基于现代文献的胃食管反流病用药规律研究

Study on Medication Regularity of Gastroesophageal Reflux disease Based on Modern Literature

目的:从现代文献中整理归纳胃食管反流病用药规律和特点,以期提高临床疗效。方法:对文献记载的356个医案进行药物频次、分类、性味及高频药物聚类、关联规则分析,挖掘该病用药及配伍规律。结果:本次研究纳入药方356个,中药276味,发现半夏、甘草、黄连、柴胡、陈皮、吴茱萸等在处方中出现的频率较高;前十位的中药分类中补虚药、理气药、化痰止咳平喘药、清热药累积使用频率超过60%;五味中苦、辛、甘最常用;四气分布依次为寒、温、平、热、凉;归经以脾胃、肺肝为主,其次为心、肾、胆、大肠、小肠、三焦、膀胱、心包等。通过高频药物关联规则分析及复杂网络可视化的构建,发现胃食管反流病临床中常用药对,如黄连和吴茱萸、半夏和黄连、半夏和厚朴等。通过聚类分析结合临床得到胃食管反流病治疗的五类核心药物群,适用于5类中医证候。结论:现代中医诊治胃食管反流病的用药规律是审查病因,谨守病机;圆机活法,调其中和。具体治疗时斡旋气机,调理脏腑;寒热并用,辛开苦降;补虚泻实,标本兼顾;分型论治,有的放矢;病证结合,随症加减。

Objective:To summarize the medication rules and characteristics of gastroesophageal reflux disease from modern literature research,so as to improve the clinical efficacy and deepen the understanding of the disease.Methods:356 medical records were analyzed by drug frequency,classification,nature and flavor,high-frequency drug clustering and association rules,and the rules of drug use and compatibility were excavated.Results:This study included356 prescriptions and 276 traditional Chinese medicines.It was found that Pinellia ternata,Licorice,Coptis chinensis,Bupleurum,Tangerine peel and Evodia appeared frequently in prescriptions.In the top 10 categories of traditional Chinese medicine,the cumulative frequency of tonifying,Qi-regulating,phlegm-resolving,cough-suppressing,panting-calming and heat-clearing medicinal was more than 60%.Bitter,pungent and sweet flavors are commonly used in GERD,and the cumulative use of sour,salty,astringent and tasteless flavors was less than 20%.The frequency of the four properties from high to low was cold,warm,flat,hot and cool.The meridians were mainly spleen and stomach,lung and liver.Besides,they were also associated with heart,kidney,gallbladder,large intestine,small intestine,Sanjiao,bladder and pericardium meridians.Through the analysis of high-frequency drug association rules and the construction of complex network visualization,we found that the commonly used combinations of GERD,such as Coptis chinensis and Evodia,Pinellia ternata and Coptis chinensis,Pinellia ternata and Magnolia officinalis and so on.Five core drug groups for the treatment of GERD were obtained by cluster analysis,corresponding to different TCM syndrome differentiation.Conclusion:The excavation of the medication rule of GERD reflects Chinese physicians in modern times ascertain the cause,fcarefully watch the trigger underlying the disease.Besides,pathomechanism and therapy are also flexilbe to harmonize the middle.When specific treatment,they facilitate the Qi dynamic,coordinate viscera and bowels,use cold and warm medicinals simultaneously,regulate Qi by pungent dispering and bitter descending,tonify deficiency and purge excess to treat the root and tip simultaneously,determine treatment on the basis of pattern types,modify herbs based on combination of disease and syndrome.