慢性阻塞性肺病中醫證-治用藥的性味及歸經規律研究

THE FLAVOR NATURE AND MERIDIAN ENTRY OF MEDICINALS IN SYNDROME DIFFERENTIATION AND TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

目的：探討慢性阻塞性肺病發作期和緩解期中醫-證治用藥的性味及歸經的規律和特點，為慢性阻塞性肺病的中醫臨床處方用藥提供借鑒。方法：借鑒循證醫學和流行病學的思路與方法，按發作期用藥和緩解期用藥分類將符合納入標準和排除標準的98篇慢性阻塞性肺病證治文獻中的用藥和藥物歸類，並分別查出其性、味、歸經，用SPSS17.0軟體進行統計分析。結果：發作期用藥332次及緩解期用藥739次所涉及的「性」進行描述統計發現發作期用藥主要是溫性，其次是寒性和平性的藥物，熱性藥物沒有使用；緩解期用藥主要也是溫性藥物，其次是平性的藥物，再次是微溫的藥物，熱性藥物也有涉及，但大寒和涼性藥物則沒有。「味」以辛味為最，其次是苦、甘，沒有使用酸澀藥物；緩解期以甘味藥為主，其次是辛、苦；「歸經」無論發作期還是緩解期都以歸肺經的藥物為最，其次是歸脾經的藥物。結論：溫性藥物無論在慢性阻塞性肺病的發作期還是緩解期都應注意合理應用，但在發作期則主要針對「寒」邪，而在緩解期則主要針對「陽」不足，法雖相同，但用意卻是迥異；慢性阻塞性肺病應該注意本藏病證的治療，無論發作期還是緩解期都應注意「培土生金」，而在緩解期則應注意歸心、腎、肝經藥物的應用，注意情志的調節以延緩復發；「肺與大腸相表裏」理論在慢性阻塞性肺病的成立性更多的體現在其發作期。Objective: To explore the lows in flavor nature and meridian entry of medicinals in Syndrome differentiation and treatment of Chronic Obstructive Pulmonary Disease in the stage of exacerbations and stable. In order to suppose provide reference for clinical treatment of Chronic Obstructive Pulmonary Disease. Method: Follow the evidence based medicine(EBM) to collect papers, then analysis its involved herbs, determine those herbs' nature of medicinals, flavor of medicinals and meridian entry, the data were analyzed with SPSS17.0 software package. Results: In the stage of exacerbations the frequencies are 332 and in stable phase the frequencies are739.and for those Traditional Chinese medicine, nature of medicinals statistical analysis found that Traditional Chinese medicine used in the stage of exacerbations is worm, cold followed, hot is not used; And in stable phase worm herbs used most frequently then peaceful property herb, moderate the third, but did not use cold and cool herb. For flavor of medicinals acrid, then bitter and sweet, but bid not use sour herbs. And in stable phase the herb in used mostly sweet, then acrid and bitter; meridian entry of medicinals no for Fei channel tropism was the most either in the stage of exacerbations or in stable phase, then for Pi channel tropism followed. Conclusion: the worm traditional Chinese medicines should be use whether in the stage of exacerbations or stable phase, although its similar but indeed is totally different, in stage of exacerbations its for worming the xie of cold, but in stable phase is to correct the defect of Yang. we should pay more attention to treat the Fei disease itself, the method of strengthening earth to generate metal should use the whole stage of COPD, and in stable phase we should better use traditional Chinese medicines for xin Pi and gan channel tropism, should pay attention to regulate emotion controlled; the theory of “the fei and the Da-chang being interior-exteriorly related” especially Reflected in the stage of exacerbations.