慢性非萎缩性胃炎证候证素分布与用药规律分析

Literature Study on Distribution Features of TCM Syndromes and Composition Principles for Prescriptions of Chronic Non-Atrophic Gastritis

目的:探讨慢性非萎缩性胃炎(chronic non-atrophy gastritis,CNAG)的证候证素分布规律及用药规律,为该病的临床辨证和治疗思路提供依据与方向。方法:全面检索中国生物医学文献数据库(CBM)、中国知网全文数据库(CNKI)、万方数据库和维普数据库(VIP),依据纳入和排除标准,纳入有关CNAG的中医临床研究。收集文献的一般资料、病例辨证分型、处方用药,以Microsoft Excel 2016建立数据库,应用SPSS 22.0分析CNAG证候证素分布规律,应用中医传承辅助平台(V2.5)进行描述性统计、关联规则分析、复杂系统熵聚类运算分析CNAG的核心用药及组方规律。结果:一共纳入文献1146篇,其中证候类研究64篇,用药类研究1082篇。CNAG常见证候类型依次为肝胃不和证、脾胃气虚证、脾胃湿热证、脾胃阳虚证、胃阴亏虚证、瘀阻胃络证。CNAG病位在胃、脾、肝。CNAG常见病性类证素依次为:气虚、热、气滞、湿、阳虚。CNAG所涉及的1226个中药处方经规范后共包含中药267味,以补气药、理气药为主。经过关联规则分析,在支持度为10%、15%、20%,置信度为0.6的条件下,CNAG中药处方的核心用药组合分别为180、57、24个,药物间关联规则分别为323、73、31条。应用复杂系统熵聚类分析,CNAG得出26个核心用药组合、13首新方。结论:CNAG病机虚实夹杂,以实证主,肝胃不和证与脾胃气虚证为其核心证候,病位在胃,与脾、肝密切相关,气虚、气滞、湿、热是其基本病机。故CNAG治以益气健脾、理气和胃法,以四君子汤合柴胡疏肝散加减为基础,辅以清热解毒、利水渗湿、活血化瘀等药。

Objective:To understand the distribution features of TCM syndromes and the rules of core medication,characteristic prescription of chronic non-atrophic gastritis(CNAG),which could provide the identified standards and the therapeutic direction for clinician.Methods:By searching Chinese Biomedical database(CBM),CNKI,Wanfang and VIP database,the epidemiological studies or clinical treatment studies on TCM of CNAG were enrolled based on inclusion and exclusion criteria.The basic information(the first author,researched years,demographic data)and the syndrome differentiation,TCM prescriptionfrom in these literatures were collected by Microsoft EXCEL 2016,and were analyzed through SPSS 22.0 and Traditional Chinese Medicine Inheritance Support Platform(V2.5)by descriptive statistics,association rules algorithm and complex system entropy clustering.Results:A total of 1146 literatures were included,including 64 syndrome studies and 1082 medication studies.The common syndrome types of CNAG are:disharmony of the liver and the stomach,Qi deficiency of the spleen and the stomach,heat and dampness of the spleen and the stomach,Yang deficiency of the spleen and the stomach,Yin deficiency of the stomach and stasis obstructing the stomach.The major syndrome elements of disease location are stomach,spleen and liver.The common syndrome elements of CNAG are Qi deficiency,heat,Qi stagnation,dampness and Yang deficiency.The 1226 prescriptions of CNAG contained 267 herbs,which mainly consist of Qi-tonifying drug and Qi-regulating drug.Under the condition of 10%,15%,20%and 0.6 confidence,analyzed by association rules,the core drug combinations were 180,57 and 24,and the association rules between drugs were 323,73 and 31.From the analysis of complex entropy clustering and improved mutual information,26 inner core drug combination and 13 new prescriptions in CNAG were found.Conclusions:The pathogenesis of CNAG is mixed with deficiency and excess.The core syndrome of CNAG is the syndrome of disharmony of liver and stomach and the syndrome of Qi deficiency of spleen and stomach.The disease is located in the stomach and closely related to the spleen and liver.The basic pathogenesis of CNAG is Qi deficiency,Qi stagnation,dampness and heat.Therefore,the methods of treating CNAG is replenishing Qi to invigorate the spleen,regulating Qi and harmonizing stomach.The pricsriptions are the addition and subtraction of Sijunzi Decoction(四君子汤)and Chaihu Shugan Powder(柴胡疏肝散),supplemented by drugs such as heat-clearing and detoxifying,inducing diuresis and excreting dampness,promoting blood circulation and removing blood stasis.