2022, 20(2): 246-250 DAI Lili, TANG Wei, XIE Daoyu, et al. Construction and analysis of predictive model of poor olfactory improvement in patients with chronic rhinosinusitis after endoscopic surgery[J]. Chinese Journal of General Practice, 2022, 20(2): 246-250
[36] 张丽川, 李希平, 胡春华, 等. 门诊过敏性鼻炎患者嗅觉障碍的调查研究[J]. 中国耳鼻咽喉头颈外科, 2019,26(08): 410-414. doi:10.16066/j.1672-7002.2019.08.003 ZHANG Lichuan, LI Xiping, HU Chunhua, et al. Investigation of olfactory disfunctions in outpatients with allergic rhinitis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(8): 410-414. doi:10.16066/j.1672-7002.2019.08.003
[37] Melis M, Haehner A, Mastinu M, et al. Molecular and genetic factors involved in olfactory and gustatory deficits and associations with Microbiota in Parkinson's disease[J]. Int J Mol Sci, 2021, 22(8): 4286. doi:10.3390/ijms22084286
[38] Maslyukov A, Li K, Su X, et al. Spontaneous calcium transients in the immature adult-born neurons of the olfactory bulb[J]. Cell Calcium, 2018, 74: 43-52. doi:10.1016/j.ceca.2018.06.001
[39] 阮岩. 中医耳鼻咽喉科学[M]. 2版. 北京: 人民卫生出版社, 2016: 134-140
[40] 黄帝内经[M]. 沈阳: 万卷出版公司, 2011: 533
[41] 顾莹莹, 焦富英. 中医辨证分型论治帕金森病的研究进展[J]. 中西医结合心脑血管病杂志, 2022, 20(5): 880-882 GU Yingying, JIAO Fuying. Research progress on treatment of Parkinson's disease based on TCM syndrome differentiation[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2022, 20(5): 880-882
[42] LEE A, GILBERT RM. Epidemiology of Parkinson Disease[J]. Neurol Clin, 2016, 34(4): 955-965
[43] 朱丹, 刘智斌, 牛文民, 等. 探讨“嗅三针”的理论渊源[J]. 四川中医, 2018, 36(2): 38-40
[44] 王蒙, 孙延平, 王知斌, 等. 中药性味理论研究评析与展望[J]. 中华中医药杂志, 2021, 36(2): 625-628 WANG Meng, SUN Yanping, WANG Zhibin, et al. Comment and prospect of research on TCM nature and flavour theory[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2021, 36(2): 625-628
[45] 危亦林. 世医得效方[M]. 上海: 上海科学技术出版社, 1964: 1028
[46] 史晶晶, 时博, 苗明三. 细辛外用抗炎镇痛作用研究[J]. 中医学报, 2011,26(10): 1191-1193 SHI Jingjing, SHI Bo, MIAO Mingsan. Anti-inflammatory and analgesic effects of Asarum for external use[J]. Acta Chinese Medicine, 2011, 26(10): 1191-1193
[47] 李娜, 高昂, 巩江, 等. 瓜蒂类药材药学研究进展[J]. 安徽农业科学, 2011, 39(14): 8369-8370 LI Na, GAO Ang, GONG Jiang, et al. Research advance on pharmaceutical science of melon pedicle[J]. Journal of Anhui Agricultural Sciences, 2011, 39(14): 8369-8370
[48] 张晓娟, 张燕丽, 左冬冬. 川芎的化学成分和药理作用研究进展[J]. 中医药信息, 2020, 37(6): 128-133 ZHANG Xiaojuan, ZHANG Yanli, ZUO Dongdong. Research progress on chemical constituents and pharmacological effects of Ligusticum chuanxiong hort[J]. Information on Traditional Chinese Medicine, 2020, 37(6): 128-133
[49] 严用和. 严氏济生方[M]. 北京: 中国医药科技出版社, 2012
[50] Chen G, Wei Y, Miao X, et al. Clinical features of olfactory disorders in patients seeking medical consultation[J]. Med Sci Monit, 2013, 19: 444-450. doi:10.12659/msm.883938
[51] 邢栋, 魏宏权. 嗅觉训练治疗嗅觉障碍的研究进展[J]. 中国中西医结合耳鼻咽喉科杂志, 2022,30(4): 317-320 XING Dong, WEI Hongquan. Research progress of olfactory training in the treatment of olfactory disorders[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2022, 30(4): 317-320
[52] 黄悦, 翟志远, 郑金龙, 等. 帕金森病嗅觉障碍研究进展[J]. 浙江医学, 2022, 44(5): 543-547, 551. doi:10.12056/j.issn.1006-2785.2022.44.5.2021-1760 HUANG Yue, ZHAI Zhiyuan, ZHENG Jinlong, et al. Research progress of olfactory disorder in Parkinson's disease[J]. Zhejiang Medical Journal, 2022, 44(5): 543-547, 551. doi:10.12056/j.issn.1006-2785.2022.44.5.2021-1760
[53] 鲍倩, 赵亚伟, 霍晓晓, 等. 中医药治疗帕金森病非运动症状研究进展[J]. 现代中西医结合杂志, 2019, 28(35): 3986-3990. doi:10.3969/j.issn.1008-8849.2019.35.029 BAO Qian, ZHAO Yawei, HUO Xiaoxiao, et al. Research progress in treating non-motor symptoms of Parkinson's disease with traditional Chinese medicine[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2019, 28(35): 3986-3990. doi:10.3969/j.issn.1008-8849.2019.35.029
[54] Stewart SA, Pimer L, Fisk JD, et al. Olfactory function and diffusion tensor imaging as markers of mild cognitive impairment in early stages of Parkinson's disease[J]. Clin EEG Neurosci, 2021: 15500594211058263. doi:10.1177/15500594211058263

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed