以小儿咳嗽为例分析中西医临床实践指南中常用方药的遴选原则

Selection Principles and Analysis of Common Prescriptions in Clinical Practice Guidelines of Traditional Chinese and Western Medicine Based on Cough in Children

目的以当今主流指导资料结合古籍经典作为检索源多途径收集常用方药,为中西医临床实践指南中常用方药的遴选原则提供参考依据。方法以《小儿咳嗽中西医临床实践指南》中的常用方药遴选研究为例,检索3类国家推荐的药品、中医(中西医)临床诊疗指南/专家共识/临床路径/诊疗方案、3本中医类儿科教材、名家经验,古籍中治疗小儿咳嗽的方药,分别建立古今方药数据库归纳分析用药规律。结果当今治疗儿童咳嗽的有71个常用方药,临床适用证型占比前3位分别为痰热闭肺证、风热犯肺证、风寒袭肺证,与高频药物对应功效前五位分别为止咳平喘、清化热痰、发散风寒、清热泻火、发散风热。最常用的中药主要是苦杏仁、桔梗、贝母、麻黄、黄芩、半夏、陈皮等,某些药物与苦杏仁、桔梗的内在关联性较高。基于《中华医典》的古籍部分治疗小儿咳嗽的有228个方药数据汇总,最常用的中药主要是半夏、苦杏仁、人参、茯苓、陈皮、桔梗、生姜、贝母等,高频药物对应功效前五位分别为发散风寒、止咳平喘、清化热痰、温化寒痰、补气。某些药物与半夏、桔梗的内在关联性较高。做古今用药对比,用药大致可归纳为两大类,宣降肺气类和化痰类。但古代小儿咳嗽用药多温补散寒,兼利水消肿、敛肺涩肠;当今儿童咳嗽方药更侧重疏风清热,兼补阴润燥。结论该研究较为系统的梳理了治疗小儿咳嗽常用的方药,为临床实践指南中医药遴选部分提供了依据。

Objective To collect common prescriptions from multiple channels based on the mainstream guidance materials combined with ancient books to provide references for the selection principles of common prescriptions in clinical practice guidelines of traditional Chinese medicine(TCM)and western medicine.Method With the research on the selection of commonly used prescriptions in Clinical Practice Guidelines of Chinese and Western Medicine for Cough in Children as an example,the nation-recommended ScheduleⅢdrugs and prescriptions for cough in children in the clinical diagnosis and treatment guidelines of TCM(TCM and western medicine)/expert consensus/clinical pathway/diagnosis and treatment protocols,three TCM pediatric textbooks,the experience of famous experts,and ancient books were searched for the establishment of a prescription database and analysis of medication regularity.Result The results showed that there were 71 commonly used prescriptions for the treatment of cough in children.The top 3 clinically indicated syndromes were the syndrome of phlegm-heat blocking the lung,the syndrome of wind-heat invading the lung,and the syndrome of wind-cold attacking the lung,and the top 5 efficacies corresponding to high-frequency drugs were reliving cough and dyspnea,clearing heat/resolving phlegm,dispersing wind/dissipating cold,clearing heat/purging fire,and dispersing wind/dissipating heat.The most commonly used Chinese medicines included Armeniacae Semen Amarum,Platycodonis Radix,Bolbostemmatis Rhizoma,Ephedrae Herba,Scutellariae Radix,Pinelliae Rhizoma,and Citri Reticulatae Pericarpium.Some drugs showed high internal correlations with Armeniacae Semen Amarum and Platycodonis Radix.There were 228 prescriptions for the treatment of cough in children based on the ancient books in the Chinese Medical Code.The most commonly used Chinese medicines were Pinelliae Rhizoma,Armeniacae Semen Amarum,Ginseng Radix et Rhizoma,Poria,Citri Reticulatae Pericarpium,Platycodonis Radix,Zingiberis Rhizoma Recens,and Bolbostemmatis Rhizoma.The top 5 efficacies corresponding to high-frequency drugs were dispersing wind/dissipating cold,relieving cough and dyspnea,clearing heat/resolving phlegm,warming cold/resolving phlegm,and tonifying Qi.Some drugs showed high internal correlations with Pinelliae Rhizoma and Platycodonis Radix.As revealed by the comparison of ancient and modern medication,the medication principles could be roughly classified into two categories:ventilating the lung/descending Qi and resolving phlegm.In ancient medication,the drugs for cough in children were mainly used for warming,tonifying,dissipating cold,excreting water,alleviating edema,and astringing lung and intestines,while in modern medication,the prescriptions were mainly for dispersing wind,clearing heat,tonifying yin,and moistening dampness.Conclusion This study systematically analyzed the commonly used prescriptions for the treatment of cough in children and provided references for the selection of TCM in clinical practice guidelines.