慢性萎缩性胃炎中医药核心用药与辨证规律解析——来自指南、临床医案及中成药的多维度数据挖掘
Analysis of Core Traditional Chinese Medicine Prescriptions and Syndrome Differentiation Patterns for Chronic Atrophic Gastritis—A Multidimensional Data Mining Study Based on Guidelines, Clinical Cases and Chinese Patent Medicines

目的：本研究通过对治疗慢性萎缩性胃炎的中医、中西医诊疗指南和共识中的推荐用药进行研究分析，利用数据挖掘发现临床治疗CAG的用药规律、核心处方，为中药治疗CAG的药物开发提供依据。方法：慢性萎缩性胃炎中医诊疗指南、慢性萎缩性胃炎中西医诊疗指南中推荐的经典名方和现代经验方纳入数据库。采用古今医案云平台进行用药频次、属性及功效分析、关联规则、聚类分析、复杂网络分析，总结临床常用药治疗CAG常针对的证候、用药规律和治法等。结果：共纳入135首方剂、240味中药，累计复现1477次。证候分布：胃阴不足证占比最高，其次为肝胃气滞证。核心用药：(炙)甘草(84次)、(炒)白芍(48次)、白术(38次)为高频前三味药。核心药对：白芍–甘草为最高频药对(共现40次，置信度 > 0.8)，陈皮–半夏、白术–茯苓、麦冬–石斛等经典药对广泛应用，聚类分析形成“柔肝止痛、健脾祛湿、养阴生津、消食导滞”四大药物集群。“证–药”规律：胃阴不足证以麦冬、沙参、石斛为核心养阴药物，契合养阴益胃治则；肝胃气滞证以柴胡、香附、枳壳为核心疏肝药物，与柴胡疏肝散组方高度一致。核心药物经现代药理揭示了可通过抑制炎症通路(TLR4/NF-κB)、参与调节氧化应激(PI3K-Akt)、修复胃黏膜等发挥作用的可能。白芍–甘草在胃阴不足证和肝胃气滞证中均高频使用。结论：CAG中医药治疗以调和肝脾为核心，兼顾修复胃黏膜核心病理，遵循“标本同治”的治疗思路。既以白芍–甘草柔肝止痛，解胃脘疼痛、黏膜损伤之“标”，又调和肝脾、养血敛阴，治疗肝脾不和，胃阴不足之“本”。配伍白术、陈皮、半夏等调脾胃虚弱、痰湿内生、气滞之兼证。胃阴不足证、肝胃气滞证为临床重点干预证型，其“证–药”对应规律可为CAG辨证标准化、用药规范化及经典配伍新药研发提供数据支撑。
Objective: This study analyzed the recommended medications in TCM (Traditional Chinese Medicine) and treatment guidelines as well as consensus statements for chronic atrophic gastritis (CAG). Data mining was used to identify the medication rules and core prescriptions for clinical CAG treatment, thereby providing a basis for the development of TCM-based drugs for CAG. Methods: Classic famous prescriptions and modern empirical prescriptions recommended in the TCM Diagnosis and Treatment Guidelines for CAG and Integrated TCM Diagnosis and Treatment Guidelines for CAG were included in the database. The Ancient and Modern Medical Cases Cloud Platform was adopted to conduct analyses on medication frequency, properties, efficacy, association rules, cluster analysis, and complex network analysis. Furthermore, this study summarized the syndromes targeted by commonly used clinical medications for CAG, as well as the medication rules and treatment principles. Results: A total of 135 prescriptions and 240 Chinese herbal medicines were included, with a cumulative recurrence of 1477 times. Syndrome distribution: The syndrome of “stomach yin deficiency” accounted for the highest proportion, followed by “liver-stomach qi stagnation”. Core medications: The top three high-frequency herbs were (processed) Gancao (84 times), (stir-fried) Baishao (48 times), and Baizhu (38 times). Core herb pairs: The herb pair of Baishao-Gancao was the most frequently used (co-occurrence 40 times, confidence