Medication rule of Professor Cui Yun in treating oligoasthenozoospermia based on data mining
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摘要:
目的 研究崔云教授治疗少弱精子症的中医用药规律，探索崔云教授治疗少弱精子症的处方经验及临床思路。 方法 筛选整理2019年1—12月期间在宁波市中医院崔云教授门诊就诊的男性不育少弱精子症患者200例，收集首次中药处方，提取方药信息，建立用药数据库，对常用药物进行频数统计，对药物性味、归经、功效进行描述性统计，并运用聚类分析挖掘崔云教授治疗少弱精子症常用的药物组合和组方。 结果 崔云教授治疗少弱精子症常用中药为87味，使用共计2 425药次。使用频次排前50味的药物累积频率达95.46%。药物功效前5位依次为补虚药、清热药、利水渗湿药、活血化瘀药、收涩药。药性以寒、温、平为主，无大寒大热之药；药味以苦、甘、辛为主。药物归经以脾、肝、肾为主。高频药物聚类分析显示崔云教授治疗少弱精子症的常用处方有：六味地黄汤、活血方、当归六黄汤、当归补血汤、自拟“脱敏煎”、二至丸；常用药物组合有：生谷芽、生麦芽；麦冬、五味子；生地榆、虎杖；豨签草、贯众、升麻等。 结论 崔云治疗少弱精子症围绕“肾虚为本、湿热瘀毒为标”这一病机，治疗上以补虚为主，重视清热利湿、活血化瘀在治疗中的作用，肝肾同调、脾肾同治，用药寒温并重，清补平调，平和轻灵。 Abstract:Objective To investigate the medication rule, prescription experience and clinical ideas of Professor Cui Yun in treating oligoasthenozoospermia. Methods The first prescriptions of 200 oligoasthenozoospermia patients who were treated by Professor Cui Yun between January 2019 and December 2019 in Ningbo TCM Hospital were collected and extracted. The database was established. The nature, taste, meridian tropism and efficacy of drugs were analysed by descriptive statistics, and the drug combinations and prescriptions commonly used by Professor Cui Yun in the treatment of oligoasthenozoospermia were analysed use cluster analysis. Results There were 87 herbs and 2 425 frequencies in the 200 prescriptions. The frequency of the top 50 herbs was up to 95.46%, and the top five herbs were energy-restoring herbs, heat-clearing herbs, urine-promoting herbs, blood circulation-promoting herbs and astringent herbs. The properties were cold, warm and neutral, and never great cold or hot herbs. The tastes were bitter, sweet and acrid. The main meridian entries were spleen, kidney and liver. The cluster analysis showed that the common prescriptions of Professor Cui Yun in treating oligoasthenozoospermia were Liu wei Di huang Soup, Huoxue Prescription, Dang gui Liu huang Soup, Dang gui Buxue Soup, Tuomin Soup and Erzhi Pills, and the common drug groups were Guya and Maiya, Maidong and Wuweizi, Shengdiyu and Huzhang, Xiqiancao Guanzhong and Shengma. Conclusion The medication rule of Professor Cui Yun in treating oligoasthenozoospermia complies with the pathological mechanism of kidney deficiency, damp heat and stasis toxin. The prescription is based on supporting weakness, taking clearing away heat and urine, activating blood circulation into account, and attaching importance to spleen and kidney, or liver and kidney. On the other hand, the data mining of the herbs' property reflects the equal stress on coldness and warmness, removing and tonifying, the prescription is gentle and flexible in brief. -
表 1 崔云教授治疗少弱精子症处方中药统计情况(使用频次排前50位)
Table 1. Statistics of Professor Cui Yun' s prescription of traditional Chinese Medicine for oligoasthenospermia (top 50 in frequency of use)
次序 药物 频次 频率(%) 次序 药物 频次 频率(%) 次序 药物 频次 频率(%) 1 黄芩 175 87.50 18 柴胡 46 23.00 35 干姜 18 9.00 2 茯苓 159 79.50 19 续断 46 23.00 36 姜半夏 18 9.00 3 当归 142 71.00 20 生甘草 42 21.00 37 生山栀 18 9.00 4 红枣 132 66.00 21 豨签草 35 17.50 38 丹参 17 8.50 5 生地黄 128 64.00 22 升麻 34 17.00 39 防风 17 8.50 6 牡丹皮 105 52.50 23 生白术 33 16.50 40 刘寄奴 14 7.00 7 泽泻 104 52.00 24 黄连 31 15.50 41 麦冬 13 6.50 8 生白芍 92 46.00 25 黄柏 30 15.00 42 熟地黄 11 5.50 9 山药 88 44.00 26 枳实 28 14.00 43 片姜黄 10 5.00 10 山茱萸 88 44.00 27 贯众 27 13.50 44 炙紫菀 10 5.00 11 徐长卿 65 32.50 28 虎杖 25 12.50 45 生谷芽 8 4.00 12 生山楂 61 30.50 29 党参 22 11.00 46 生麦芽 8 4.00 13 川芎 61 30.50 30 连翘 22 11.00 47 五加皮 8 4.00 14 生黄芪 61 30.00 31 红花 20 10.00 48 蝉衣 8 4.00 15 生地榆 58 29.00 32 桃仁 20 10.00 49 鸡血藤 8 4.00 16 女贞子 54 27.00 33 墨旱莲 19 9.50 50 乌梅 7 3.50 17 五味子 51 25.50 34 秦皮 18 9.00 注: 频次=单味药在200首处方中出现的次数；频率=单味药使用频次/处方总数×100%。 
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表 2 中药性味频次与频率统计
Table 2. Statistics of frequency of Chinese herbal medicines property and flavor
药性 频数 频率(%) 药味 频数 频率(%) 寒 585 24.12 辛 703 14.16 微寒 458 18.89 甘 1 248 25.14 热 18 0.74 微甘 42 0.85 温 633 26.10 酸 408 8.22 微温 295 12.16 苦 2 176 43.83 凉 65 2.68 微苦 41 0.83 平 371 15.30 咸 5 0.10 淡 163 3.28 涩 179 3.61 注：频数=同类中药属性药物在200首处方中出现的次数；频率=某类中药属性频次/总频次×100%。
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表 3 中药的归经频次与频率统计
Table 3. Statistics of frequency of Chinese herbal medicines meridian entry
归经 频数 频率(%) 归经 频数 频率(%) 脾 1 270 18.39 大肠 415 6.01 肝 1 267 18.34 胆 360 5.21 肾 995 14.41 小肠 197 2.85 心 955 13.83 膀胱 153 2.22 胃 708 10.25 心包 78 1.13 肺 491 7.11 三焦 18 0.26 注：频率=各归经总频次/十二经总频次×100%。
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表 4 中药功效类别频次与频率统计
Table 4. Statistics of frequency of Chinese herbal medicines efficacy categories
药物类别 功效 味数 频次 频率(%) 药物类别 味数 频次 频率(%) 补虚药 补气 8 383 15.79 解表药 10 116 4.78 补血 3 245 10.10 祛风湿药 5 111 4.58 补阴 5 95 3.92 消食药 3 77 3.18 补阳 4 52 2.14 止血药 2 58 2.39 清热药 清热燥湿 5 281 11.59 理气药 4 41 1.69 清热凉血 3 234 9.65 化痰止咳平喘药 4 31 1.28 清热解毒 1 22 0.91 温里药 1 18 0.74 清热泻火 2 21 0.87 安神药 3 10 0.41 清虚热 2 5 0.21 化湿药 2 9 0.37 利水渗湿药 5 296 12.21 泻下药 1 5 0.21 活血化瘀药 9 160 6.60 平肝熄风药 1 4 0.16 收涩药 4 150 6.19 开窍药 1 1 0.04 注：味数=相同功效中包含的药味数；频次=同类药物中单味药出现频次之和；频率=某类药物频次/药物总频次(2 425)×100%。
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表 5 聚类分析所得药物组合
Table 5. Results of drug combination cluster analysis
序号 药物组合 1 生谷芽、生麦芽 2 麦冬、五味子 3 生地榆、虎杖 4 生山楂、片姜黄 5 豨签草、贯众、升麻 6 续断、丹参、五加皮 7 党参、姜半夏、干姜
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表 6 聚类分析所得药物组方
Table 6. Results of drug formulae cluster analysis
序号 药物组方 1 生地黄、山药、山茱萸、牡丹皮、茯苓、泽泻 2 柴胡、生白芍、枳实、生甘草、桃仁、红花、川芎 3 当归、黄芪、黄芩、黄柏、黄连、熟地黄、生山栀 4 当归、黄芪 5 徐长卿、防风、乌梅、蝉衣 6 女贞子、墨旱莲
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