【作者】 侯如艳；

【导师】 杜同仿；

【作者基本信息】 广州中医药大学 ， 中药学， 2008， 硕士

【摘要】 【目的】中医药治疗冠心病有独特的优势,但治则治法纷繁复杂。本研究通过分析从古至今有效治疗冠心病的中药复方的基础上,对中药治疗冠心病用药规律作初步探讨,以更好地指导临床用药,为冠心病治则治法及临床用药提供科学依据。【方法】通过收集20部著名古代医籍中记载的治疗胸痹心痛的名家名方和1979-2007年间40多种省级以上中医药期刊中涉及到的治疗冠心病的中药复方1000余首,按照药味完整、药量准确、疗效确切的标准,再次筛选出600首,建立治疗冠心病的中药复方数据库,基于数据库运用excel及统计学方法分析中医药治疗冠心病用药规律。并用中医、中药基础理论知识及中药药理研究知识阐明了用药规律的合理性。【结果】1.复方的收集及数据库的建立通过对20部古典医籍及近30年来40多种省级以上中医药期刊所载的治疗冠心病的有效复方搜集,共收集到有效方剂1000余首。依照药味完整、药量准确、疗效确切等标准,再次从这些方剂中筛选出600首方剂,按照中文文摘的方式建立中医药治疗冠心病有效复方数据库。2.冠心病有效复方中涉及的中药种类在治疗冠心病的600首有效复方中,总共涉及18类中药,运用中药多达235种,总计用药5937次。其中,应用频率最高的前4类药分别是:补益药、活血化瘀药、理气药、化痰止咳平喘药,相对使用频率分别为27.88%、23.20%、8.79%、7.33%。而驱虫药、泻下药等虽然仍有使用,但使用频率仅为0.05%和0.22%。3.各类药物的配伍规律研究在搜集到的600首方剂中,根据方剂组成逆向分析,数据库中涉及到的各类药物配伍方法有:补气药+活血化瘀药;清热药+活血化瘀药;理气药+活血化瘀药;养阴药+补气药;化痰药+理气药;化痰药+活血化瘀药等等。临床上使用频率较高的有补气药+活血化瘀药、理气药+活血化瘀药。4.冠心病复方中涉及的单味中药及使用频率研究数据库中总共涉及中药235种,不同中药使用频率有很大差别。在活血化瘀类药物中,使用频率最高的为丹参、川芎、红花,在600首方剂中分别出现400次、314次和159次。补益药中使用频率最高的为补气药黄芪、补血药当归、养阴药麦冬,出现频率分别为292次、216次、151次。5.各个中药之间配伍规律各种药物之间配伍规律主要体现在药对的应用上。药对是临床上常用的、相对固定的两味药物的配伍形式,是复方的最小单元。临床治疗冠心病最常用药对有:瓜蒌与薤白;人参与三七;丹参与赤芍;乳香与没药等。这些药对的应用十分普遍,增强了单味药治疗的效果。【结论】1.研究显示,治疗冠心病的中药复方共涉及所有中药中的18类,共计235种中药。涉及范围十分广泛,而不局限于某一类或某几类中药。中医药治疗冠心病仍以辩证论治为基础,根据证型选择用药,辨证论治是中医学的根本特征。2.在涉及的所有中药中,应用频率最高的中药为补益药、活血化瘀药、理气药、化痰止咳平喘药,且这几类中药常常相互配伍使用。其中,补气药配伍活血化瘀药、理气药配伍活血化瘀药、理气药配伍化痰药最为常见,由此可见,冠心病的临床证型仍以气虚血瘀证、气滞血瘀证、气滞痰阻证最为常见。3.在治疗冠心病的235种中药中,出现频率排在前20位的中药分别是丹参、川芎、黄芪、当归、赤芍、桂枝、瓜蒌、红花、麦冬、炙甘草、三七、郁金、人参、茯苓、半夏、薤白、生甘草、五味子。这些药物在临床治疗冠心病中应用频率最高,疗效确切,在临床应用及新药开发中具有较好的前景。更多还原

【Abstract】 Objective:Traditional Chinese Medicine has its own advantage in curing coronary heart disease。The research based on analyzing lots of herbal prescription materials from antient to now in treating coronary,will explore the Traditional Chinese Medicine rule in therapy coronary heart disease.The research will do a good favor in clinical medication and improve the curative effect,lt will also provide scinetific basis for therapeutic principle and therapeutic method in curing coronary heart disease.Method:By collecting 20 famous antient medical books and the latest thirty years’ 40 journals which contains meika’ effective herbal prescriptions in treating coronary heart disease,we got about 1000 effective prescriptions.According to complete components、accurate dose,exact curative effect criteria,we chose 600 effective herbal prescriptions again and made a herbal prescription databases in treating coronary heart disease.We use Excel and statistics analyzing medical rule in treating coronary heart disease.We also use basic theory of TCM and basic theory of Traditional Chinese Pharmacy and contemporary pharmacology knowledge to illustrate reasonaleness of medication rule.Result:1.Build the databasesBy collecting effective herbal prescriptions in curing coronary heart disease from 20 famous ancient,medical books and the latest 40 TCM journals,we got 1000 effective herbal priscription.According to complete components、accurate dose、exact curative effect criteria,we chose 600 effective herbal prescriptions again and made a herbal prescription databases in treating coronary heart disease.2.How many Species it involvesIn all the 600 effective herbal prescription,it concerning 18 kinds of herbs,and uses 235 herbs for 5937 times.Among them,the three most highest using drugs are tonics、promoting blood circulation and removing blood stasis drugs、qi regulating drugs.The using frequency for each is 27.88%,23.20%and 8.79%.Although anthelmintic drugs and purgatives drugs are also used,the frequency is only 0.05%and 0.22%.3.Study on compatibility regulation of every kindIn all the 600 collected herbal prescriptions,we analyze the components of the herbal prescription by reverse thinaking,and we know that different prescription with different etiology and pathogenesis. All kinds of drugs inferred in the database are combined in these ways:qi invigorating drugs and promoting blood circulation and removing blood stasis drugs;antipyretics and promoting blood circulation and removing blood stasis drugs and so on.The most highly used are the qi invigorating drugs and promoting blood circulation and removing blood stasis drugs4.The study on single herb’ frequency in the herbal prescriptionsIn the 600 herbal prescriptions,it contains 235 kinds of herbs and it is complete.Among them,the different frequency between different kinds of drugs is so large,even drugs of the same kind are of different frequency,ln the promoting blood circulation and removing blood stasis drugs,salvia,rhizomaligustici chuanxiong,safflower are used most frequently and the frequency are 400 times,314 times,159 times.5.The compotibility regulation between different drugsWeanalyze the collecting 600 effective herbal prescriptions,different drugs has different compotihility regulation,and the regulation reflects on the usage of drug pair.Drug pair is an usual compotibility type with a pair of fixed drugs in clinical practice,it is the smallest unit of herbal prescription.Two drugs use together can either enhance drug’ s effect or release drug’,s toxic and side effects,then reinforce clinical effect.For instance,trichosanthes kirilowii and allium macrostemon are a pair of drug;ginseng and panax notoginseng are often used together;salvia and radixpaeoniaerubra are drug pair;frankincense are used together with myrrh.It is very.common to use drug pairs in clinical practice which can reinforce the treatment effect.Conclusion:1.Our study shows that the herbal prescriptions on curing coronary heart disease infer 18 kinds of all drugs,and 235 drugs are contained.The drugs are widely used but not located by some special kinds.Treating coronery heart disease by TCM bases on dialectics and treatment determination.Dialectics and treatment determination is the fundamental character of TCM.2.Of all the drugs,the highly used drugs are tonics,the activating blood and removing stasis drugs,the qi regulating drugs and the eliminating phlegm drugs,and these kinds are usually used together.In the herbal compatibility,the qi invigorating drugs together with the acticating blood and removing satasis drugs,the qi regulating drugs with acticating blood and removing stasis drugs,the qi regulating drugs with the resolving phlegm drugs are used more often.So we can conclude that the most types of coronary heart disease are qi deficiency and blood stasis,qi stagnation and blood stasis,qi stagnation and phlegm resistance type.3.Among all the 235 drugs,20 drugs are used most frequently,they are salvia,rhizomaligusticichuanxiong、astragalus、angelica,red peony root、Cassia twig、trichosanthis、safflower、liriope、gril]ing glycyrrhiza, panax notoginseng、curcuma、ginseng、poria、pinellia、scallion、licorice、Schisandra fruit.They are most frequently used in clinical practice,the effect is exact and it will have a good prospect in the future.更多还原