基于文献挖掘冠心病合并抑郁辨证分型及用药规律

Exploration of the Syndrome Pattern and Medication Regularity of Traditional Chinese Medicine on Coronary Heart Disease with Depression Based on Literature Mining

目的 基于文献总结、分析冠心病合并抑郁的中医证型、证素分布及用药规律。方法 计算机检索PubMed、EMBASE、Cochrane Library、中国知网、万方、维普数据库,检索发表的有关中药治疗冠心病合并抑郁的随机对照试验。采用频数统计的方法,分析冠心病合并抑郁的中医证型和病性证素分布。基于中医传承辅助平台,采用频数分析、关联规则、复杂系统熵聚类等方法,分析处方中药物的使用频次、药物之间的关联规则,开发潜在新药对及药队,挖掘用药规律。结果 共筛选出88首处方。气滞血瘀证为主要证候,其次是气虚血瘀证。主要病性证素以血瘀、气滞为主,另外涉及气虚、阴虚、痰、火热。处方中药物以入肝经、心经居多,药性以温性为主,药味以苦为主、辛味为次。柴胡为使用频数最高的药物,柴胡、白芍、郁金、川芎组成核心处方。候选新药队中燮理气血、益气养阴、调和心神的药物组合较多。结论 “瘀阻心脉、气机留滞”可能是冠心病合并抑郁的基本病机。医家多从“调肝治心”或“双心同治”的角度治疗冠心病合并抑郁。以“调肝治心”为主者,多以疏肝理气、活血通脉为基本治法;若以“双心同治”为主要辨治思路,多在燮理气血的基础上,佐以益气养阴、调养心神。该结论虽有一定的临床参考价值,但中医治病讲求辨证论治,需结合具体情况选择用药。

Objective To analyze the syndrome type and medication regularity of coronary heart disease(CHD)comorbidities depression based on the literature review. Methods We searched the published randomized controlled trials(RCTs)of Chinese herbs in the treatment of CHD comorbidized depression by Pub Med,Embase,Cochrane Library,CNKI,Wan Fang and VIP databases. Frequency analysis was used to syndrome types and syndrome elements of coronary heart disease with depression. Also,we analyzed the frequency of herbs and association rules among herbs on the Traditional Chinese Medicine Inheritance Assist Platform,further developed potential new medicine pairs and medicine teams,in order to dig out prescription regularity. Results A total of 88 prescriptions were screened out. The syndromes mainly included Qi stagnation and blood stasis syndrome and Qi deficiency and blood stasis syndrome. The key syndrome elements included blood stasis and Qi stagnation. Syndrome elements also involved Qi deficiency,Yin deficiency,phlegm and heat. Most of the herbs entered the liver meridian and heart meridian. The medicinal properties were mainly warm,bitter and acrid. Chaihu(Bupleuri Radix)was the most frequently used herbs. The core prescriptions included Chaihu(Bupleuri Radix),Baishao(Paeoniae Radix Alba),Yujin(Curcumae Radix)and Chuanxiong(Chuanxiong Rhizoma). Among the candidate medicine teams,there were more combinations of herbs to tonify Qi and Yin,promote blood circulation and regulate the heart. Conclusion The basic pathogenesis of CHD combined with depression might be“stasis of heart arteries and Qi stagnation”. Most of doctors treated CHD comorbid with depression from the angle of“the liver”or“psycho-cardiology”. For the former principles,the basic therapeutic methods were regulating the liver and activating blood circulation. On condition of psycho-cardiology forum,the significant contents were managing Qi and activating blood,reinforcing Qi and nourishing Yin,as well as regulating mental states. Although this conclusion has a certain clinical reference value,but traditional Chinese medicine treatment should be based on syndrome differentiation,and medication should be selected according to the specific situation.