中医药治疗缺血性中风痰湿证的用药规律研究

Literature Research on Medication Rules of Traditional Chinese Medicine in Treatment of Ischemic Stroke with Phlegm-Dampness Syndrome

目的通过文献整理及数据挖掘总结中医药治疗缺血性中风病痰湿证的临床用药规律。方法分别检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanFang Data)、维普数据库中关于中医药治疗缺血性中风痰湿证的临床研究文献。按照纳入、排除标准筛选后建立数据库,利用频次统计、聚类分析、复杂网络分析等方法研究临床用药的频次、中药属性(性味、归经、功效)、常用配伍及核心处方等规律。结果共纳入117篇文献,包括53种处方,涉及5063例患者,在痰湿主证基础上兼有风、火热、血瘀、气虚等证素。其中针对痰湿证素使用频次较高的药物为茯苓、半夏、甘草、白术、陈皮等;性味以温、寒、平性及苦、甘、辛味为主,归经以脾经、肝经以及胃经为主;具有较强关联的药物组合为陈皮-茯苓、白术-茯苓、半夏-茯苓等;核心处方以半夏白术天麻汤、星蒌承气汤、补阳还五汤为基础加减。结论祛湿化痰类中药是治疗缺血性中风痰湿证的基础用药,同时随证加减熄风、清热、活血、益气等药物有助于取得更理想疗效。

Objective To summarize the clinical medication rules of traditional Chinese medicine in treatment of ischemic stroke with phlegm-dampness syndrome,so as to provide reference for clinical syndrome differentiation and new drug development of apoplexy.Methods Clinical research literatures in treating apoplexy with phlegmdampness syndrome were reviewed in China national knowledge infrastructure database(CNKI),China biology medicine disc(CBM),Wanfang digital database and Vip citation databases.The data of TCM prescriptions in included literatures were extracted and standardized.Methods of frequency statistics,cluster analysis and complex network analysis were used to study the frequency of clinical application of drugs,drug information(four natures,five flavors,and channel tropism),common drug combinations and core prescriptions.Results Totally,117 qualified documents were included,involving 53 prescriptions.There were a total of 5063 patients being treated.On the basis of the main syndrome of phlegm-dampness,those patients can have the syndrome elements such as wind,heat,blood stasis,and qi deficiency.Among them,the frequency of medication for phlegm-dampness syndrome in the top five is Poria cocos,Pinelliae rhizoma,licorice,Atractylodes macrocephala and dried Citri reticulatae pericarpium.The main properties and flavors of commonly used Chinese medicines were warm,cold,mild in nature,and bitter,sweet and pungent in flavor.Their main channel tropisms belong to spleen,liver and stomach.The closely related drug combinations are Citri reticulatae pericarpium-Poria cocos,Atractylodes macrocephala-Poria cocos,Pinelliae rhizome-Poria cocos,etc.The core prescription was based on the addition and subtraction of Banxia Baizhu Tianma Tang,Xing Lou Chengqi Tang,Buyang Huanwu Tang.Conclusion Herbs that can clear dampness and reduce phlegm were basic herbs in treating apoplexy with phlegm-dampness syndrome.Meanwhile,herbs of calming the liver to stop the wind,clearing heat,removing blood stasis and tonifying deficiency were modified with syndromes to achieve better effect.Our research provides some reference for the treatment and drug development for apoplexy with phlegm-dampness syndrome.