基于掌跖脓疱病“脾虚湿热,瘀阻脉络”病机假说的组方规律

Acupoint Formula Patterns Based on the Pathogenesis Hypothesis of “Spleen Deficiency,Dampness and Heat,Blood Stasis in Meridians and Channels” in Palmoplantar Pustulosis

目的:基于中医传承辅助平台(V3.0)分析中医药治疗掌跖脓疱病的组方用药规律,并提出“脾虚湿热,瘀阻脉络”病机假说。方法:检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)3个中文数据库,收集使用内服中药治疗掌跖脓疱病的文献,然后录入该软件分析其用药规律。结果:共检索纳入了87篇文献,从中筛选出内服方剂76首,涉及中药177种。其中累计出现频数最高的前5味中药分别是地黄、土茯苓、甘草、薏苡仁、牡丹皮;药物的四气以寒性、平性、温性为主,五味以苦、甘、辛为主,归经以胃、肝、肺、脾、心经为主;主要药类以清热类、利水渗湿类、补虚类、活血化瘀类为主;通过关联规则分析,得到常用药对44组,关联药组13组;最后通过复杂系统熵聚类分析提取出5组聚类组合。结论:掌跖脓疱病是本虚标实之证,脾虚为本,湿热瘀毒为标,“脾虚湿热,瘀阻脉络”为其基本病机,并且总结出治疗该病的组方用药规律,为现代临床应用和新药开发提供思路和数据支撑。

Objective:To explore the medication rules of traditional Chinese medicine(TCM) prescriptions for treating palmoplantar pustulosis by the application of the Traditional Chinese Medicine Inheritance Support System(TCMISS,V 3.0),and to propose the pathogenesis hypothesis of “spleen deficiency,dampness and heat,blood stasis in meridians and channels”.Methods:Three databases of China National Knowledge Infrastructure(CNKI),China Science Periodical Database(CSPD),and Chinese Citation Database(CCD) were searched to collect the literature about the application of traditional Chinese medicine in the treatment of palmoplantar pustulosis.Then the data were input into the software to analyze the medication rules.Results:A total of 87 articles were included,from which 76 medication prescriptions were selected,involving 177 kinds of traditional Chinese medicine.The top 5 herbs with the highest cumulative frequency were rehmannia glutinosa,glabrous greenbrier rhizome,liquorice root,coix seed and tree peony root bark.The four natures of drugs were mainly cold,flat and warm.The five flavours were mainly bitter,sweet and pungent.The meridians were mainly stomach,liver,lung,spleen and heart meridians.The main drugs were heat-clearing,clearing water and promoting diuresis,tonifying deficiency,promoting blood circulation and removing blood stasis.By association rule analysis,44 common drug pairs and 13 associated drug groups were obtained.Finally,five groups of clustering combinations were extracted by entropy clustering analysis of complex system.Conclusion:Palmoplantar pustulosis is the syndrome of deficiency in origin and excess in superficiality,which means that spleen deficiency is the basis,damp-heat and blood-stasis poison is the superficiality.“Spleen deficiency,dampness and heat,blood stasis in meridians and channels” is the basic pathogenesis.And the medication rules of TCM prescriptions for the treatment of the disease is summed up.Ideas and data support could be provided for modern clinical application and new drug development.