中医药辨证治疗慢性乙型肝炎用药规律文献研究

Literature Research of Medication Rule of Chinese Medicine Treatment of Chronic Hepatitis B by Syndrome Differentiation

目的总结慢性乙型肝炎各中医证型中药配伍规律。方法收集中国知识资源总库、维普中文期刊数据库、万方学术期刊全文数据库、中国生物医学文献数据库中医药治疗慢性乙型肝炎相关文献,将慢性乙型肝炎分为肝郁气滞、肝郁脾虚、湿热蕴结、瘀血阻络、肝肾阴虚、脾肾阳虚证,分别统计纳入文献中各证型药物使用情况,对各证型使用频率超过10%的中药进行因子分析及聚类分析。结果共纳入文献243篇。肝郁气滞证型出现53次,涉及108味中药,使用频率在10%以上的中药共26味,可聚为8类,常用药物组合为柴胡、茵陈、板蓝根、白花蛇舌草、香附、郁金、枳壳等;湿热内蕴型出现204次,涉及中药174味,使用频率在10%以上的中药共30味,可聚为6类,常用药物组合为柴胡、黄芩、赤芍、白芍、当归、丹参、茯苓、薏苡仁、板蓝根、蒲公英、茵陈、大黄、栀子、白术、虎杖、郁金、白花蛇舌草、黄芪;肝郁脾虚型出现206次,涉及中药163味,使用频率在10%以上的中药共28味,可聚为5类,常用药物组合为柴胡、白术、茯苓、当归、白芍、枳壳、党参、郁金、黄芪、丹参、白花蛇舌草、虎杖、陈皮、板蓝根、甘草;瘀血阻络型出现147次,涉及中药151味,使用频率在10%以上的中药共35味,可聚为5类,常用药物组合为丹参、柴胡、当归、白芍、白术、茯苓、桃仁、红花、黄芪、白花蛇舌草、虎杖、赤芍、甘草、鳖甲、穿山甲、郁金;肝肾阴虚型出现142次,涉及中药161味,使用频率在10%以上的中药共30味,可聚为6类,常用药物组合为生地黄、沙参、麦冬、茯苓、白术、丹参、白花蛇舌草、郁金、柴胡、当归、白芍、女贞子、枸杞子、黄芪;脾肾阳虚型出现103次,涉及中药157味,使用频率在10%以上的中药共31味,可聚为6类,常用药物组合为附子、黄芪、党参、白术、茯苓、淫羊藿、丹参、巴戟天、柴胡、当归、白芍、山药、白花蛇舌草、虎杖、郁金、菟丝子、枸杞子、女贞子。结论疏肝健脾与清热解毒利湿中药在慢性乙型肝炎各证型中均有涉及,是本病的基本治疗方法,在此基础上或滋补肝肾或温补脾肾。

Objective To summarize the herb compatibility rules in the treatment of Chronic Hepatitis B with different Chinese medicine syndrome types. Methods Related literature on Chinese medicine treatment of Chronic Hepatitis B were collected from China Integrated Knowledge Resources Database,VIP Data,Full text database of Wanfang academic journals and Chinese Biological Medical Literature Database on disc. Chronic Hepatitis B were divided into syndromes of liver depression and Qi stagnation,stagnation of liver Qi and spleen deficiency,accumulation and binding of damp-heat,static blood blocking collaterals,Yin deficiency of liver and kidney,and Yang deficiency of spleen and kidney. Herbs used in these syndromes in included literature were calculated. Herbs with use frequency in these syndromes more than 10% were made factor analysis and cluster analysis. Results Totally 243 papers were included. Syndrome of liver depression and Qi stagnation occurred 53 times,involving 108 herbs. There were 26 herbs with use frequency more than 10%,which could be clustered into 8 categories. Combination of commonly used herbs were Chaihu [Radix Bupleuri,柴胡],Yinchen [Herba Artemisiae Scopariae,茵陈],Banlan＇ gen[Radix Isatidis,板蓝根],Baihua Sheshecao [Herba Hedyotis,白花蛇舌草],Xiangfu [Rhizoma Cyperi,香附],Yujin [Radix Curcumae,郁金],Zhiqiao [Fructus Aurantii,枳壳],etc. Syndrome of accumulation and binding of damp-heat occurred 204 times,involving 174 herbs. There were 30 herbs with use frequency more than 10%,which could be clustered into 6 categories. Combination of commonly used herbs were Chaihu,Huangqin [Radix Scutellariae,黄芩],Chishao [Radix Paeoniae Rubra,赤芍],Baishao [Radix Paeoniae Alba,白芍],Danggui [Radix Angelicae Sinensis,当归],Danshen [Radix Salviae Miltiorrhizae,丹参],Fuling [Poria,茯苓],Yiyiren [Semen Coicis,薏苡仁],Banlan＇gen,Pugongying [Herba Taraxaci,蒲公英],Yinchen,Dahuang [Radix et Rhizoma Rhei,大黄],Zhizi[Fructus Gardeniae,栀子],Baizhu [Rhizoma Atractylodis Macrocephalae,白术],Huzhang [Rhizoma Polygoni Cuspidati,虎杖],Yujin,Baihuasheshecao,Huangqi [Radix Astragali seu Hedysari,黄芪],etc. Syndrome of stagnation of liver Qi and spleen deficiency occurred 206 times,involving 163 herbs. There were 28 herbs with use frequency more than 10%,which could be clustered into 5 categories. Combination of commonly used herbs were Chaihu,Baizhu,Fuling,Danggui,Baishao,Zhiqiao,Dangshen [Radix Codonopsis,党 参 ],Yujin,Huangqi,Danshen,Baihuasheshecao,Huzhang,Chenpi [Pericarpium Citri Reticulatae,陈皮],Banlan＇ gen,Gancao [Radix Glycyrrhizae,甘草]. Syndrome of static blood blocking collaterals occurred 147 times,involving 151 herbs. There were 35 herbs with use frequency more than 10%,which could be clustered into 5 categories. Combination of commonly used herbs were Danshen,Chaihu,Danggui,Baishao,Baizhu,Fuling,Taoren [Semen Persicae,桃仁],Honghua [Flos Carthami,红花],Huangqi,Baihuasheshecao,Huzhang,Chishao,Gancao,Biejia [Carapax Trionycis,鳖甲],Chuanshanjia [Squama Manis,穿山甲],Yujin. Syndrome of Yin deficiency of liver and kidney occurred 142 times,involving 161 herbs. There were 30 herbs with use frequency more than 10%,which could be clustered into 6categories. Combination of commonly used herbs were Shengdihuang [Radix Rehmanniae Recens,生地黄],Shashen[Adenophora stricta,沙参],Maidong [Radix Ophiopogonis,麦冬],Fuling,Baizhu,Danshen,Baihuasheshecao,Yujin,Chaihu,Danggui,Baishao,Nyuzhenzi [Fructus Ligustri Lucidi,女贞子],Gouqizi [Fructus Lycii,枸杞子],Huangqi. Syndrome of Yang deficiency of spleen and kidney occurred 103 times,involving 157 herbs. There were 31 herbs with use frequency more than 10%,which could be clustered into 6 categories. Combination of commonly used herbs were Fuzi [Radix Aconiti Lateralis Preparata,附子],Huangqi,Dangshen,Baizhu,Fuling,Yinyanghuo [Herba Epimedii,淫羊藿],Danshen,Bajitian [Radix Morindae Officinalis,巴戟天],Chaihu,Danggui,Baishao,Shanyao[Rhizoma Dioscoreae,山药],Baihuasheshecao,Huzhang,Yujin,Tusizi [Semen Cuscutae,菟丝子],Gouqizi,Nyuzhenzi. Conclusion Herbs of dispersing the stagnated liver-Qi,invigorating the spleen,clearing heat,removing toxicity and promoting diuresis were commonly used in Chinese medicine syndromes of Chronic Hepatitis B. They were basic treatment methods of this disease. In addition to these treatment methods,nourishing liver and kidney or warmly invigo-rating spleen and kidney might be added.