基于临床文献的糖尿病冠心病中医证候分布规律研究
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摘要
目的:通过对近二十年糖尿病冠心病中医证候临床研究文献的分析和挖掘,揭示糖尿病冠心病临床常见的基本证型及证候要素分布规律,为糖尿病冠心病的中医临床诊治及疗效评价提供更多依据。方法:检索获得中国学术期刊全文数据库(CNKI)、万方数据知识服务平台、中国生物医学1998年-2018年公开发表的糖尿病冠心病中医证候临床研究文献542篇,按照纳入、排除标准筛选出符合标准的45篇文献,进行统计分析。结果:糖尿病冠心病中医证型有40余种,分布呈虚实夹杂、本虚标实的特点,本虚以气阴两虚为主,标实以痰、瘀、湿、热为主;糖尿病冠心病证素分布中,病位证素分布由高到低依次为肾(48.02%)、肝(22.33%)、心(17.98%)、脾(11.66%),病性证素分布由高到低依次为气虚、阴虚、瘀、痰、湿、阳虚、热;证候研究文献中包含舌脉信息的文献较少,仅为3篇,出现2种舌形,9种舌色,7种舌苔,9种脉象。结论:肝在糖尿病冠心病发病中的核心和枢纽地位越来越突出,位于脏腑病位的第二位,高于心和脾;除传统的气虚、阴虚、痰、瘀外,湿、热证素在疾病病机演变中具有重要作用;糖尿病冠心病临床诊治要标本兼顾,在辨证论治基础上,尤其要注重调肝和清利湿热,综合治疗,方可取效。
Objective: To reveal the common clinical syndromes and distribution of syndrome elements in diabetic coronary heart disease by analyzing and excavating the clinical research literature of traditional Chinese medicine(TCM)syndromes of diabetic coronary heart disease in the past 20 years and provide more evidences for the TCM clinical diagnosis and efficiency evaluation of diabetic coronary heart disease. Methods: 542 clinical research literatures on TCM syndrome of diabetic coronary heart disease that have been published from 1998 to 2018 were obtained in the China National Knowledge Internet(CNKI), Wanfang Data Knowledge Service Platform and Chinese Biomedical Science.According to the inclusion and exclusion criteria, a total of 45 literatures meeting the criteria were statistically analyzed.Results: There were more than 40 kinds of TCM syndromes of diabetic coronary heart disease. The distribution had characteristics of deficiency and excess inclusion, deficiency in origin and excess in superficiality. The deficiency in origin was mainly due to qi and yin deficiency, the excess in superficiality was mainly due to phlegm, stasis, dampness and heat; in the distribution of diabetic coronary heart disease syndrome element, the distribution of the disease location syndrome element from high to low was kidney(48.02%), liver(22.33%), heart(17.98%) and spleen(11.66%), the distribution of the disease nature syndrome element from high to low was qi deficiency, yin deficiency, stasis, phlegm,dampness, yang deficiency and heat; There were only three articles containing the tongue and pulse information in the syndrome research literature with 2 kinds of tongue shapes, 9 kinds of tongue colors, 7 kinds of tongue coatings and nine kinds of pulses. Conclusion: The core of the liver in the pathogenesis of diabetic coronary heart disease is more and more prominent, it is the second place in the visceral disease location syndrome element, higher than the heart and spleen; in addition to the traditional qi deficiency, yin deficiency, phlegm and stasis, the dampness and heat syndrome elements play an important role in the evolution of disease pathogenesis. It is suggested that looking into both its roots cause and symptoms should be taken into account of clinical diagnosis and treatment of diabetic coronary heart disease. On the basis of syndrome differentiation treatment, it is especially necessary to pay attention to regulating liver and clearing away heat and dampness comprehensively, which can be effective.
Objective: To reveal the common clinical syndromes and distribution of syndrome elements in diabetic coronary heart disease by analyzing and excavating the clinical research literature of traditional Chinese medicine(TCM)syndromes of diabetic coronary heart disease in the past 20 years and provide more evidences for the TCM clinical diagnosis and efficiency evaluation of diabetic coronary heart disease. Methods: 542 clinical research literatures on TCM syndrome of diabetic coronary heart disease that have been published from 1998 to 2018 were obtained in the China National Knowledge Internet(CNKI), Wanfang Data Knowledge Service Platform and Chinese Biomedical Science.According to the inclusion and exclusion criteria, a total of 45 literatures meeting the criteria were statistically analyzed.Results: There were more than 40 kinds of TCM syndromes of diabetic coronary heart disease. The distribution had characteristics of deficiency and excess inclusion, deficiency in origin and excess in superficiality. The deficiency in origin was mainly due to qi and yin deficiency, the excess in superficiality was mainly due to phlegm, stasis, dampness and heat; in the distribution of diabetic coronary heart disease syndrome element, the distribution of the disease location syndrome element from high to low was kidney(48.02%), liver(22.33%), heart(17.98%) and spleen(11.66%), the distribution of the disease nature syndrome element from high to low was qi deficiency, yin deficiency, stasis, phlegm,dampness, yang deficiency and heat; There were only three articles containing the tongue and pulse information in the syndrome research literature with 2 kinds of tongue shapes, 9 kinds of tongue colors, 7 kinds of tongue coatings and nine kinds of pulses. Conclusion: The core of the liver in the pathogenesis of diabetic coronary heart disease is more and more prominent, it is the second place in the visceral disease location syndrome element, higher than the heart and spleen; in addition to the traditional qi deficiency, yin deficiency, phlegm and stasis, the dampness and heat syndrome elements play an important role in the evolution of disease pathogenesis. It is suggested that looking into both its roots cause and symptoms should be taken into account of clinical diagnosis and treatment of diabetic coronary heart disease. On the basis of syndrome differentiation treatment, it is especially necessary to pay attention to regulating liver and clearing away heat and dampness comprehensively, which can be effective.
引文
1唐振媚.糖尿病合并冠状动脉粥样硬化性心脏病治疗研究进展.医学综述, 2009, 15(6):892-895.
2 李瑞杰,王亚娟,郑晓敏.糖尿病与冠心病:循证医学的证据.中国医刊, 2006(11):12-14.
3 中华人民共和国国家标准.中医临床诊疗术语·证候部分.北京:中国标准出版社, 1997.
4 朱文锋.中医诊断学.北京:中国中医药出版社, 2007.
5 吴勉华.中医内科学.北京:中国中医药出版社, 2012.
6 邓铁涛.中医证候规范.广州:广东科技出版社, 1990.
7 朱文峰.证素辨证学.北京:人民卫生出版社, 2008:162-289, 33-37.
8 魏军平,高嘉良,林兰.糖尿病及慢性并发症中医证候的文献研究分析.世界中医药, 2015, 10(10):1614-1617.
9 吴以岭,高怀林,贾振华,等.糖尿病合并心脏病中医诊疗标准.世界中西医结合杂志, 2011, 6(5):455-460.
10 朱文锋,张华敏.“证素”的基本特征.中国中医基础医学杂志, 2005,11(1):17-18.
11 朱文锋,晏峻峰.证素辨证新体系的内容及科学意义.医学与哲学,2005(1):69-70.
12 李赛美,李易崇,李伟华,等.糖尿病湿热证候特征及演变规律的探讨——1000例临床资料分析.湖南中医药大学学报, 2007(5):65-68.
13 刘路路,吴秀艳,王天芳,等.基于现代文献的脾胃湿热证疾病分布及处方用药研究.北京中医药大学学报, 2016, 39(8):685-689.
14 刘宁.冠心病合并糖尿病中医证候要素、证候特征及证候病机演变规律研究.沈阳:辽宁中医药大学博士研究生学位论文, 2014.
15 黎元元,郭蕾,高思华,等.基于专家观点的糖尿病证候要素提取文献分析.现代中西医结合杂志, 2012, 21(6):571-572+575.
16 龚燕冰,罗增刚,高思华,等.运用因子分析方法探索2型糖尿病证候要素及其靶位特征.中医杂志, 2011, 52(13):1100-1102.
2 李瑞杰,王亚娟,郑晓敏.糖尿病与冠心病:循证医学的证据.中国医刊, 2006(11):12-14.
3 中华人民共和国国家标准.中医临床诊疗术语·证候部分.北京:中国标准出版社, 1997.
4 朱文锋.中医诊断学.北京:中国中医药出版社, 2007.
5 吴勉华.中医内科学.北京:中国中医药出版社, 2012.
6 邓铁涛.中医证候规范.广州:广东科技出版社, 1990.
7 朱文峰.证素辨证学.北京:人民卫生出版社, 2008:162-289, 33-37.
8 魏军平,高嘉良,林兰.糖尿病及慢性并发症中医证候的文献研究分析.世界中医药, 2015, 10(10):1614-1617.
9 吴以岭,高怀林,贾振华,等.糖尿病合并心脏病中医诊疗标准.世界中西医结合杂志, 2011, 6(5):455-460.
10 朱文锋,张华敏.“证素”的基本特征.中国中医基础医学杂志, 2005,11(1):17-18.
11 朱文锋,晏峻峰.证素辨证新体系的内容及科学意义.医学与哲学,2005(1):69-70.
12 李赛美,李易崇,李伟华,等.糖尿病湿热证候特征及演变规律的探讨——1000例临床资料分析.湖南中医药大学学报, 2007(5):65-68.
13 刘路路,吴秀艳,王天芳,等.基于现代文献的脾胃湿热证疾病分布及处方用药研究.北京中医药大学学报, 2016, 39(8):685-689.
14 刘宁.冠心病合并糖尿病中医证候要素、证候特征及证候病机演变规律研究.沈阳:辽宁中医药大学博士研究生学位论文, 2014.
15 黎元元,郭蕾,高思华,等.基于专家观点的糖尿病证候要素提取文献分析.现代中西医结合杂志, 2012, 21(6):571-572+575.
16 龚燕冰,罗增刚,高思华,等.运用因子分析方法探索2型糖尿病证候要素及其靶位特征.中医杂志, 2011, 52(13):1100-1102.