中医外治法治疗大肠癌化疗所致周围神经病变用药规律分析

An analysis of medication rule of TCM external therapy in treating peripheral neuropath due to colorectal cancer chemotherapy

目的:探寻中医外治法治疗大肠癌化疗所致周围神经病变(Chemotherapy-Induced Peripheral Neuropath,CIPN)的用药规律。方法:通过检索中国期刊全文数据库、万方数据库和维普中文期刊平台2011年1月-2021年1月中医外治法治疗大肠癌CIPN相关临床文献,收集相关方剂及中药复方,运用Excel 2010、IBM SPSS Statistics 26.0、IBM SPSSModeler 14.2软件建立药物数据库,并对数据进行频数分析、性味归经分析、聚类分析、高频用药关联规则分析。结果:对中医外治法治疗大肠癌CIPN相关临床文献进行检索及整理,共纳入文献68篇,涉及方剂及中药复方68首,共涉及药物117味,高频药物(≥6)共23味,前十味依次是桂枝、红花、当归、黄芪、鸡血藤、川芎、威灵仙、赤芍、艾叶、伸筋草。药性以温性药物使用频率最高。药味以辛味药使用频率最高。药物归经以肝经最多,其次为脾经、肾经。高频药物聚类分析可划分为5类,分别为补虚止痛类:白芍、附子、甘草;活血止痛类:桂枝、川芎、丹参、桃仁、威灵仙;活血通络类:地龙、川乌、赤芍、牛膝、当归、细辛;温经通络类:艾叶、透骨草、伸筋草、木瓜;行气活血类:红花、老鹳草、黄芪、鸡血藤、桑枝。药物关联规则分析表明,桂枝-川芎是二阶关联规则中支持度最高的组合,黄芪-鸡血藤-当归是三阶关联规则中支持度最高的药物组合。结论:中医外治法治疗大肠癌CIPN治之当以活血化瘀为本,通经活络为辅,兼虚者补气、补血,湿困者祛湿缓拘挛,寒凝者散寒除痹。

Objective:To explore the medication rules of TCM external therapy in treating peripheral neuropathy due to colorectal cancer chemotherapy.Methods:The clinical literature related to treating CIPN by TCM external therapy in CNKI,Wanfang,VIP from January 2011 to January 2021 was retrieved,and the relevant prescriptions and TCM compound prescriptions were collected.A medicines database was established by Excel 2010,IBM SPSS Statistics 26.0 and IBM SPSS Modeler 14.2 software.The frequency analysis,character and flavor analysis,cluster analysis,and high-frequency medicine association rule analysis of the data were performed.Results:The clinical literature related to treating CIPN by TCM external therapy was retrieved and sorted out.A total of 68 studies were included,involving 68 TCM compound prescriptions and 117 medicines.There were 23 high-frequency(≥6)medicines,the top ten flavors are Guizhi(Ramulus cinnamomi),Honghua(Safflower),Danggui(Angelica),Huangqi(Astragalus),Jixueteng(Suberect spatholobus stem),Chuanxiong(Rhizoma Ligustici Chuanxiong),Weilingxian(Radix Clematidis),Chishao(Radix paeoniae rubra),Aiye(Wormwood),and Shenjincao(Herba lycopodii).The frequency of mild property medicines is the highest.The frequency of spicy medicines is the highest.The medicines most frequently flowed into the liver meridian,followed by the spleen meridian and the kidney meridian.According to high�frequency medicines cluster analysis,there were 5 categories of TCM medicines,namely the tonifying deficiency and relieving pain type such as Baishao(White paeonia radiata),Fuzhi(Aconite)and Gancao(Licorice);the promoting blood circulation and relieving pain type such as Guizhi,Chuanxiong,Danshen(Salvia),Taoren(Peach kernel)and Weilingxian;the promoting blood circulation and collaterals type such as Dilong(Earthworm),Chuanwu(Radix Aconiti),Chishao,Niuxi(Achyranthes bidentata),Danggui and Xixin(Asarum);the warming meridian and dredging collaterals type such as Aiye,Tougucao(Garden balsam stem),Shenjincao and Mugua(Papaya);the promoting Qi(气)and blood circulation type such as Honghua,Laohecao(Geranium),Huangqi,Jixueteng and Shanzhi(Mulberry branch).The analysis of medicines association rules shows that Guizhi-Chuanxiong is the most supported medicines combination in the second-order association rules,and Huangqi-Jixueteng-Danggui is the most supported medicines combination in the third-order association rules.Conclusion:Treating CIPN by TCM external therapy should be based on activating blood and removing blood stasis,supplemented by dredging meridians and collaterals,plus replenishing Qi and blood for those with deficiency,eliminating dampness and relieving contracture for those with dampness,and dispelling cold and removing paralysis for those with cold.