中药治疗类风湿关节炎用药特点初探
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摘要
目的:探究中药治疗类风湿关节炎潜在用药规律,为临床治疗类风湿关节炎提供中药用药参考。方法:检索口服中药治疗类风湿关节炎的中英文数据库文献,通过统一的纳入标准、排除标准,合并和删除重复文献,采用聚类统计分析类风湿关节炎的中药用药潜在规律。结果:从57篇有效文献中整理出使用频率最高的前30味中药依次是:桂枝、川芎、甘草、当归、没药、栀子、伸筋草、牛膝、川乌、附子、麻黄、细辛、防风、秦艽、鸡血藤、三七、全蝎、地龙、草乌、土鳖虫、熟地黄、淫羊藿、白芍、桑寄生、苍术、延胡索、威灵仙、姜黄、土茯苓、穿山甲。结论:文献中中药治疗类风湿关节炎的主要功效以祛风散寒、缓急止痛(桂枝、川芎、甘草),活血通络、祛瘀消肿(当归、没药、牛膝、土鳖虫、延胡索,姜黄),清热泻火、凉血止痛(栀子),温经散寒、祛风除湿通痹(伸筋草、川乌、附子、麻黄、细辛、防风、秦艽、草乌、苍术、威灵仙、土茯苓),消肿止痛、舒筋活络(鸡血藤、三七、全蝎、地龙、白芍),以及温肾助阳、强筋健骨(熟地黄、淫羊藿、桑寄生)类中药为主,而禁用的穿山甲频次最少。
Objective:To explore the potential law of medication in traditional Chinese medicine(TCM)in the treatment of rheumatoid arthritis to provide clinical reference.Methods:Chinese and English literature on treating rheumatoid arthritis with oral administration of Chinese medicine was searched.After screening,the standard literature was analyzed by clustering analysis to find the potential law of medication.Results:Thirty Chinese medicines with the highest frequency of use out of 57 literature were as follows:Guizhi(Ramulus Cinnamomi),Chuanxiong(Rhizoma Chuanxiong),Gancao(Radix et Rhizoma Glycyrrhizae),Danggui(Radix Angelicae Sinensis),Moyao(Myrrha),Zhizi(Fructus Gardeniae),Shenjincao(Herba Lycopodii),Niuxi(Radix Achyranthis Bidentatae),Chuanwu(Radix Aconiti),Fuzi(Radix Aconiti Lateralis Praeparata),Mahuang(Herba Ephedrae),Xixin(Radix et Rhizoma Asari),Fangfeng(Radix Saposhnikoviae),Qinjiao(Radix Gentianae Macrophyllae),Jixueteng(Caulis Spatholobi),Sanqi(Radix et Rhizoma Notoginseng),Quanxie(Scorpio),Dilong(Pheretima),Caowu(Radix Aconiti Kusnezoffii),Tubiechong(Eupolyphaga seu Steleophaga),Shudihuang(Radix Rehmanniae Praeparata),Yinyanghuo(Herba Epimedii),Baishao(Radix Paeoniae Alba),Sangjisheng(Herba Taxilli),Cangzhu(Rhizoma Atractylodis),Yanhusuo(Rhizoma Corydalis),Weilingxian(Radix et Rhizoma Clematidis), Jianghuang( Rhizoma Curcumae Longae),Tufuling(Rhizoma Smilacis Glabrae)and Chuanshanjia(Squama Manitis).Conclusion:The main efficacy and related Chinese medicines are as follows:Dispelling wind cold,relieving pain (Guizhi,Chuanxiong,Gancao);activating blood circulation and dredging collaterals,removing blood stasis and relieving swelling(Danggui,Moyao,Niuxi,Tubiechong,Yanhusuo,Jianghuang);clearing heat and purging fire,cooling blood and relieving pain(Zhizi);warming meridians and dispelling cold,dispelling wind,removing dampness and dredging bi(Shenjincao,Chuanwu,Fuzi,Mahuang,Xixin,Fangfeng,Qinjiao,Caowu,Cangzhu,Weilin gxian,Tufuling);relieving swelling and pain,relaxing tendons and activating collaterals(Jixueteng,Sanqi,Quanxi e,Dilong,Baishao);warming kidney to strengthening yang,strengthening tendons and bones(Shudihuang,Yinyan ghuo,Sangjisheng).Chuanshanjia is rarely used.
Objective:To explore the potential law of medication in traditional Chinese medicine(TCM)in the treatment of rheumatoid arthritis to provide clinical reference.Methods:Chinese and English literature on treating rheumatoid arthritis with oral administration of Chinese medicine was searched.After screening,the standard literature was analyzed by clustering analysis to find the potential law of medication.Results:Thirty Chinese medicines with the highest frequency of use out of 57 literature were as follows:Guizhi(Ramulus Cinnamomi),Chuanxiong(Rhizoma Chuanxiong),Gancao(Radix et Rhizoma Glycyrrhizae),Danggui(Radix Angelicae Sinensis),Moyao(Myrrha),Zhizi(Fructus Gardeniae),Shenjincao(Herba Lycopodii),Niuxi(Radix Achyranthis Bidentatae),Chuanwu(Radix Aconiti),Fuzi(Radix Aconiti Lateralis Praeparata),Mahuang(Herba Ephedrae),Xixin(Radix et Rhizoma Asari),Fangfeng(Radix Saposhnikoviae),Qinjiao(Radix Gentianae Macrophyllae),Jixueteng(Caulis Spatholobi),Sanqi(Radix et Rhizoma Notoginseng),Quanxie(Scorpio),Dilong(Pheretima),Caowu(Radix Aconiti Kusnezoffii),Tubiechong(Eupolyphaga seu Steleophaga),Shudihuang(Radix Rehmanniae Praeparata),Yinyanghuo(Herba Epimedii),Baishao(Radix Paeoniae Alba),Sangjisheng(Herba Taxilli),Cangzhu(Rhizoma Atractylodis),Yanhusuo(Rhizoma Corydalis),Weilingxian(Radix et Rhizoma Clematidis), Jianghuang( Rhizoma Curcumae Longae),Tufuling(Rhizoma Smilacis Glabrae)and Chuanshanjia(Squama Manitis).Conclusion:The main efficacy and related Chinese medicines are as follows:Dispelling wind cold,relieving pain (Guizhi,Chuanxiong,Gancao);activating blood circulation and dredging collaterals,removing blood stasis and relieving swelling(Danggui,Moyao,Niuxi,Tubiechong,Yanhusuo,Jianghuang);clearing heat and purging fire,cooling blood and relieving pain(Zhizi);warming meridians and dispelling cold,dispelling wind,removing dampness and dredging bi(Shenjincao,Chuanwu,Fuzi,Mahuang,Xixin,Fangfeng,Qinjiao,Caowu,Cangzhu,Weilin gxian,Tufuling);relieving swelling and pain,relaxing tendons and activating collaterals(Jixueteng,Sanqi,Quanxi e,Dilong,Baishao);warming kidney to strengthening yang,strengthening tendons and bones(Shudihuang,Yinyan ghuo,Sangjisheng).Chuanshanjia is rarely used.
引文
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[15]付长龙,梅阳阳,林洁,等.川芎嗪干预类风湿关节炎的机制探讨[J].风湿病与关节炎,2016,5(9):45-47.
[16]汤小虎,唐辉.桂枝在《滇南本草》中的配伍运用[J].现代中医药,2013,33(5):94-96.
[17]梁娜娜,张莉芸,张改连,等.类风湿关节炎疾病活动度研究进展[J].中华风湿病学杂志,2016,20(12):849-853.
[18]张建平,余土根,程立峰.张仲景经方论治雷诺病探略[J].中华中医药杂志,2014,29(6):1884-1886.
[19]左月明,严欢,张忠立,等.栀子化学成分研究(Ⅵ)[J].中药材,2017,40(3):596-599.
[20]FERNáNDEZ-RUIZ JC,RAMOS-REMUS C,SáN-CHEZ-C J,et al.Analysis of miRNA expression in patients with rheumatoid arthritis during remission and relapse after a 5-year trial of tofacitinib treatment[J].Int Immunopharmacol,2018,63(7):35-42.
[21]张智,张建华.中药外治法治疗膝关节滑膜炎研究进展[J].中医药临床杂志,2018,30(1):179-181.
[22]裴代平.关节腔清理术配合中药治疗膝关节骨性关节炎临床分析[J].长春中医药大学学报,2013,28(1):140-141.
[23]张新军,谢建军,马杰,等.谢建军教授运用附子经验介绍[J].新中医,2015,47(5):24-26.
[24]刘卫.中医药治疗类风湿性关节炎概况[J].光明中医,2008,10(3):1626-1627.
[25]郭琳娟,张卫华,郭诚杰.国医大师郭诚杰临床应用附子、川乌和草乌经验[J].湖南中医药大学学报,2016,27(2):1-2,19.
[26]邓华萍,陈博,詹红生.石氏中药熏蒸联合单穴电针治疗急性期腰椎间盘突出症的研究[J].检验医学与临床,2018,15(4):447-450.
[27]南京中医药大学.中药大辞典[M].5版.上海:上海科学技术出版社,2015:1078.
[28]齐贵阳.鸡血藤提取物与阿胶液体外对化疗大鼠升白细胞计数功效的实验比较[J].抗感染药学,2016,13(2):276-277.
[29]左艇,李桓,李松伟,等.类风湿关节炎相关肺间质病变的中医证素分布及组合规律研究[J].中华中医药杂志,2015,30(8):2942-2944.
[30]ZHANG XM,LIN ZJ,ZHANG B,et al.Traditional prescription rules of Aconitum herbs in treatment of Bi syndrome[J].China Journal of Chinese Materia Medica,2018,43(2):211-215.
[31]张文举,杨豪,黄金承,等.独活寄生汤联合来氟米特治疗肝肾亏虚型类风湿关节炎30例[J].风湿病与关节炎,2013,2(9):24-26.
[32]王少纯,王俊颀,王明杰.补脾祛湿法治疗类风湿关节炎[J].中医正骨,2008,20(9):68.
[33]薛崇祥,于航,呼明哲,等.基于文献多元分析的类风湿关节炎用药规律研究[J].世界科学技术-中医药现代化,2018,20(4):608-612.
[34]袁作武,游济洲,陈海丽,等.中药配伍对雷公藤治疗育龄女性类风湿关节炎减毒增效的研究[J].风湿病与关节炎,2018,7(7):28-32.
[2]LAU CS,CHIA F,HARRISON A,et al.APLAR rheumatoid arthritis treatment recommendations[J].Int JRheum Dis,2015,18(7):685-713.
[3]李宁,王拥军,施杞.从中医“治未病”思想谈类风湿关节炎的防治[J].中国中医骨伤科杂志,2012,20(11):64-65.
[4]XU T,LIU S,ZHAO J,et al.A study on the effective substance of the Wu-tou formula based on the metabonomic method using UPLC-Q-TOF-HDMS[J].Mol Biosyst,2015,11(11):3081-3091.
[5]中华医学会风湿病学分会.2018中国类风湿关节炎诊疗指南[J].中华内科杂志,2018,57(4):242-251.
[6]DRS ROBERT R RICH,THOMAS A FLEISHER,WIL-LIAM T SHEARER,et al.Clinical Immunology[M].5 th.Amstel dam:Elsevier Ltd,2018:705-721.
[7]何清波,苏丙华,钱元.医学统计学及其软件包[M].上海:上海科学技术文化出版社,2009:285.
[8]武松,潘发明.SPSS统计分析大全[M].北京:清华大学出版社,2017:323-328.
[9]孙振,李屏,周晓东,等.当代名中医治疗类风湿关节炎经验集萃[J].世界中医药,2017,12(6):1484-1485.
[10]张伟强,李波,李帆冰.膝骨性关节炎分期与疼痛部位的相关性研究[J].云南中医学院学报,2017,39(5):78-81.
[11]杜彩凤,赵勇,邹小娟.基于现代文献的类风湿性关节炎证候、证候要素分布特点的研究[J].世界中西医结合杂志,2011,6(2):161-163.
[12]周祖兵,刘毅,刘兰,等.五积丸治疗腹部肿瘤的可行性分析[J].中华中医药杂志,2017,32(7):3263-3265.
[13]徐锋,王德健,王凤桂,等.桂枝挥发油的药理作用研究进展[J].中华中医药杂志,2016,3(11):4653-4657.
[14]SUN L,ZONG SB,LI JC,et al.The essential oil from the twigs of Cinnamomum cassia Presl alleviates pain and inflammation in mice[J].J Ethnopharmacol,2016,194(12):904-912.
[15]付长龙,梅阳阳,林洁,等.川芎嗪干预类风湿关节炎的机制探讨[J].风湿病与关节炎,2016,5(9):45-47.
[16]汤小虎,唐辉.桂枝在《滇南本草》中的配伍运用[J].现代中医药,2013,33(5):94-96.
[17]梁娜娜,张莉芸,张改连,等.类风湿关节炎疾病活动度研究进展[J].中华风湿病学杂志,2016,20(12):849-853.
[18]张建平,余土根,程立峰.张仲景经方论治雷诺病探略[J].中华中医药杂志,2014,29(6):1884-1886.
[19]左月明,严欢,张忠立,等.栀子化学成分研究(Ⅵ)[J].中药材,2017,40(3):596-599.
[20]FERNáNDEZ-RUIZ JC,RAMOS-REMUS C,SáN-CHEZ-C J,et al.Analysis of miRNA expression in patients with rheumatoid arthritis during remission and relapse after a 5-year trial of tofacitinib treatment[J].Int Immunopharmacol,2018,63(7):35-42.
[21]张智,张建华.中药外治法治疗膝关节滑膜炎研究进展[J].中医药临床杂志,2018,30(1):179-181.
[22]裴代平.关节腔清理术配合中药治疗膝关节骨性关节炎临床分析[J].长春中医药大学学报,2013,28(1):140-141.
[23]张新军,谢建军,马杰,等.谢建军教授运用附子经验介绍[J].新中医,2015,47(5):24-26.
[24]刘卫.中医药治疗类风湿性关节炎概况[J].光明中医,2008,10(3):1626-1627.
[25]郭琳娟,张卫华,郭诚杰.国医大师郭诚杰临床应用附子、川乌和草乌经验[J].湖南中医药大学学报,2016,27(2):1-2,19.
[26]邓华萍,陈博,詹红生.石氏中药熏蒸联合单穴电针治疗急性期腰椎间盘突出症的研究[J].检验医学与临床,2018,15(4):447-450.
[27]南京中医药大学.中药大辞典[M].5版.上海:上海科学技术出版社,2015:1078.
[28]齐贵阳.鸡血藤提取物与阿胶液体外对化疗大鼠升白细胞计数功效的实验比较[J].抗感染药学,2016,13(2):276-277.
[29]左艇,李桓,李松伟,等.类风湿关节炎相关肺间质病变的中医证素分布及组合规律研究[J].中华中医药杂志,2015,30(8):2942-2944.
[30]ZHANG XM,LIN ZJ,ZHANG B,et al.Traditional prescription rules of Aconitum herbs in treatment of Bi syndrome[J].China Journal of Chinese Materia Medica,2018,43(2):211-215.
[31]张文举,杨豪,黄金承,等.独活寄生汤联合来氟米特治疗肝肾亏虚型类风湿关节炎30例[J].风湿病与关节炎,2013,2(9):24-26.
[32]王少纯,王俊颀,王明杰.补脾祛湿法治疗类风湿关节炎[J].中医正骨,2008,20(9):68.
[33]薛崇祥,于航,呼明哲,等.基于文献多元分析的类风湿关节炎用药规律研究[J].世界科学技术-中医药现代化,2018,20(4):608-612.
[34]袁作武,游济洲,陈海丽,等.中药配伍对雷公藤治疗育龄女性类风湿关节炎减毒增效的研究[J].风湿病与关节炎,2018,7(7):28-32.