【作者】 杨庆邦；

【导师】 洪永敦；

【作者基本信息】 广州中医药大学 ， 中医学， 2011， 硕士

【摘要】 【目的】通过对岭南地区中医药治疗冠心病的临床研究文献整理、归纳、分析,探讨岭南地区的冠心病的中医证候分布及用药规律,希望为中医临床工作提供有价值的参考。【方法】通过收集1990-2010年岭南地区中医药治疗冠心病的临床研究文献,根据研究需要制定文献资料收集表,包括文献名称、出处、证候、用药等,将符合纳入标准的文献原始资料录入计算机,在Excel 2003软件支持下建立数据库,进行统计分析,最终得出冠心病的证候和用药规律。【结果】1、证候分布：①总体证候分布依病例频次由高到低排在前8位的依次为：气虚血瘀证>心血瘀阻证>气虚血瘀,痰阻心脉证>气阴两虚,心血瘀阻证>气滞血瘀证>痰阻心脉,心血瘀阻证>痰阻心脉证>气阴两虚证。②常见证候频次分布：气虚血瘀证>心血瘀阻证>痰阻心脉证>气阴两虚证>阳气虚衰证>气滞血瘀证>气虚血瘀,痰阻心脉证>气阴两虚,心血瘀阻证。⑧证素的病例频次分布：由高到低排列,依次为：血瘀证、气虚证、痰浊证、阴虚证、阳虚证、气滞证、寒凝证、热毒证。④证素频次分布：由高到低排列,依次为：血瘀证、气虚证、痰浊证、阴虚证、阳虚证、气滞证、寒凝证、热毒证,与证素的病例频次分布相同。2、总体用药规律：①药物类别规律：用药频率由高到低前10位依次为：活血化瘀药、补虚药、理气药、化痰药、解表药、利水渗湿药、温里药、平息肝风药、收涩药、清热药。②具体药物频次规律：用药频率由高到低前10位依次为：丹参、川芎、黄芪、当归、赤芍、甘草、瓜蒌、红花、田七、薤白。3、各单证型及常见复合证型用药规律：按用药频次由高至低依次为：心血瘀阻证：川芎、赤芍、桃仁、红花、丹参、甘草、柴胡、枳壳、黄芪、瓜蒌、生地、田七、牛膝等；气虚血瘀证：黄芪、丹参、川芎、赤芍、当归、桃仁、人参、田七、红花、党参、甘草、地龙、瓜蒌、郁金等；气滞血瘀证：川芎、赤芍、柴胡、枳壳、甘草、当归、红花、桃仁、牛膝、生地、桔梗等；痰阻心脉证：瓜蒌、半夏、茯苓、薤白、丹参、桂枝、白术、川芎、人参、枳实等；阴寒凝滞证：瓜蒌、薤白、附子、桂枝、丹参、当归、枳实、细辛、川芎、檀香、黄芪、干姜、田七等；气阴两虚证：甘草、黄芪、五味子、川芎、当归、麦冬、丹参、人参、赤芍、红花、瓜蒌等；心肾阴虚证：丹参、麦冬、熟地、山茱萸、生地、黄芪、甘草、赤芍、川芎、山药、酸枣仁、五味子、当归等；阳气虚衰证：附子、桂枝、瓜蒌、黄芪、当归、川芎、人参、薤白、甘草、干姜等；气虚血瘀兼痰浊证：丹参、黄芪、半夏、瓜萎、甘草、茯苓、薤白、田七、人参、桂枝等；气阴两虚兼血瘀证：丹参、麦冬、黄芪、川芎、五味子、当归、党参、赤芍、田七等；痰阻心脉兼血瘀证：赤芍、丹参、川芎、当归、红花、甘草、桃仁、瓜蒌、桂枝、茯苓、半夏、柴胡、黄芪等。4、各证素主要用药规律：血瘀证：丹参、川芎、当归、赤芍、红花、田七、桃仁、水蛭、郁金等；气虚证：黄芪、甘草、人参、党参、白术、太子参、山药等；痰浊证：瓜蒌、茯苓、半夏、桔梗、厚朴、竹茹等；阴虚证：麦冬、五味子、熟地、白芍、黄精、枸杞等；阳虚证：淫羊藿、菟丝子、补骨脂、巴戟、杜仲、肉苁蓉、仙茅等；气滞证：薤白、枳壳、柴胡、枳实、陈皮、檀香、橘红、香附等；寒凝证：桂枝、附子、干姜、肉桂、小茴香、高良姜等。【结论】岭南地区冠心病的主要病机为气虚血瘀,这与前人研究全国的冠心病病机有相同之处,但本研究表明,岭南地区中冠心病常由痰浊相兼为病,气虚血瘀兼痰浊证、痰瘀相兼证、痰阻心脉证分别位居第3、6、7位。这与岭南地区的气候、人们的饮食习惯相关。用药上,本研究显示活血药、补虚药、理气药、化痰药位居前4位,与证候分布相符。更多还原

【Abstract】 ObjectiveTo study the syndromes and traditional Chinese medicine regularity of coronary heart disease(CHD) in Lingnan region, according to the statistics and analysis of clinical research references about CHD treated by TCM in Lingnan region, hope that provides a valuable reference for Chinese medicine clinical work.MethodsAccording to collect references about research on syndromes and Chinese material medicine treatment of CHD from 1990 to 2010, data collection forms were made for the research, including the names, source, syndromes, medication, etc. The data matching inclusion criteria was input into computer. Database was set up in Excel 2003 software. According to the statistics and analysis, regularity of syndromes and traditional Chinese medicine using in CAD were got finally.Result1. Syndromes disposition:①The Syndrome sequence related to case frequency, descending order, the top 8 were:syndrome of qi asthenia causing blood stasis> syndrome of cariac blood stasis> syndrome of qi asthenia causing blood stasis and stagnation of phlegm in the vessel> syndrome of deficiency of both vital energy and yin, and cariac blood stasis>syndrome of qi stagnation and blood stasis>syndrome of stagnation of phlegm in the vessel, and cariac blood stasis> syndrome of stagnation of phlegm in the vessel> syndrome of deficiency of both vital energy and yin.②The sequence related to frequent syndrome frequency, descending order, were:syndrome of qi asthenia causing blood stasis> syndrome of cariac blood stasis> syndrome of stagnation of phlegm in the vessel> syndrome of deficiency of both vital energy and yin> syndrome of deficient and weak YANG QI> syndrome of qi stagnation and blood stasis > syndrome of qi asthenia causing blood stasis and stagnation of phlegm in the vessel> syndrome of deficiency of both vital energy and yin, and cariac blood stasis.③The syndrome elements sequence related to case frequency, descending order, were:syndrome of blood stasis, syndrome of deficiency of QI, syndrome of stagnation of phlegm, syndrome with yin asthenia, syndrome with yang asthenia, syndrome of stagnation of QI, syndrome of cold coagulation, syndrome of pyretic toxicity.④The sequence related to syndrome elements frequency, descending order, were:syndrome of blood stasis, syndrome of deficiency of QI, syndrome of stagnation of phlegm, syndrome with yin asthenia, syndrome with yang asthenia, syndrome of stagnation of QI, syndrome of cold coagulation, syndrome of pyretic toxicity. It is the same to the simple syndrome sequence related to case frequency.2. The total regularity of medication:①The frequeney of medication descending order, the top 10 were:blood-activating and stasis-resolving medicinals, deficineney tonificating medicinals, qi-regulating medicinals, phlegresolving medicinals, exterior-releasing medicinals, diuresis-inducing and dampness-draining medicinals, interior-warming medicinals, liver-pacifying and wind-extinguishing medicinals, astringent medicinal, heat-clearing medicinals.㏕he concrete regularity of Chinese medicine herbs:descending order, the top 10 were:salvia miltiorrhiza, szechwan lovage rhizome, milkvetch root, angelica root, red peony root, licorice root, snakegourd fruit, safflower, Panax pseudo-ginseng, longstamen onion bulb.3. The regularity of medication of every unitary syndrome and compound syndrome:by descending order of frequency of herbs use:syndrome of cariac blood stasis:szechwan lovage rhizome, red peony root, peach seed, safflower, salvia miltiorrhiza, licorice root, Chinese thorowax root, auranti Fructus, milkvetch root, snakegourd fruit, rehmannia dride rhizome, panax pseudo-ginseng, achyranthis radix, etc. Syndrome of qi asthenia causing blood stasis:milkvetch root, salvia miltiorrhiza, szechwan lovage rhizome, red peony root, angelica root,peach seed, ginseng, panax pseudo-ginseng, safflower, codonopsis pilosula, licorice root, angle worm, snakegourd fruit, curcuma aromatica, etc. Syndrome of qi stagnation and blood stasis:szechwan lovage rhizome, red peony root, Chinese thorowax root, auranti Fructus, licorice root, angelica root, safflower, peach seed, achyranthis radix, rehmannia dride rhizome, platycodon root, etc. Syndrome of stagnation of phlegm in the vessel: snakegourd fruit, pinelliae tuber, hoelen, longstamen onion bulb, salvia miltiorrhiza, cassia twig, white atractylodes, szechwan lovage rhizome, ginseng, immature orange fruit, ect. Syndrome of cold coagulation:snakegourd fruit, longstamen onion bulb, aconite root, cassia twig, salvia miltiorrhiza, angelica root, immature orange fruit, manchurian wildginger, szechwan lovage rhizome, sandalwood, milkvetch root, dried ginger, pseudo-ginseng, etc. Syndrome of deficiency of both vital energy and yin:licorice root, milkvetch root, Chinese magnoliavine fruit, szechwan lovage rhizome, angelica root, ophiopogonis tuber, salvia miltiorrhiza, ginseng, red peony root, saf flower, snakegourd fruit, etc. Syndrome of deficiency of kidney-YIN and heart-YIN:salvia miltiorrhiza, ophiopogonis tuber, prepared rhizome of rehmannia, asiatic cornelian cherry fruit, rehmannia dride rhizome, milkvetch root, licorice root, red peony root, szechwan lovage rhizome, common yam rhizome, spine date seed, Chinese magnoliavine fruit, angelica root,etc. Syndrome of deficient and weak YANG QI:aconite root, cassia twig, snakegourd fruit, milkvetch root, angelica root, szechwan lovage rhizome, ginseng, longstamen onion bulb, licorice root, dried ginger,etc. Syndrome of qi asthenia causing blood stasis and stagnation of phlegm in the vessel:salvia miltiorrhiza, milkvetch root, pinelliae tuber, snakegourd fruit, licorice root, hoelen, longstamen onion bulb, pseudo-ginseng, ginseng, cassia twig, etc. Syndrome of deficiency of both vital energy and yin, and cariac blood stasis:salvia miltiorrhiza, ophiopogonis tuber, milkvetch root, szechwan lovage rhizome, Chinese magnoliavine fruit, angelica root, codonopsis pilosula,red peony root, pseudo-ginseng, etc. Syndrome of stagnation of phlegm in the vessel, and cariac blood stasis:red peony root, salvia miltiorrhiza, szechwan lovage rhizome,angelica root, safflower, licorice root, peach seed,snakegourd fruit, cassia twig, hoelen, pinelliae tuber, Chinese thorowax root, milkvetch root, etc.4. The regularity of medication of syndrome elements:syndrome of blood stasis:salvia miltiorrhiza, szechwan lovage rhizome, angelica root, red peony root, safflower, pseudo-ginseng, peach seed, leech, curcuma aromatica, etc. Syndrome of deficiency of QI:milkvetch root, licorice root, ginseng, codonopsis pilosula, white atractylodes, heterophylly falsestarwort root, common yam rhizome,etc. Syndrome of phlegm obstruction:snakegourd fruit,hoelen, pinelliae tuber, platycodon root, magnolia bark, bambusae caulis im taeniam, etc. Syndrome with yin asthenia:ophiopogonis tuber,Chinese magnoliavine fruit, prepared rhizome of rehmannia, white peony root, solomonseal rhizome, barbary wolfberry fruit, etc. Syndrome with yan asthenia:epimedium herb,cuscuta seed, psoralea fruits, morinda root, eucommia bark, caulis cistanchis, curculiginis rhizoma, etc. Syndrome of stagnation of QI:longstamen onion bulb, auranti fructus, Chinese thorowax root, immature orange fruit, orange peel, sandalwood, epicarpium citri, nutgrass galingale rhizome, etc. Syndrome of cold coagulation:cassia twig, aconite root, dried ginger, cinnamon, cumin, lesser galangal rhizome, etc.Come I us i onThe main mechanism of disease of CHD is qi asthenia causing blood stasis. This is the same to the previous studies of the pathogenesis of CHD natioi-wide. But this study shows that, coronary heart disease is often caused by phlegm-phase in Lingnan region. Syndrome of qi asthenia causing blood stasis and stagnation of phlegm in the vessel, syndrome of stagnation of phlegm in the vessel and cariac blood stasis, syndrome of stagnation of phlegm in the vessel are respectively ranked 3,6,7 bit. This is associated with the climate and people’s eating habits in the Lingnan region. On medication,this study shows that, blood-activating and stasis-resolving medicinals,deficineney tonificating medicinals, qi-regulating medicinals and phlegresolving medicinals are among the top four drugs, this is in conformity with syndrome distribution.更多还原