《丹溪心法》在慢性腎臟病治療中的臨床應用及用藥規律分析

Clinical Application and Medication Regularity Analysis of ''Danxi's Mastery of Medicine'' in the Treatment of Chronic Kidney Disease

目的：分析《丹溪心法》中適用於慢性腎臟病之方藥，闡述其辨證思維、用藥配伍特點、藥物關聯規則，供臨床參考。材料與方法：利用ChatGPT比較蒐集《丹溪心法》與慢性腎臟病症狀相關之中醫病症及方藥，利用Microsoft 365 Excel統計藥物頻次。使用IBM SPSS Statistics及Cytoscape進行藥物複雜網路分析，歸納核心高頻用藥。針對核心高頻用藥進行Apriori演算法及階層式集聚分析法之關聯規則分析，推測出藥物組合。結果：高頻核心用藥為茯苓、熟地黃、人參等；功效為補脾腎、補血、利水；藥味為甘>苦>辛；藥性為溫>寒>平；歸經為脾、腎經。Apriori演算法得出六味地黃丸與其衍方；階層式集聚分析法獲得封髓丹相關方藥。結論：朱丹溪治療慢性腎臟病與其症狀，注重脾腎虧虛、血瘀、痰濕等病因病機，治法以補益脾腎、補血活血、利水滲濕。可以六味地黃丸或其衍方，搭配封髓丹、補腎陽、利水等藥物隨證加減。

Objective: This study aims to analyze the Traditional Chinese Medicines(TCMs) from ''Danxi's Mastery of Medicine'' applicable to chronic kidney disease (CKD), elucidating the diagnostic principles, characteristics of TCMs combinations, and drug association rules for clinical reference. Materials and Methods: Using ChatGPT3.5, this study collected and compared traditional Chinese medical symptoms and corresponding TCMs related to CKD symptoms described in ''Danxi's Mastery of Medicine''. Microsoft 365 Excel was utilized for frequency analysis of TCMs. IBM SPSS Statistics 18 and Cytoscape 3.9.0 were used for complex network analysis of the drugs to identify core high-frequency medications. Association rule analysis using the Apriori algorithm and hierarchical clustering was conducted to hypothesize potential herbal combinations. Results: The core high-frequency medications included Poria, Rehmannia glutinosa, Ginseng, Honey-fried Licorice Root, and Chinese Yam. The primary functions of these TCMs were to strengthen the spleen and kidney, enrich the blood, invigorate blood circulation, and promote diuresis and dampness removal. The predominant flavors of these TCMs were sweet > bitter > pungent, and their properties were mainly warm > cold > neutral, primarily associated with the spleen and kidney meridians. Combinations derived from the Apriori algorithm were classified under Liu Wei Di Huang Wan and its derivatives, while hierarchical clustering analysis identified related TCMs of San Cai Feng Sui Dan. Conclusion: Zhu Dan-xi’s approach to treating CKD and its common symptoms emphasizes the pathological mechanisms of spleen and kidney deficiency, blood stasis and deficiency, as well as phlegm-dampness. The therapeutic methods focus primarily on nourishing the spleen and kidney, enriching and invigorating the blood, supplemented by promoting diuresis and dampness removal, consolidating essence, and clearing heat and dryness. Formulations like Liu Wei Di Huang Wan and its derivatives, combined with Feng Sui Dan, kidney-yang tonics, and diuresis-promoting herbs can be adjusted according to specific symptoms.