腰椎间盘突出症的古籍证据评价及辨证规律探析

Evaluation of ancient evidence of lumbar disc herniation and exploration of dialectical rules

[目的]梳理腰椎间盘突出症的古籍证据及辨证规律并评价其证据质量,以期对中医临床循证医学的研究提供参考依据。[方法]检索《中华医典》以筛选腰椎间盘突出症相关的防治证据,应用《中医古籍防治证据评价分级量表》对每条证据进行评价,并通过“以方测证”的方式为临床医生提供经典方剂的辨证规律总结。[结果]共获腰椎间盘突出症的防治证据197条,其中知识类证据192条,案例类证据5条。共涉及136个方剂,古籍共74本。136个方剂中,20个被评为Ⅰ级证据;55个被评为Ⅱ级证据;61个被评为Ⅲ级证据。辨证分型多以肾虚腰痛(55条)、寒湿腰痛(35条),淤血腰痛(9条)、湿热腰痛(9条)次之。[结论]中药方剂治疗腰椎间盘突出症的古籍证据质量不高,中医古籍的研究仍有待深入探索。古籍证据表明,在腰椎间盘突出症辨证中以肾虚腰痛、寒湿腰痛常见,治则治法多为补肾壮阳、散寒除湿、温经通络、理气止痛、化痰除湿等。

[Objective]To sort out the ancient book evidence and dialectical law of lumbar disc herniation and evaluate its quality of evidence,in order to provide reference for the study of clinical evidence-based medicine in traditional Chinese medicine.[Methods]Search the Chinese medical classics to screen the prevention and treatment evidence related to lumbar disc herniation,evaluate each evidence with the evaluation and grading scale of prevention and treatment evidence of ancient chinese medicine,and provide clinicians with a summary of the syndrome differentiation rules of classic prescriptions through the way of“measuring the syndrome by prescription”.[Results]A total of 197 pieces of prevention and treatment evidence of lumbar disc herniation were obtained,including 192 pieces of knowledge evidence and 5 pieces of case evidence.A total of 136 prescriptions and 74 ancient books are involved,in which 136 prescriptions,20 were rated as LevelⅠevidence;55 were rated as LevelⅡevidence;61 were rated as LevelⅢevidence.Most of the dialectical types are kidney deficiency lumbago(55),cold and wet lumbago(35),congested lumbago(9),and damp-heat lumbago(9).[Conclusion]The quality of evidence in ancient books of traditional Chinese medicine for the treatment of lumbar disc herniation is not high,and the research of ancient books of traditional Chinese medicine still needs to be further explored.Evidence from ancient books shows that kidney deficiency lumbago and cold-dampness lumbago are common in the dialectics of lumbar disc herniation,and the treatment principles and methods are mostly kidney tonifying and yang strengthening,dispelling cold and dehumidifying,warming meridians and collaterals,regulating qi to relieve pain,resolving phlegm and dehumidifying,etc.