近30年中医药治疗冠心病痰瘀互结证用药概况分析

Analysis of the Medications in Treating Coronary Heart Disease with Binding of Phlegm and Stasis Syn⁃drome by Traditional Chinese Medicine in Recent 30 Years

目的分析近30年中医药治疗冠心病痰瘀互结证用药概况,为中医药治疗冠心病痰瘀互结证提供参考。方法计算机检索1991年1月1日至2021年9月1日中国知识资源总库、中文科技期刊数据库、中国学术期刊数据库、PubMed收录的中医药治疗冠心病痰瘀互结证相关研究文献,根据美国国家临床指南交换所(NGC)的证据等级对纳入文献进行证据分级。提取冠心病痰瘀互结证随机对照试验研究(A级证据)中的常用传统方剂、自拟方剂及中成药药物信息,并分析不同等级文献单味中药使用情况。结果共纳入冠心病痰瘀互结证临床治疗用药文献286篇,其中传统方剂79篇(27.62%),自拟方剂165篇(57.69%),中成药42篇(14.69%),累计治疗患者11276例。文献证据级别评价结果为A级文献196篇(68.53%),B级文献20篇(6.99%),C级文献70篇(24.48%)。A级文献中,瓜蒌薤白半夏汤及血府逐瘀汤为常用的传统方剂,涉及其加减组合的文献共计27篇;冠脉宁通方(5篇)为最常用的自拟方;丹蒌片(17篇)是最常用的中成药。治疗冠心病痰瘀互结证的高频次药物有瓜蒌(67.48%)、丹参(63.29%)、半夏(62.24%)、川芎(47.90%)、薤白(47.90%)、甘草(40.21%)、黄芪(33.57%)、赤芍(30.77%)、红花(30.77%)、郁金(30.07%);其中A级文献涉及高频次药物为瓜蒌(46.15%)、半夏(41.61%)、丹参(41.26%)、川芎(33.22%)、薤白(30.07%);B级文献涉及高频次药物为瓜蒌(5.59%)、半夏(5.59%)、丹参(5.59%)、薤白(5.24%)、川芎(3.50%);C级文献涉及高频次药物为丹参(16.43%)、瓜蒌(15.73%)、半夏(15.03%)、薤白(12.59%)、川芎(11.19%)。结论中医药治疗冠心病痰瘀互结证常用药物为瓜蒌、丹参、半夏、川芎、薤白、甘草、黄芪、赤芍、红花、郁金等,体现了化痰祛瘀的主要治则,以及对清热解毒、凉血活血、宽胸散结方药的合理运用。

Objective To analyze the medications of traditional Chinese medicine(TCM)in the treatment of coronary heart disease(CHD)with binding of phlegm and stasis syndrome in recent 30 years,thereby providing reference for TCM treatment of CHD with binding of phlegm and stasis syndrome.Methods The literature on TCM for CHD with binding of phlegm and stasis syndrome was searched from CNKI,VIP,Wanfang and PubMed from January 1st,1991 to September 1st,2021 by computer.The included literature was graded according to the National Guide⁃line Clearinghouse(NGC)grade of evidence.The commonly used traditional prescriptions,self-designed prescrip⁃tions and Chinese patent medicines in the randomized controlled trials(GRADE A evidence)were extracted,and the use of single herbs in different grades of evidence was analyzed.Results A total of 286 papers on medications for CHD with binding of phlegm and stasis syndrome were included,involving 79(27.62%)traditional prescriptions,165(57.69%)self-made prescriptions and 42(14.69%)Chinese patent medicines,and with 11276 patients.The number of grade A,B and C literature were 196(68.53%),20(6.99%),and 70(24.48%),respectively.In grade A literature,Gualou Xiebai Banxia Decoction(瓜蒌薤白半夏汤),Xuefu Zhuyu Decoction(血府逐瘀汤)and their modi⁃fications were the most commonly used traditional prescriptions(27 papers);Guanmai Ningtong Formula(冠脉宁通方)was the mostly used self-designed prescription(5 papers);and Danlou tablet was the most commonly used Chi⁃nese patent medicine(17 papers).The high frequently used single herbs were Gualou(Fructus Trichosanthis,67.48%),Danshen(Radix et Rhizoma Salviae Miltiorrhizae,63.29%),Banxia(Rhizoma Pinelliae,62.24%),Ch⁃uanxiong(Rhizoma Chuanxiong,47.90%),Xiebai(Bulbus Allii Macrostemi,47.90%),Gancao(Radix et Rhizoma Glycyrrhizae,40.21%),Huangqi(Radix Astragali,33.57%),Chishao(Radix Paeoniae Rubra,30.77%),Hong⁃hua(Flos Carthami,30.77%),and Yujin(Radix Curcumae,30.07%).The single herbs with high frequency in grade A literature were Gualou(46.15%),Banxia(41.61%),Danshen(41.26%),Chuanxiong(33.22%),and Xiebai(30.07%).In grade B literature,the most commonly used single herbs were Gualou(5.59%),Banxia(5.59%),Danshen(5.59%),Xiebai(5.24%)and Chuanxiong(3.50%).The high frequent herbs mentioned in grade C literature were Danshen(16.43%),Gualou(15.73%),Banxia(15.03%),Xiebai(12.59%)and Chuanx⁃iong(11.19%).Conclusion The commonly used herbs in the treatment of CHD with the binding of phlegm and stasis syndrome are Gualou,Danshen,Banxia,Chuanxiong,Xiebai,Gancao,Huangqi,Chishao,Honghua,and Yujin,following the principle of dissolving phlegm and dispelling stasis,and rationally using prescriptions that have the function of clearing heat and resolving toxins,cooling and invigorating blood,broadening chest and dissipating masses.