老年期痴呆古代医案改良层次分析

作者	单位
孙岩,吴承艳,崔书克	1.河南中医药大学康复医学院（郑州 450058）；2.南京中医药大学中医药文献研究所（南京 210023）；3.河南中医药大学经方方证研究所（郑州 450058）

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中文摘要:

目的收集、整理关于老年期痴呆的古代医案，总结古代医家对老年期痴呆病的认识，补充病因病机理论，探寻辨证规律，为临床提供文献学参考。方法以第5版《中华医典》为主要范围，网络APP“翰堂典藏数据库”和“超星图书”为参照和补充，检索“健忘、痴呆、神呆、不慧”等关键词，收集相关医案。对医案进行改良层次分析，对经过加权赋值的诊疗经验进行总结。结果脏腑辨证加权总频次由高到低依次为心肾不交、心血不足、痰火蒙心等。气血津液辨证加权总频次由高到低依次为痰证、津液不足、气血两虚等。虚实辨证加权总频次由高到低依次为虚证、虚实夹杂证和实证。涉及的脏腑加权总频次由高到低依次为心、肝、胆等。治疗以补虚药、安神药和清热药等为主，远志、麦冬、酸枣仁等 33味中药高频次出现。结论本病以虚证为主并尤以阴虚为多见，病位主要在心。在方证对应上有两个显著特点：第一是病位以心为主而用药归肺经为最多；第二是病性属阴虚、血虚居多而用药偏重补气、补阳。

英文摘要:

Objective To collect and organize ancient medical records on senile dementia， to summarize ancient physicians' understanding of senile dementia， to supplement the theory of etiology and pathogenesis， to explore the law of syndrome differentiation， thus providing bibliographic reference for clinical practice. Methods Taking the fifth edition of "Chinese Medical Classics" as the main scope， and the online APP "Hantang Collection Database" and "Chaoxing Books" as reference and supplements， search for keywords such as "forgetfulness， dementia， delusion， and ignorance" to collect relevant medical records. An improved analytic hierarchy process（AHP） was carried out on medical records， and the weighted diagnosis and treatment experience was summarized. Results From high to low， the total weighted frequency of visceral syndrome differentiation was in the order of Xin-Shen incoordination， lack of Xin-blood， and phlegm-fire moistening Xin. The weighted total frequency of syndrome differentiation of qi， blood， and body fluid was sequenced from high to low as phlegm syndrome， insufficient body fluid， deficiency of both qi and blood. The weighted total frequency of syndrome differentiation of deficiency and excess from high to low was sequenced as deficiency syndrome， mixed syndrome of deficiency and excess， and excess syndrome. The weighted total frequency of the organs involved from high to low was sequenced as Xin， Gan， Dan， and so on. The treatment was mainly based on tonics， tranquilizers， and heat-clearing drugs， and 33 traditional Chinese medicines such as Polygala， Ophiopogon japonicus， and Semen Zizyphi Spinosae appear frequently. Conclusions Senile dementia is mainly based on deficiency syndrome and is especially common with yin deficiency， and the disease location is mainly in Xin. There are two notable characteristics in the correspondence between prescriptions and syndromes： the first is that it is mainly located in Xin， and the most medicines go to the lung meridian； the second is that yin deficiency and blood deficiency are mostly seen， and the medicines focus on invigorating qi and supplementing yang.

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