吴朦 唐仕欢

摘要 目的：基于国医大师诊治肝郁证候的医案，发掘肝郁证候的诊治规律。方法：检索1999年12月至2020年11月收录于检索国家知识基础设施数据库（CNKI）的国医大师肝郁证候医案，运用频次统计、关联规则、聚类分析等方法进行数据挖掘。结果：分析40位国医大师共258则医案，肝郁证候主要表现为失眠、烦躁、食少、疲乏、月经异常等，常兼夹脾虚、血瘀、湿热、痰湿等证候，遣方用药多以柴胡疏肝散、四逆散、逍遥丸、温胆汤等为基础方，根据兼夹证候具体化裁。结论：国医大师针对肝郁证候治疗的用药平实，重在辨治与精准用药，其理论与诊治经验值得临床应用与推广。

关键词 国医大师;肝郁;证候;诊治规律;临床医案;数据挖掘

Abstract Objective：To explore the rules of diagnosis and treatment of liver depression syndrome based on the medical cases of TCM masters.Methods：The medical cases of liver depression syndrome of traditional Chinese medicine masters collected in CNKI from December，1999 to November，2020 were retrieved，and the data mining methods such as frequency statistics，association rules and cluster analysis were used.Results：A total of 258 medical cases of 40 Chinese medical master were analyzed.The syndrome of liver depression was mainly characterized by insomnia，irritability，poor appetite，fatigue，abnormal menstruation，etc.And it was often combined with spleen deficiency，blood stasis，damp-heat，phlegm dampness，etc.The prescription was mainly based on Chaihu Shugan powder，Sini powder，Xiaoyao pill，Wendan decoction，etc.The prescription was specified according to accompanying syndromes.Conclusion：The Traditional Chinese Medicine master′s medication for the treatment of liver depression syndrome is simple in the usage of medicinal，focusing on differentiation and precision medication，and its theory as well as diagnosis and treatment experience are worth clinical application and promotion.

Keywords Masters of TCM;Liver stagnation;Syndrome;Rules of Diagnosis and Treatment; Clinical medical cases; Data mining

中圖分类号：R249文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.24.021

医案是中医临证的记录，是诊疗过程中的宝贵资料。名老中医、国医大师等顶级中医医家的医案更是承载了其学术思想与临证经验，具有很高的学术研究价值。近年来，数据挖掘技术与方法在中医药研究领域的应用日益广泛，特别是在名老中医经验传承中发挥着重要作用[1-2]。针对中医医案的数据挖掘已有报道，对名医临证经验总结具有重要意义，但多以一家一病的用药经验挖掘为主，针对国医大师群体的医案挖掘研究有待更多的关注[3]。本研究以国医大师医案为研究群体，基于已公开发表的临床有效医案报道，选择临床常见的肝郁证候相关医案作为研究对象，进一步分析肝郁证候的疾病分布和四诊信息，以及国医大师治疗肝郁证候的用药经验。……