中医教材在变应性鼻炎中医诊疗指南制定中的证据价值探讨  

Discussion on the Evidence Value of Textbooks in the Formulation of Traditional Chinese Medicine Diagnosis and Treatment Guidelines for Allergic Rhinitis

作　　者：刘翠芳 卫东锋[1] 杨伟[1] 谢飞彪 郑丹平 向兴华 刘孟宇[1] LIU Cuifang;WEI Dongfeng;YANG Wei;XIE Feibiao;ZHENG Danping;XIANG Xinghua;LIU Mengyu(Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing,100700;School of Mathematics and Computational Science,Hunan University of Science and Technology;Institute of Information on Traditional Chinese Medicine,China Academy of Chinese Medical Sciences)

机构地区：[1]中国中医科学院中医临床基础医学研究所,北京市100700 [2]湖南科技大学数学与计算科学学院 [3]中国中医科学院中医药信息研究所

出　　处：《中医杂志》2024年第4期368-375,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(61771491);中国中医科学院科技创新工程(CI2021A00701-2);中国中医科学院基本科研业务费自主选题项目(Z0557)。

摘　　要：目的以变应性鼻炎为例,探讨中医类教材相关诊疗方案作为中医诊疗指南中证据应用的可行性与合理性。方法检索1949年10月至2022年12月出版的教材,检索截至2022年12月发表的变应性鼻炎中医诊疗指南,提取教材中变应性鼻炎相关章节诊疗内容,比较分析不同时期的教材之间、现行不同版本教材之间、现行教材与指南之间的异同点。结果共纳入1975年至2021年中医耳鼻喉科的国家规划教材12本及变应性鼻炎中医诊疗指南4份。不同时期教材显示了诊疗方案的演变过程,从2003年出版的教材开始增加了肺经伏热证,并丰富了涂鼻法、滴鼻法等特色疗法,以及预防调摄、预后转归的内容,主要证型为肺气虚寒证、脾气虚弱证、肾阳不足证及肺经伏热证,常见推荐方剂分别为温肺止流丹、玉屏风散合苍耳子散,补中益气汤、参苓白术散,肾气丸或真武汤,辛夷清肺饮。现行不同版本教材之间比较显示其证型一致,方药略有差异。现行不同版本教材与指南的比较显示,教材推荐方剂增加了苍耳子散、小青龙汤、真武汤等,丰富了特色疗法如吹鼻、嗅法、塞鼻、洗鼻等,并增加了用药加减、预防调摄、预后转归等信息,可为指南补充相应证据。结论教材可以作为中医诊疗指南制定证据的有力补充,但仍需进一步研究教材证据的质量评价体系,以提高其应用于指南证据的可信度。Objective To explore the feasibility and rationality of applying relevant diagnostic and treatment programmes from textbooks as evidence in traditional Chinese medicine(TCM)diagnosis and treatment guidelines,using allergic rhinitis as an example.Methods Textbooks published from October 1949 to December 2022,as well as TCM diagnosis and treatment guidelines published until December 2022 on allergic rhinitis were searched,and the contents of diagnosis and treatment related to allergic rhinitis were extracted.The similarities and differences between textbooks in different periods,between textbooks in different versions,and between textbooks and guidelines were compared and analyzed.Results A total of 12 national planning textbooks on TCM otolaryngology and 4 Chinese medicine diagnosis and treatment guidelines on allergic rhinitis from 1975 to 2021 were included.The evolution of diagnostic and treatment programmes was shown by the textbooks in different periods.Since 2003,syndrome of latent heat in lung channel has been added in the published textbook,and TCM featured therapies,such as nasal packing,intranasal spray were enriched,as well as the contents related to prevention and prognosis.The main syndromes included lung qi deficiency and cold,spleen qi deficiency,kidney yang deficiency,and latent heat in lung meridian.The most common recommended prescriptions were Wenfei Zhiliu Pill(温肺止流丹),Yupingfeng Powder(玉屏风散)and Cangerzi Powder(苍耳子散);Buzhong Yiqi Decoction(补中益气汤),Shenling Baizhu Powder(参苓白术散);Shenqi Pill(肾气丸)or Zhenwu Decoction(真武汤);Xinyi Qingfei Decoction(辛夷清肺饮).A comparison of different versions of textbooks showed that the classification of syndromes was consistent,while the formulas were slightly different.The comparison between different versions of the current textbooks and the guidelines showed that the recommended prescriptions of the textbooks had more Cangerzi Powder,Xiaoqinglong Decoction(小青龙汤),Zhenwu Decoction,etc.,while TCM

关 键 词：变应性鼻炎 中医诊疗指南 教材 证据 

分 类 号：R276.1[医药卫生—中医五官科学]