胸痹的中医证候及用药规律文献研究
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摘要
目的基于文献分析胸痹的中医证候及用药规律。方法以"胸痹"作为关键词检索中文生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)和万方数据库2008年1月1日至2018年4月12日中医药口服治疗胸痹的临床研究文献,建立数据库,应用Frequency法对中医证候、药物功效、性、味、归经分别进行频数统计。结果筛选出符合标准的文献69篇,涉及中医证候13种,方剂69首,药物113味。胸痹中医证型主要以实证(59. 42%)和虚实夹杂证(36. 23%)为主;辨证方法主要采用气血津液辨证(92. 75%),辅助以脏腑辨证(4. 35%)、病因辨证(2. 90%); 113味中药中使用频次≥10次的中药共有22种,使用频次前5位中药分别是丹参、瓜蒌、甘草、当归、川芎; 113种中药按功效可分为16种,使用频率最高的是活血化瘀药(30. 82%),其次是补气药(14. 93%)、化痰药(12. 74%)、理气药(12. 60%)、解表药(5. 89%)、补血药(5. 75%)。药性出现频率最高的是温(48. 93%),其次是寒、平,这3类药物累计频率达95. 72%;药味出现频率排在首位的是苦味(32. 72%),其次是甘、辛,这3类药物累计频率达到95. 13%。药性归经排在首位的是心经(18. 23%),其次是肝经、脾经、肺经、胃经,前5位累计频率为80. 86%。结论胸痹中医证型主要以实证和虚实夹杂证为主,辨证主要采用气血津液辨证,治疗以活血化瘀、补气通阳、化痰散结为基本治则,临床常用活血化瘀、补气、化痰、温阳等药物。
Objective To analyze Chinese medicine syndrome and related medicine principles of thoracic obstruction based on published literature. Methods All published literature of clinical research about Chinese medicine in the treatment of thoracic obstruction from Chinese Biology Literature Database( CBM),Journal Full-Text Database of China National Knowledge Infrastructure( CNKI) and Wanfang Data from January 1,2008 to April 12,2018 was retrieved,and the database on Chinese medicine in the treatment of thoracic obstruction established. The frequency of Chinese medicine syndrome,drug efficacy,sexuality,taste and meridian were counted by frequency method. Results A total of 69 papers were included,involving 13 kinds of TCM syndrome,69 prescription,113 flavor drugs. The TCM syndromes of thoracic obstruction included empirical( 59. 42%) and actual deficiency syndrome( 36. 23%). Dialectical methods mainly used qi and blood fluid( 92. 75%),assisted with viscera syndrome( 4. 35%),the cause of syndrome differentiation( 2. 90%). There are 22 kinds of traditional Chinese medicines used in 113 Chinese medicines with a frequency of 10 or more times,and top five were Danshen,Gualou,Gancao,Danggui and Chuanxiong. 113 herbs were classified into 16 types according to effect.The most frequent herbs applied were herbs of activating blood and removing stasis( 30. 82%),more frequent herbs were herbs of invigorating qi( 14. 93%),expelling phlegm( 12. 74%),regulating qi( 12. 60%),relieving the exterior( 5. 89%)and invigorating blood( 5. 75%). The most frequent herb property applied was warm( 48. 93%) and total frequency of warm,cold and flat herbs was 95. 2%. The most frequent herb flavor applied was bitter( 32. 72%) and total frequency of bitter,pungent and sweet herbs was 95. 13%. The most frequent herb channel tropism was heart meridian( 18. 23%),and total frequency of heart meridian,liver meridian,spleen meridian,lung meridian and stomach meridian were 80. 86%. Conclusion The TCM syndromes of thoracic obstruction include empirical and actual deficiency syndrome. Dialectical methods mainly use qi and blood fluid,assisted with viscera syndrome the cause of syndrome differentiation. The basic medication principles are activating blood and removing stasis,activating yang and removing obstruction,reducing phlegm and resolving masses treating thoracic obstruction. Activating blood and removing stasis,invigorating qi,expelling phlegm and warm yang are commonly applied clinically.
Objective To analyze Chinese medicine syndrome and related medicine principles of thoracic obstruction based on published literature. Methods All published literature of clinical research about Chinese medicine in the treatment of thoracic obstruction from Chinese Biology Literature Database( CBM),Journal Full-Text Database of China National Knowledge Infrastructure( CNKI) and Wanfang Data from January 1,2008 to April 12,2018 was retrieved,and the database on Chinese medicine in the treatment of thoracic obstruction established. The frequency of Chinese medicine syndrome,drug efficacy,sexuality,taste and meridian were counted by frequency method. Results A total of 69 papers were included,involving 13 kinds of TCM syndrome,69 prescription,113 flavor drugs. The TCM syndromes of thoracic obstruction included empirical( 59. 42%) and actual deficiency syndrome( 36. 23%). Dialectical methods mainly used qi and blood fluid( 92. 75%),assisted with viscera syndrome( 4. 35%),the cause of syndrome differentiation( 2. 90%). There are 22 kinds of traditional Chinese medicines used in 113 Chinese medicines with a frequency of 10 or more times,and top five were Danshen,Gualou,Gancao,Danggui and Chuanxiong. 113 herbs were classified into 16 types according to effect.The most frequent herbs applied were herbs of activating blood and removing stasis( 30. 82%),more frequent herbs were herbs of invigorating qi( 14. 93%),expelling phlegm( 12. 74%),regulating qi( 12. 60%),relieving the exterior( 5. 89%)and invigorating blood( 5. 75%). The most frequent herb property applied was warm( 48. 93%) and total frequency of warm,cold and flat herbs was 95. 2%. The most frequent herb flavor applied was bitter( 32. 72%) and total frequency of bitter,pungent and sweet herbs was 95. 13%. The most frequent herb channel tropism was heart meridian( 18. 23%),and total frequency of heart meridian,liver meridian,spleen meridian,lung meridian and stomach meridian were 80. 86%. Conclusion The TCM syndromes of thoracic obstruction include empirical and actual deficiency syndrome. Dialectical methods mainly use qi and blood fluid,assisted with viscera syndrome the cause of syndrome differentiation. The basic medication principles are activating blood and removing stasis,activating yang and removing obstruction,reducing phlegm and resolving masses treating thoracic obstruction. Activating blood and removing stasis,invigorating qi,expelling phlegm and warm yang are commonly applied clinically.
引文
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[11]Shi CG,Yang YS,Li H,et al. Tanshinol protects hippocampus and attenuates vascular dementia development[J]. J Asian Nat Prod Res,2014,16(6):667-76.
[12]Yang J,Yang S,Yuan YJ,et al. Integrated investigation of lipidome and related signaling pathways uncovers molecular mechanisms of tetramethylpyrazine and butylidenephthalide protecting endothelial cells under oxidative stress[J]. Mol Biosyst,2012,8(6):1789.
[13]黄咏梅,邓景赞,肖加尚.瓜蒌薤白汤加减浸膏的药效学研究[J].中药材,2004,27(9):667-669.
[14]刘萍,张丽萍.桂枝化学成分及心血管药理作用研究[J].辽宁中医杂志,2012,39(10):1926-1927.
[2]李新,赵灿灿,潘栋.瓜蒌薤白半夏汤辅助治疗顽固性心绞痛的疗效观察[J].中西医结合心脑血管病杂志,2017,15(1):86-88.
[3]宋婷婷,王东海,刘呈宇,等.温阳活血方治疗阳虚血瘀型冠心病心绞痛的疗效观察[J].中西医结合心脑血管病杂志,2014,12(6):668-669.
[4]秦敬品.温阳活血疗法治疗冠心病心绞痛疗效分析[J].中西医结合心血管病电子杂志,2015,3(23):110-111.
[5]高学敏.中药学[M].北京:中国中医药出版社,2002.
[6]国家技术监督局.中国人民共和国国家标准中医临床诊疗术语证候部分[M].北京:中国标准出版社,1997.
[7]朱文峰.中医诊断学[M].北京:中国中医药出版社,2002.
[8]郑虎占.对《金匮要略》“阳微阴弦”的认识及应用体会[J].北京中医药,2008,27(4):270-271.
[9]Pan Y,Qian JX,Lu SQ,et al. Protective effects of tanshinone IIA sodium sulfonate on ischemia-reperfusion-induced myocardial injury in rats[J]. Iran J Basic Med Sci,2017,20(3):308-315.
[10]Yang Y,Wang L,Wu Y,et al. Tanshinol suppresses inflammatory factors in a rat model of vascular dementia and protects LPS-treated neurons via the MST1-FOXO3 signaling pathway[J]. Brain Res,2016(1646):304-314.
[11]Shi CG,Yang YS,Li H,et al. Tanshinol protects hippocampus and attenuates vascular dementia development[J]. J Asian Nat Prod Res,2014,16(6):667-76.
[12]Yang J,Yang S,Yuan YJ,et al. Integrated investigation of lipidome and related signaling pathways uncovers molecular mechanisms of tetramethylpyrazine and butylidenephthalide protecting endothelial cells under oxidative stress[J]. Mol Biosyst,2012,8(6):1789.
[13]黄咏梅,邓景赞,肖加尚.瓜蒌薤白汤加减浸膏的药效学研究[J].中药材,2004,27(9):667-669.
[14]刘萍,张丽萍.桂枝化学成分及心血管药理作用研究[J].辽宁中医杂志,2012,39(10):1926-1927.