中医药治疗肠易激综合征的专家经验挖掘分析

目的肠易激综合征（irritable bowel syndrome，IBS）作为一种功能性胃肠病，发病机制复杂，中医药综合治疗较西医具有明显的优势。本文旨在挖掘分析中医药治疗IBS的专家经验。方法以“肠易激综合征”为主题词，系统检索中国期刊全文数据库和博士、硕士学位论文全文数据库1994―2012年来所有相关资料，筛选有效医案，采用结构化电子病历采集系统建立数据库，进行数据挖掘，分析现代医家治疗IBS的思路和用药经验。结果共筛选了46名中医药专家的116个医案，结果显示脾虚、肝郁为IBS最基本的证候要素，寒湿、湿热、阳虚、肾虚为腹泻型IBS的演变证候要素，气滞、阴虚、气虚、血瘀为便秘型IBS的演变证候要素，疏肝健脾为最主要治法，白芍、炒白术、炙甘草、陈皮、茯苓、柴胡、防风、党参、木香为最常用的药物。结论（1）肝郁脾虚为IBS的关键病机，临床当根据其病机演变进行诊治，以痛泻要方为基础方加减用药是IBS最主要的病证结合思路。（2）数据挖掘在医案研究中具有良好的应用前景。

英文摘要:

ObjectiveThe pathogenesis of irritable bowel syndrome （IBS）， a functional gastrointestinal disorder， is poorly understood. Treatment by Chinese medicine and pharmacy （CMP） is superior to treatment by Western medicine （WM）. Therefore， we aimed to analyze Chinese medical experts′ experiences in treating IBS by data mining. MethodsBy retrieving related literatures from 1994 to 2012 from CNKI， we chose proved cases and screened effective medical records to establish a database using structural electronic medical case collecting system and data mining. The thinking ways of modern physicians in diagnosis and treatment of IBS were analyzed. ResultsTotally 116 medical cases from 46 Chinese medical experts were recruited and analyzed. Results showed that Gan depression and Pi deficiency were most basic syndrome elements. In addition， cold dampness， damp heat， yang deficiency， and Shen deficiency were main elements for the development of diarrhea predominant IBS （IBS D）. Qi stagnation， yin deficiency， qi deficiency， and blood stasis were main elements for the development of constipation predominant IBS （IBS C）. Soothing Gan qi and strengthening Pi was the most important treatment method. White peony root， prepared atractylodes， prepared licorice， tangerine peel， poria， bupleurum， Radix sileris， lanceolata， and Radix aucklandiae were the most common Chinese herbs used in treating IBS. Conclusions（1） Gan depression and Pi deficiency was the main pathogenesis for IBS. Diagnosis and treatment of IBS should be performed clinically according to its development. Tongxie Yaofang should be used as the basic prescription with modification according to syndrome differentiation. （2） Data mining will have a wide application prospect in studying medical cases.

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