基于贝叶斯网络探讨姜良铎教授从状态论治慢性阻塞性肺疾病的用药规律*
作者：吴建军1，张 沂1，杜维莎1，李奕璇1，姜良铎2
单位：1.北京中医药大学第三附属医院，北京 100029；2.北京中医药大学东直门医院，北京 100700
引用：引用：吴建军，张沂，杜维莎，李奕璇，姜良铎.基于贝叶斯网络探讨姜良铎教授从状态论治慢性阻塞性肺疾病的用药规律[J].中医药导报,2025,31(2):145-151.
DOI：10.13862/j.cn43-1446/r.2025.02.026
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摘要：
目的：探讨姜良铎教授治疗慢性阻塞性肺疾病的用药规律。方法：纳入姜良铎教授治疗慢性阻塞性肺疾病患者的中药处方118份，采用贝叶斯网络分析主方，探索姜良铎教授从状态论治慢性阻塞性肺疾病的用药规律。结果：以麻黄为目标的主方包括麻黄、苦杏仁、石膏、金沸草、厚朴、半夏、前胡、射干、芦根、黄芪、麦冬、山茱萸、蛤蚧、大黄、天麻、牡丹皮；以柴胡为目标的主方包括柴胡、黄芩、半夏、芦根、蛤壳、白果、五味子、知母、山茱萸、蛤蚧、白芍、牛蒡子、黄连、石决明、地龙、牡丹皮；以紫苏子为目标的主方包括紫苏子、紫苏梗、半夏、前胡、厚朴、苦杏仁、枳壳、枳实、瓜蒌、青黛、天麻、麦芽、山茱萸、五味子、白茅根、赤芍；以黄芪为目标的主方包括黄芪、黄精、白术、知母、五味子、白芍、麻黄、石膏、前胡、黄芩、紫菀、半夏、葶苈子、地龙、牡丹皮、三七。结论：姜良铎教授认为虚、痰、瘀为慢性阻塞性肺疾病的基础状态，虚以肺脾肾气阴亏虚为关键，痰以痰热壅肺为特征，瘀以瘀血阻滞肺络为突出表现。患者所处的阶段不同，虚、痰、瘀的比重各有侧重；对应在治疗方面，以补益肺脾肾气阴、活血化痰为基础，或侧重补益，或侧重活血、化痰，兼顾通利三焦、肝肺同治、肺胃同治。
关键词：慢性阻塞性肺疾病；主方；贝叶斯网络；从状态论治；姜良铎
Abstract：
Objective: To explore the rule of JIANG Liangduo's medication in treating chronic obstructive pulmonary disease (COPD). Method: A total of 118 herbal prescriptions of JIANG Liangduo for the treatment of patients with COPD were included, and the main prescriptions were analyzed by Bayesian network to explore JIANG Liangduo's medication rules for treating COPD in terms of state theory. Result: The main formula targeting Mahuang (Ephedrae Herba) includes: Mahuang (Ephedrae Herba), Kuxingren (Armeniacae Semen Amarum), Shigao (Gypsum Fibrosum), Jinfeicao (Inulae Herba), Houpo (Magnoliae Officinalis Cortex), Banxia (Pinelliae Rhizoma), Qianhu (Peucedani Radix), Shegan (Belamcandae Rhizoma), Lugen (Phragmitis Rhizoma), Huangqi (Astragali Radix), Maidong (Ophiopogonis Radix), Shanzhuyu (Corni Fructus), Gejie (Gecko), Dahuang (Rhei Radix et Rhizoma), Tianma (Gastrodiae Rhizoma), and Mudanpi (Moutan Cortex). The main formula targeting Caihu (Bupleuri Radix) includes: Caihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Lugen (Phragmitis Rhizoma), Geqiao (Meretricis seu Cyclinae Concha), Baiguo (Ginkgo Semen), Wuweizi (Schisandrae Fructus), Zhimu (Anemarrhenae Rhizoma), Shanzhuyu (Corni Fructus), Gejie (Gecko), Baishao (Paeoniae Radix Alba), Niubangzi (Arctii Fructus), Huanglian (Coptidis Rhizoma), Shijueming (Haliotidis Concha), Dilong (Pheretima), and Mudanpi (Moutan Cortex). The main formula targeting Zisuzi (Perillae Fructus) includes: Zisuzi (Perillae Fructus), Zisugeng (Perillae Caulis), Banxia (Pinelliae Rhizoma), Qianhu (Peucedani Radix), Houpo (Magnoliae Officinalis Cortex), Kuxingren (Armeniacae Semen Amarum), Zhiqiao (Aurantii Fructus), Zhishi (Aurantii Fructus Immaturus), Gualou (Trichosanthis Fructus), Qingdai (Indigo Naturalis), Tianma (Gastrodiae Rhizoma), Maiya (Hordei Fructus Germinatus), Shanzhuyu (Corni Fructus), Wuweizi (Schisandrae Fructus), Baimaogen (Imperatae Rhizoma), and Chishao (Paeoniae Radix Rubra). The main formula targeting Huangqi (Astragali Radix) includes: Huangqi (Astragali Radix), Huangjing (Polygonati Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Zhimu (Anemarrhenae Rhizoma), Wuweizi (Schisandrae Fructus), Baishao (Paeoniae Radix Alba), Mahuang (Ephedrae Herba), Shigao (Gypsum Fibrosum), Qianhu (Peucedani Radix), Huangqin (Scutellariae Radix), Ziwan (Asteris Radix), Banxia (Pinelliae Rhizoma), Tinglizi (Lepidii/Descurainiae Semen), Dilong (Pheretima), Mudanpi (Moutan Cortex), and Sanqi (Notoginseng Radix). Conclusion: JIANG Liangduo holds that deficiency, phlegm, and blood stasis are the basic states of COPD. Deficiency is characterized by deficiency of Qi and Yin in the lungs, spleen, and kidney, phlegm is characterized by phlegm heat blocking the lungs, and blood stasis obstructs the lung meridians. In clinical practice, the proportion of deficiency, phlegm, and blood stasis varies depending on the stage of the patient. In terms of treatment, it is based on tonifying the lungs, spleen, and kidney Qi Yin, promoting blood circulation and resolving phlegm, with a focus on tonifying the lungs, spleen, and kidney Qi Yin, or promoting blood circulation and resolving phlegm, while also taking into account promoting the circulation of the three jiao, treating liver and lung together, and treating lung and stomach together.
Key words：chronic obstructive pulmonary disease; main prescription; Bayesian network; state-based treatment; JIANG Liangduo
发布时间：2025-12-13
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