中医药辨病辨证治疗脂肪肝的文献分析

Literature Analysis of TCM Differential Treatment of Fatty Liver

目的:对中医药辨病辨证治疗脂肪肝的核心期刊文献进行统计学分析,以了解中医药辨病辨证治疗脂肪肝存在的问题及原因。方法:通过中国知网(http://www.cnki.net)"中国学术期刊网络出版总库(http://acad.cnki.net/Kns55/brief/result.aspx?dbPrefix=CJFQ)"中的"标准收索"引擎,收索"主题"词-"脂肪肝",逐页入选题名为"某方(或某法)治疗脂肪肝的临床观察(或临床研究、疗效观察等)"的文献,并进一步按"2007年中国科技论文统计源期刊(中国科技核心期刊)一览表"中的科技核心期刊挑选中药组治疗例数在100例以上的文献,共获得符合条件的论著33篇。再按作者所在单位的南北行政区域划分南、北两方(以秦岭、淮河为界),并按作者具体用药的主要治法分为化痰湿、疏肝郁、健脾胃、祛瘀血、解热毒等5类,分别统计治愈率及总有效率,并用SAS9.1软件对治愈率及总有效率进行两因素析因设计二元定量资料的方差分析。结果:南、北地区脂肪肝患者的治疗效果差别有极显著的统计学意义(Wilks'λ=0.71010963,F=6.12,P=0.0059);不同辨病辨证类型的脂肪肝患者的治疗效果差别无统计学意义(Wilks'λ=0.74229884,F=0.92,P=0.5059);地区与辨病辨证类型的交互效应无统计学意义(Wilks'λ=0.71515776,F=0.40,P=0.2354)。结论:结合实际数据,中医药辨病辨证治疗脂肪肝的报道以北方地区的治疗效果总体上比南方地区的治疗效果好,北方地区的平均治愈率及平均有效率总体上比南方地区的高。这种差距可能是因为北方地区以"健脾胃"、"疏肝郁"、"解热毒"为主要治法,而南方地区以"疏肝郁"、"化瘀血"为主要治法造成的。潜在的可能性是,脂肪肝以肝郁脾虚、湿热内蕴为"病"本质,次以瘀血、痰浊为"证"表现。因此对于脂肪肝的中医治疗,可能以辨病与辩证相结合治疗效果最佳。

Objective：To explore the problems and causes of TCM Differential Treatment of fatty liver disease by analyzing some main reports in those core journals.Methods：Inquiry the theme word,fat liver,in http：//acad.cnki.net/Kns55/brief/result.aspx？dbPrefix=CJFQ,and get 33 main reports,which were clinical observation with the number of cases above one hundred cases and were reported in the technological core journals.Then we divided those reporters into two groups with a nature line,the Qinling Mountains and the Huaihe River as a border,because they belongs to differential administrative regions.Yet we divided those reports into 5 styles because of 5 differential treatment tactics,melting sputum and wet,easing liver Qi,promoting spleen and stomach,removing stasis,and clearing away toxic hot.Then we analyse statistical cure rate and total effective rate with SAS 9.1 software and the total efficiency of the dual two-factor factorial design analysis of variance of quantitative data.Results：Those areas north and south treatment of patients with fatty liver were significantly different（Wilks′=0.71010963,F=6.12,P=0.0059）;different identified types of fatty liver disease syndrome in patients with no significant difference between treatment（Wilks ′=0.74229884,F=0.92,P=0.5059）;area and Disease Syndrome type no significant interaction effect（Wilks′=0.71515776,F=1.40,P=0.2354）.Conclusion：As those clinical reports of TCM Differential Treatment of fatty liver disease,the therapeutic effect of the whole northern region is better than that in the south region,the average cure rate of the northern areas and the average overall efficiency is higher than the southern region.This gap may be due to north treatment styles different from those of south.Because the styles of promoting spleen and stomach,easing liver Qi,and clearing away toxic hot are the main treatment in north area and then easing liver Qi and melting sputum and wet are the main treatment in south area.Potential possibility is that liver depression,spleen deficiency and dampness-hot is the essence of fatty liver,and blood stasis and phlegm is its manifestations.Therefore,Traditional Chinese medical treatment for fatty liver should combine with identify diseases and Disease Syndrome type to get the best treatment outcomes.