复发性口腔溃疡的证候特点与遣药组方规律研究
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摘要
目的：运用文献学与统计学相结合的方法。研究复发性口腔溃疡的常见证型、用药特点,初步揭示其组方配伍规律,为中医临床研究及新药研发提供文献依据。
方法：(1)文献研究法：选择中国生物医学文献数据库、维普期刊全文数据库、清华同方期刊等数据库,检索1989年至2011年中医药治疗复发性口腔溃疡临床文献。利用Microsoft access建立资料数据表,并录入成都中医药大学与西南交通大学联合开发的“中药复方分析”软件。(2)统计分析法：利用频数分析法、关联规则分析法、聚类分析法,对内治方与外治方的证型、组方药类、核心药物、药对药组、常用方剂及常见证型的常用药物、药组药对、方剂进行统计分析。
结果：(1)证型特点：482首内治方证型中,实证占41.08%,虚证占32.37%；虚实夹杂证占24.07%,以实证所占比例相对较多；频次居前5位的证型为阴虚火旺、心脾积热、湿热困脾、气阴两虚、热毒炽盛。83首外治方证型中,实证占67.47%,虚证占15.66%,虚实夹杂证占14.46%；频次居前5位的证型为热毒炽盛：瘀热内郁；湿热困脾；肾阴亏虚,兼热毒炽盛；阴虚火旺。(2)用药特点：内治方药类居前10位的依次是清热药、补虚药、利水渗湿药、解表药、温里药、活血化瘀药、化痰止咳平喘药、收涩药、芳香化湿药、理气药；核心药物使用居前10位的依次为：生地黄、黄连、茯苓、麦门冬、牡丹皮、黄芩、当归、黄芪、黄柏、玄参；常用药对有生地黄、竹叶,泽泻、山药等。外治方药类居前7位的依次是清热药、解表药、开窍药、补虚药、其他药、拔毒化腐生肌药、收涩药；核心药物频次居前10位的依次为冰片、青黛、黄柏、黄连、五倍子、硼砂、薄荷、孩儿茶、细辛、明矾；常用药对有冰片、青黛,冰片、黄柏等。(3)遣方特点：内治方居前4位依次为导赤散、增液汤、玉女煎、清胃散。(4)证与常配药物、药对：内治方阴虚火证旺常伍黄柏、知母、牡丹皮、生地黄、玄参等；心脾积热证伍生地黄、木通、黄连、竹叶、栀子等；湿热困脾证伍黄芩、黄连、栀子等；气阴两虚证伍白术、生地黄、麦门冬、黄连等；热毒炽盛伍黄连、黄芩、黄柏、栀子、金银花等；药对由常用药物相配而成。
结论：ROU的病变特点不外虚实两端,但虚实夹杂证亦可见；该病本虚多见阴虚、气阴两虚、阳虚,标实以热、湿为主,虚则气阴两虚,或脾气亏虚,或脾肾阳虚,以致口舌肌膜失养；或肝肾阴虚,虚火上炎,以致口舌肌膜灼腐。实则心脾积热,火热上冲；或湿热困脾,湿热上渍：或火毒上攻,熏灼口舌,气血壅滞,血败肉腐,肌膜溃破而为病。久病则虚实兼夹,本虚标实。内治方通过清热、祛湿、散寒、化瘀以消除病因,益气、养阴、温阳以顾护正气；外治用药一方面针对局部辨病,配用具有收湿敛疮,消肿止痛,拔毒祛腐等功效的药物外,另一方面依据整体辨证,采用清热、活血、补气、除湿等治疗,以消除病因、内调脏腑,体现了辨病与辨证相结合的辨治模式。
Objective:To study common syndrome types and drug-using characteristics of Recurrent oral ulcer(ROU) by the method of philology and statistics, preliminarily reveal prescription compatibility regularity,and provide literature basis for Chinese medicine clinical research and new drug research and development.
Methods:(1)Literature research method:Choosing China Biology Medicine disc (CBMdisc), VIP journal full-text database, Tsinghua tongfang periodical database, searching clinical literature about TCM treating ROU from1989to2011. We established data sheet according to microsoft access,and it has been typed-in analysis of Traditional Chinese Medical prescription software which was united developed by Chengdu university of TCM and Southwest Jiaotong University.(2)Statistical analysis method:frequency analysis.relational analysis and clustering analysis were applied to statistical analyze syndrome types,compound prescription herb sort.core medicine.couple drug, commonly used formula and indication in both internal treatment and external therapy prescription.
Results:(1)Syndrome type characteristics:In482syndrome types of internal treatment prescription, excess syndrome accounts for41.08percent, deficiency syndrome accounts for32.37percent,mix of deficiency and excess syndrome which takes larger proportion,accounts for24.07percent.The top five syndrome types by frequency are Yin Huo-wang, heart and spleen accumulated heat, damp, spleen, Qi and Yin deficiency, toxic heat flaming. In83syndrome types of external treatment prescription, excess syndrome accounts for61.47percent, deficiency syndrome accounts for15.66percent,mix of deficiency and excess syndrome accounts for14.46percent.The top five syndrome types by frequency are Toxic heat flaming; stasis heat within the depression; spleen hot and humid; Yin deficiency of toxic heat flaming; Yin Huowang.(2)Medication charateristics:The top ten internal treatment prescription herb sort successively are heat-clearing medicine,complement deficiency medicine, dampness-clearing drugs, diaphoretic drugs, interior-warming drugs, activating blood and dissolving stasis medicine,reducing phlegm-relieving cough and asthma medicine, astringent medicine, aromatic damp-resolving drugs and qi-regulating drugs.The top ten core herbs by usage successively are radix rehmanniae recen, berberine, poria, ophiopogon, tree peony bark, skullcap, angelica, astragalus, treats, Scrophulariaceae.Couple drugs in common use are rehmanniae, bamboo, alisma, yams,ect.The top seven external treatment prescription herb sort successively are heat-clearing medicine, diaphoretic drugs, awaking drugs, complement deficiency medicine,other drugs,drawing pus-promoting tissue regeneration drugs and astringent medicine. The top ten core herbs by usage successively are borneol, indigo, treats, berberine, gall,, borax, mint, cutch, asarum,Alum.Couple drugs in common use are borneol, indigo, borneol, treats,ect.(3)Prescription characteristics:The top four internal treatment prescriptions are Daochi Powder,by liquid soup,Yu Nvjian, Qingwei Powder.(4)Common use herbs based on syndrome:In internal treatment prescription, golden cypress,anemarrhena,moutan rehmanniae, scrophulariaceae are often used in type of yin deficiency-fire excess; rehmannia root, akebia, berberine, bamboo leaves, gardenia are often used in type of brimming heat of heart and spleen; atractylodes, rehmannia, ophiopogon, berberine often used in type of deficiency of both qi and yin: baicalin, berberine. gardenia often used in type of dampness-heat retention; Toxic heat flaming compatibility berberine, baicalin, Treats, gardenia, honeysuckle, codonopsis, Drugs on the mutual compatibility made by the commonly used drugs.
Conclusions:The syndrome characteristics of ROU include two sides:the deficiency and the excess,while syndrome of intermingled deficiency and excess is the relatively common one.Yin deficiency,deficiency of both qi and yin and yang deficiency are commonly seen in the deficient root syndromes of ROU,while fire-heat and dampness-heat often constitue the excessive superficial syndrome which presents symptom of brimming heat of heart and spleen,up-flaming fire,or dampness-heat retention, caused by dampness-heat steeping myolemma of mouth and tongue. The deficient root presents symptom of both qi and yin deficiency,or yin-fluid insufficiency which gives rise to up-flaming fire,or yang deficiency of both kidney and spleen, deficient yang with upper manifestation,leading to myolemma malnutrition in mouth and tongue,then myolemma decays into ROU,ultimately caused the meridian barrier, blood stagnation, burning rot sarcolemma disease.Long time desease causes deficiency-excess mixing and the deficient root-excessive superficial syndrome.The internal treatment prescription can remove pathogenesis by the method of heat-clearing,dampness-resolving,cold-dissipating and stasis-dispersing,and also consolidate vital healthy qi by supplementing qi,nourishing yin and warming yang.The external theraphy prescription can string dampness and furuncle, relieve swelling-pain and drawing pus-rot according to the local disease differentiation on one hand,also can remove pathogenesis and regulate the viscera based on entire body syndrome differentiation by the method of heat-clearing,blood-activating, qi-supplementing and dampness-resolving,which reflects the differentiation theraphy model of disease differentiation combined with syndrome differentiation.
方法：(1)文献研究法：选择中国生物医学文献数据库、维普期刊全文数据库、清华同方期刊等数据库,检索1989年至2011年中医药治疗复发性口腔溃疡临床文献。利用Microsoft access建立资料数据表,并录入成都中医药大学与西南交通大学联合开发的“中药复方分析”软件。(2)统计分析法：利用频数分析法、关联规则分析法、聚类分析法,对内治方与外治方的证型、组方药类、核心药物、药对药组、常用方剂及常见证型的常用药物、药组药对、方剂进行统计分析。
结果：(1)证型特点：482首内治方证型中,实证占41.08%,虚证占32.37%；虚实夹杂证占24.07%,以实证所占比例相对较多；频次居前5位的证型为阴虚火旺、心脾积热、湿热困脾、气阴两虚、热毒炽盛。83首外治方证型中,实证占67.47%,虚证占15.66%,虚实夹杂证占14.46%；频次居前5位的证型为热毒炽盛：瘀热内郁；湿热困脾；肾阴亏虚,兼热毒炽盛；阴虚火旺。(2)用药特点：内治方药类居前10位的依次是清热药、补虚药、利水渗湿药、解表药、温里药、活血化瘀药、化痰止咳平喘药、收涩药、芳香化湿药、理气药；核心药物使用居前10位的依次为：生地黄、黄连、茯苓、麦门冬、牡丹皮、黄芩、当归、黄芪、黄柏、玄参；常用药对有生地黄、竹叶,泽泻、山药等。外治方药类居前7位的依次是清热药、解表药、开窍药、补虚药、其他药、拔毒化腐生肌药、收涩药；核心药物频次居前10位的依次为冰片、青黛、黄柏、黄连、五倍子、硼砂、薄荷、孩儿茶、细辛、明矾；常用药对有冰片、青黛,冰片、黄柏等。(3)遣方特点：内治方居前4位依次为导赤散、增液汤、玉女煎、清胃散。(4)证与常配药物、药对：内治方阴虚火证旺常伍黄柏、知母、牡丹皮、生地黄、玄参等；心脾积热证伍生地黄、木通、黄连、竹叶、栀子等；湿热困脾证伍黄芩、黄连、栀子等；气阴两虚证伍白术、生地黄、麦门冬、黄连等；热毒炽盛伍黄连、黄芩、黄柏、栀子、金银花等；药对由常用药物相配而成。
结论：ROU的病变特点不外虚实两端,但虚实夹杂证亦可见；该病本虚多见阴虚、气阴两虚、阳虚,标实以热、湿为主,虚则气阴两虚,或脾气亏虚,或脾肾阳虚,以致口舌肌膜失养；或肝肾阴虚,虚火上炎,以致口舌肌膜灼腐。实则心脾积热,火热上冲；或湿热困脾,湿热上渍：或火毒上攻,熏灼口舌,气血壅滞,血败肉腐,肌膜溃破而为病。久病则虚实兼夹,本虚标实。内治方通过清热、祛湿、散寒、化瘀以消除病因,益气、养阴、温阳以顾护正气；外治用药一方面针对局部辨病,配用具有收湿敛疮,消肿止痛,拔毒祛腐等功效的药物外,另一方面依据整体辨证,采用清热、活血、补气、除湿等治疗,以消除病因、内调脏腑,体现了辨病与辨证相结合的辨治模式。
Objective:To study common syndrome types and drug-using characteristics of Recurrent oral ulcer(ROU) by the method of philology and statistics, preliminarily reveal prescription compatibility regularity,and provide literature basis for Chinese medicine clinical research and new drug research and development.
Methods:(1)Literature research method:Choosing China Biology Medicine disc (CBMdisc), VIP journal full-text database, Tsinghua tongfang periodical database, searching clinical literature about TCM treating ROU from1989to2011. We established data sheet according to microsoft access,and it has been typed-in analysis of Traditional Chinese Medical prescription software which was united developed by Chengdu university of TCM and Southwest Jiaotong University.(2)Statistical analysis method:frequency analysis.relational analysis and clustering analysis were applied to statistical analyze syndrome types,compound prescription herb sort.core medicine.couple drug, commonly used formula and indication in both internal treatment and external therapy prescription.
Results:(1)Syndrome type characteristics:In482syndrome types of internal treatment prescription, excess syndrome accounts for41.08percent, deficiency syndrome accounts for32.37percent,mix of deficiency and excess syndrome which takes larger proportion,accounts for24.07percent.The top five syndrome types by frequency are Yin Huo-wang, heart and spleen accumulated heat, damp, spleen, Qi and Yin deficiency, toxic heat flaming. In83syndrome types of external treatment prescription, excess syndrome accounts for61.47percent, deficiency syndrome accounts for15.66percent,mix of deficiency and excess syndrome accounts for14.46percent.The top five syndrome types by frequency are Toxic heat flaming; stasis heat within the depression; spleen hot and humid; Yin deficiency of toxic heat flaming; Yin Huowang.(2)Medication charateristics:The top ten internal treatment prescription herb sort successively are heat-clearing medicine,complement deficiency medicine, dampness-clearing drugs, diaphoretic drugs, interior-warming drugs, activating blood and dissolving stasis medicine,reducing phlegm-relieving cough and asthma medicine, astringent medicine, aromatic damp-resolving drugs and qi-regulating drugs.The top ten core herbs by usage successively are radix rehmanniae recen, berberine, poria, ophiopogon, tree peony bark, skullcap, angelica, astragalus, treats, Scrophulariaceae.Couple drugs in common use are rehmanniae, bamboo, alisma, yams,ect.The top seven external treatment prescription herb sort successively are heat-clearing medicine, diaphoretic drugs, awaking drugs, complement deficiency medicine,other drugs,drawing pus-promoting tissue regeneration drugs and astringent medicine. The top ten core herbs by usage successively are borneol, indigo, treats, berberine, gall,, borax, mint, cutch, asarum,Alum.Couple drugs in common use are borneol, indigo, borneol, treats,ect.(3)Prescription characteristics:The top four internal treatment prescriptions are Daochi Powder,by liquid soup,Yu Nvjian, Qingwei Powder.(4)Common use herbs based on syndrome:In internal treatment prescription, golden cypress,anemarrhena,moutan rehmanniae, scrophulariaceae are often used in type of yin deficiency-fire excess; rehmannia root, akebia, berberine, bamboo leaves, gardenia are often used in type of brimming heat of heart and spleen; atractylodes, rehmannia, ophiopogon, berberine often used in type of deficiency of both qi and yin: baicalin, berberine. gardenia often used in type of dampness-heat retention; Toxic heat flaming compatibility berberine, baicalin, Treats, gardenia, honeysuckle, codonopsis, Drugs on the mutual compatibility made by the commonly used drugs.
Conclusions:The syndrome characteristics of ROU include two sides:the deficiency and the excess,while syndrome of intermingled deficiency and excess is the relatively common one.Yin deficiency,deficiency of both qi and yin and yang deficiency are commonly seen in the deficient root syndromes of ROU,while fire-heat and dampness-heat often constitue the excessive superficial syndrome which presents symptom of brimming heat of heart and spleen,up-flaming fire,or dampness-heat retention, caused by dampness-heat steeping myolemma of mouth and tongue. The deficient root presents symptom of both qi and yin deficiency,or yin-fluid insufficiency which gives rise to up-flaming fire,or yang deficiency of both kidney and spleen, deficient yang with upper manifestation,leading to myolemma malnutrition in mouth and tongue,then myolemma decays into ROU,ultimately caused the meridian barrier, blood stagnation, burning rot sarcolemma disease.Long time desease causes deficiency-excess mixing and the deficient root-excessive superficial syndrome.The internal treatment prescription can remove pathogenesis by the method of heat-clearing,dampness-resolving,cold-dissipating and stasis-dispersing,and also consolidate vital healthy qi by supplementing qi,nourishing yin and warming yang.The external theraphy prescription can string dampness and furuncle, relieve swelling-pain and drawing pus-rot according to the local disease differentiation on one hand,also can remove pathogenesis and regulate the viscera based on entire body syndrome differentiation by the method of heat-clearing,blood-activating, qi-supplementing and dampness-resolving,which reflects the differentiation theraphy model of disease differentiation combined with syndrome differentiation.
引文
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[10]唐建,沈怡,宋佳.在校大学生复发性阿弗他溃疡患病率及相关因素分析[J].淮海医药,2003,21(5)：384
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[12]李奉华,刘虹,彭解英等.复发性阿弗他溃疡致病因素及机制的研究进展[J].中国现代医学杂志,2003,13(7)：41-43
[13]孙鹏.淋巴细胞、细胞因子与复发性阿弗他溃疡[J].解放军医学杂志,2004,29(2)：180
[14]张秀贞,马泉生,张艺晶.复发性口腔溃疡患者免疫功能的研究[J].山东大学学报(医学版),2002,40(6)：570.
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[22]张慧,陈柯.口腔幽门螺杆菌与复发性口腔溃疡发病的研究进展[J].人民军医,200548,(7)：416—418
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