中药治疗儿童紫癜性肾炎血尿型辨证及用药规律分析

Analysis on syndrome differentiation and medication rules of Chinese materia medica in the treatment of children with purpura nephritic hematuria type

目的探讨中药治疗儿童紫癜性肾炎血尿型的辨证及用药规律,以期为本病的临床诊治提供参考。方法利用国内三大中文数据库《中国知网中国学术期刊网络出版总库》《维普中文科技期刊数据库》和《万方数据中国学术期刊数据库》,以"血尿""紫癜性肾炎"为检索词,检索2000—2019年国内公开发表的使用中医药治疗儿童紫癜性肾炎血尿型的临床文献,对文献报道中所辨证型及所用药物的分类、功效、药性、药味、归经进行统计分析。结果在符合纳入条件的中医药治疗儿童紫癜性肾炎血尿型的52篇临床文献中,共涉及101味中药,12类药物,累积频次1299次,其中居前5位的药物类别分别是清热药、补虚药、止血药、活血化瘀药和利湿药,居前20位的单味药分别是生地黄、当归、旱莲草、三七、茜草、甘草、白茅根、山萸肉、黄柏、黄芪、党参、白术、栀子、大蓟、小蓟、丹参、知母、地龙、虎杖、枸杞子。辨证分型主要有血热妄行证、阴虚内热证、脾肾两虚证、脾不统血证、瘀血阻络证、湿瘀互结证、气阴两虚证。结论儿童紫癜性肾炎血尿型辨证以血热妄行证为主,多从"瘀""热""虚""湿"论治,常运用活血化瘀、清热解毒、凉血止血、益气养阴类中药治疗。

Objective To explore syndrome differentiation and medication rules of Chinese materia medica(CMM)in the treatment of children with purpura nephritic hematuria type,and to provide references for clinical diagnostic treatment of it.Methods With the search terms of"hematuria"and"purpura nephritis",three domestic Chinese databases were used to search the clinical literature published in China from 2000 to 2019 on CMM in the treatment of children with purpura nephritic hematuria type,including China National Knowledge Infrastructure China Academic Journal Network Publishing Database(CNKI),VIP Chinese Sci-tech Journal Database and Wanfang Data China Academic Journal Publishing Database.The syndrome types differentiated and the classification,efficacy,property,taste and meridian tropism of the medicinals used which were reported in the literature were statistically analyzed.Results In the 52 clinical literature which met the inclusion criteria on CMM in the treatment of children with purpura nephritic hematuria type,there were 101 flavors of CMM and 12 categories of medicinals,with the cumulative frequency of 1,299 times.The top 5 categories of medicinals were heat-clearing medicinals,reinforcing deficiency medicinals,stopping bleeding medicinals,promoting blood circulation to resolve stasis medicinals and dispersing dampness medicinals.The top 20 single medicinals were Rehmanniae radix,Angelicae sinensis radix,Ecliptae herba,Notoginseng radix et rhizoma,Rubiae radix et rhizoma,glycyrrhizae radix et rhizoma,Imperatae rhizoma,Corni fructus,Phellodendri chinensis cortex,Astragali radix,Codonopsis radix,Atractylodis macrocephalae rhizoma,Gardeniae fructus,Cirsii japonici herba,Cirsii herba,Salviae miltiorrhizae radix et rhizoma,Anemarrhenae rhizoma,Pheretima,Polygoni cuspidati rhizoma et radix and Lycii fructus.Typing according to syndrome differentiation mainly includes syndrome of failure of blood to flow in the vessel due to heat,syndrome of interior heat due to yin-asthenia,syndrome of simultaneous asthenia of spleen and kidney,syndrome of failure of spleen to control blood,syndrome of blood stasis obstructing collaterals,syndrome of binding of dampness and stasis and syndrome of asthenia of both qi and yin.Conclusion Syndrome differentiation of children with purpura nephritic hematuria type focuses on failure of blood to flow in the vessel due to heat syndrome,mainly is treated based on syndrome differentiation from"stasis""heat""asthenia""dampness",often uses categories of CMM involving promoting blood circulation to resolve stasis,clearing away heat to remove toxin,cooling blood to stop bleeding and replenishing qi and nourishing yin.