目的:《名医类案》、《续名医类案》所载医案是明清以前中医医案的精华,古代医案是具有中医临床诊疗特色的数据信息来源,对其进行系统整理与挖掘,为揭示"肾藏精"的科学内涵提供文献依据。方法:对《名医类案》、《续名医类案》进行版本认定、文字校对和名词术语标准化,以从肾论治医案为研究对象,建立医案的纳入、排除标准,理清从肾论治医案共521例,通过数据库知识发现(KDD)技术,对医案的病名、证名、体质、病因、病机、症状、治则、治法、方剂、中药、针灸、调护等内容分类系统研究,并以上述12项内容为变量,进行频数聚类和关联分析。结果:《名医类案》、《续名医类案》从肾论治医案来自163种疾病,可见证名23种,有明确体质内容描述的有33例;156例医案明确了致病因素,房劳虚损为首要病因;334例医案具有病机分析内容,可总体上分为13类,其中肾阴虚为最常见病机;包含不可拆分症状要素1 500多种,小便异常为第一主症;126例医案中能体现出治则,扶正固本应用频率最高;该类医案中出现治法58种,使用方剂189条,中药206种,腧穴23个,83例医案中有调护内容。此外,数据挖掘管理平台可显示任两个变量间的关联分析结果。结论:基于KDD技术,从古代医案入手,提炼从肾论治的关联性、规律性知识,可以从一个新的视角深刻解读肾藏象理论,推广应用深入研究中医理论,从而指导临床实践。
Objective: The clinical records in the 'classified medical records of famous doctors' and 'supplement to classified medical records of famous doctors' are elite among all the clinical records before Ming and Qing Dynasty. In order to reveal the nature of kidney-storing essence, ancient clinical records are sorted out systemetically, which is the reservoir of feature clinical information. Methods: Through version identifying, proof-reading, vocabulary of terms-standardization, the clinical records of treating kidney are clarified, as the object of study including 521 clinical records, by the method of records-establishing and standard-identifying. The 12 variable including name of disease, syndrome type, constitution, etiology, pathogenesis syndrome, treating principle, therapy, prescription, traditional Chinese medicine and nursing are arranged systematically through the technology of KDD. A new understanding of Kidney-Visceral Manifestation theory is established by the method of finding correlation and regulation of treating kidney and association analysis, which can direct the clinical treatment. Results: There are 23 syndrome types and 33 detail-descriped types among 163 diseases about the treatment through kidney in these two books. Exhaustion due to sexual indulgence is dominant of 156 clinical records. 334 clinical records with details of pathogenesis can be sorted in 13 catergories, which kidney-Yin deficiency are the most common pathogenesis. Dysfunction of urination is dominant of more than 1 500 elements. Strengthening the body resistance to consolidate the constitution as the rule of treatment is used mostly in 126 clinical records. There are 58 therapies, 189 priscriptions, 206 kinds of Chinese traditional medicine, 26 acupoints in theseclinical records. Conclusion: To find relevance and regularity of treatment through kidney can provide a new understanding of Kidney-Visceral Manifestation through conclusions of wide indication of treating kidney, growing kidney-qi slowly, to strengthe