胸痹中医古籍证据的评价、推荐及辨证规律研究  

Evidence Evaluation,Recommendation,and Rule of Syndrome Differentiation of Ancient TCM Books of Chest Impediment

作　　者：张磊 张华敏[3] 孙敏[4] 佟琳[2] 陆惠[5] 商洪才 ZHANG Lei;ZHANG Huamin;SUN Min;TONG Lin;LU Hui;SHANG Hongcai(Jiangxi University of Chinese Medicine,Nanchang 330004,China;Institute of Information on Traditional Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Heilongjiang University of Chinese Medicine,Harbin 150006,China;The Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518107,China;Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China;Key Laboratory of Chinese Internal Medicine of Ministry of Education,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]江西中医药大学,南昌330004 [2]中国中医科学院中医药信息研究所,北京100700 [3]中国中医科学院中医基础理论研究所,北京100700 [4]黑龙江中医药大学,哈尔滨150006 [5]中山大学附属第七医院,深圳518107 [6]北京中医药大学东方医院,北京100078 [7]北京中医药大学中医内科学教育部重点实验室,北京100700

出　　处：《世界中医药》2024年第16期2441-2447,共7页World Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(82305440);黑龙江省中医药经典普及化专项(ZYW2024-019);中国中医科学院创新工程项目(CI2021A00507);中央级公益性科研院所基本科研业务费专项(ZZ15-YQ-074,ZZ160308)。

摘　　要：目的:运用中医古籍证据评价方法对中医古籍中治疗胸痹的方剂证据进行系统评价和推荐,并总结其辨证规律。方法:文献来自第5版《中华医典》及中国中医科学院中医药信息研究所开发的“国医典藏”数据库。对1911年(包括1911年)以前治疗胸痹的古方进行收集、筛选,应用《中医古籍防治证据评价分级量表》(胸痹)进行评价与分级,用拟定的推荐标准进行证据推荐。结果:最终纳入155条治疗胸痹的中医古籍证据,其中31条证据被评价为高等级证据,65条证据被评为中等级证据,59条证据被评为低等级证据。遵循“以方测证”思维方法,可得胸痹的证型为寒凝心脉(34.19%)、气滞心脉(23.87%)、瘀血痹阻(16.13%)、痰浊凝滞(9.68%)、心阳不足(5.81%)、心气不足(4.52%)、心阴亏虚(3.87%)及心阳痹阻(1.94%)。源自《金匮要略》的人参汤、茯苓杏仁甘草汤、瓜蒌薤白半夏汤、枳实薤白桂枝汤、瓜蒌薤白白酒汤,《太平惠民和剂局方》的苏合香丸、失笑散,《正体类要》的归脾汤8条古籍证据进行强推荐,乌头赤石脂丸、丹参饮、血府逐瘀汤、橘枳姜汤4条古籍证据进行弱推荐,其他古籍证据暂不推荐。结论:《金匮要略》是治疗胸痹的经典古籍,具有完备的辨证论治体系;化痰法和活血法是治疗胸痹的基本治法,瓜蒌薤白三方、血府逐瘀汤等是治疗胸痹的重要方剂。Objective:To systematically evaluate and recommend formulas for treating chest impediment based on evidence from traditional Chinese medicine(TCM)classics,and to summarize the rule of syndrome differentiation.Methods:The literature was sourced from the 5th edition of the Zhonghua Medical Canon and the National TCM Heritage database developed by the Institute of Information on Traditional Chinese Medicine,China Academy of Chinese Medical Sciences.Ancient formulas for treating chest impediment before or up to 1911 were collected and screened.The Grading Scale for Evaluating Evidence of TCM Treatment in Ancient Texts(Chest Impediment)was applied to evaluate and grade the evidence,and a predetermined recommendation standard was used to recommend the evidence.Results:A total of 155 pieces of evidence from TCM classics on the treatment of chest impediment were included,with 31 pieces rated as high-level evidence,65 as medium-level evidence,and 59 as low-level evidence.Following the“formula-based syndrome differentiation”approach,the identified syndromes for chest impediment were cold coagulation in the heart meridian(34.19%),qi stagnation in the heart meridian(23.87%),blood stasis obstructing the meridian(16.13%),phlegm-turbidity obstruction(9.68%),deficiency of heart yang(5.81%),deficiency of heart qi(4.52%),deficiency of heart yin(3.87%),and obstruction of heart yang(1.94%).Eight pieces of classical evidence were strongly recommended,including Renshen Decoction,Fuling Xingren Gancao Decoction,Gualou Xiebai Banxia Decoction,Zhishi Xiebai Guizhi Decoction,and Gualou Xiebai Baijiu Decoction from Synopsis of the Golden Chamber(Jin Gui Yao Lue),Suhexiang Pills and Shixiao Powder from Formulary of the Bureau of Taiping People′s Welfare Pharmacy(Tai Ping Hui Min He Ji Ju Fang),and Guipi Decoction from Categorized Synopsis of the Whole(Zheng Ti Lei Yao).Four pieces of evidence were weakly recommended,including Wutou Chishizhi Pills,Danshen Decoction,Xuefu Zhuyu Decoction,and Juzhijiang Decoction.Other pieces of evidenc

关 键 词：胸痹 冠心病 中医古籍 证据 循证评价 证据推荐 评价量表 辨证规律 

分 类 号：R272.5[医药卫生—中医儿科学]