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[1]趙睿晞,王人彥.張玉柱教授治療腰椎間盤突出癥的用藥規(guī)律分析[J].中醫(yī)正骨,2021,33(08):39-42.
　ZHAO Ruixi,WANG Renyan.An analysis of clinical medication rules of Professor ZHANG Yuzhu in treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):39-42.
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張玉柱教授治療腰椎間盤突出癥的用藥規(guī)律分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年08期
頁(yè)碼:
39-42
欄目:
調(diào)查研究
出版日期:
2021-08-20

文章信息/Info

Title:
An analysis of clinical medication rules of Professor ZHANG Yuzhu in treatment of lumbar disc herniation
作者:
趙睿晞1; 王人彥2
(1.杭州市富陽(yáng)中醫(yī)骨傷醫(yī)院,浙江 杭州 311400; 2.浙江骨傷醫(yī)院,浙江 杭州 310015)
Author(s):
ZHAO Ruixi1; WANG Renyan2
1.Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China2.Zhejiang Orthopaedics Hospital,Hangzhou 310015,Zhejiang,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  中藥療法;  方劑分析; 計(jì)算機(jī)輔助;  數(shù)據(jù)挖掘
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  drug therapy(TCD);  formula anal comput assist;  data mining
摘要:
目的:分析富陽(yáng)“張氏骨傷療法”代表性傳承人張玉柱教授治療腰椎間盤突出癥的用藥規(guī)律。方法:收集2016年3月至2019年12月經(jīng)張玉柱教授診治的腰椎間盤突出癥患者的病例資料,提取患者的診斷信息(包括診斷和中醫(yī)證型)、處方信息(包括方劑組成、藥物劑量)及治療前后的日本骨科學(xué)會(huì)(Japanese Orthopedic Association,JOA)腰痛疾患評(píng)分。對(duì)原始數(shù)據(jù)進(jìn)行規(guī)范處理,建立數(shù)據(jù)庫(kù)。利用SPSS Clementine12.0軟件進(jìn)行數(shù)據(jù)挖掘,統(tǒng)計(jì)分析處方中藥物的出現(xiàn)頻次,采用關(guān)聯(lián)規(guī)則分析方劑的組方規(guī)律,采用因子分析預(yù)測(cè)可能的新方組合。利用患者治療前后的JOA腰痛疾患評(píng)分驗(yàn)證入選方劑治療腰椎間盤突出癥的臨床療效。結(jié)果:①用藥頻次分析結(jié)果。共納入602例患者,涉及2109首方劑、73味中藥。使用頻次排在前10位的藥物分別為川牛膝、狗脊、牛膝、澤蘭、續(xù)斷片、紅花、豨薟草、炒杜仲、威靈仙、鹿角。②組方規(guī)律分析結(jié)果。將所有入選藥物進(jìn)行關(guān)聯(lián)規(guī)則分析,共獲得10個(gè)核心藥物組合,分別為狗脊-豨薟草-續(xù)斷片、川牛膝-獨(dú)活、狗脊-豨薟草-牛膝、川牛膝-澤蘭-續(xù)斷片、狗脊-豨薟草-川牛膝、狗脊-豨薟草、狗脊-當(dāng)歸-炒杜仲、狗脊-炒杜仲、炒杜仲-枸杞子-狗脊、川牛膝-地龍。將用藥頻次前10位的中藥與中醫(yī)證型進(jìn)行關(guān)聯(lián)規(guī)則分析,得到5條關(guān)聯(lián)規(guī)則,分別為川牛膝→濕熱證、牛膝→肝腎虧虛證、狗脊→肝腎虧虛證、川牛膝→血瘀證、澤蘭→血瘀證。③新方預(yù)測(cè)結(jié)果。通過(guò)因子分析,結(jié)合用藥頻次前10位的藥物與中醫(yī)證型的關(guān)聯(lián)規(guī)則,共得到3首新方。④療效驗(yàn)證結(jié)果。按照J(rèn)OA腰痛疾患評(píng)分標(biāo)準(zhǔn)評(píng)定,納入的602例腰椎間盤突出癥患者中優(yōu)199例、良254例、可90例、差59例,治療有效率90.20%。結(jié)論:張玉柱教授治療腰椎間盤突出癥的用藥特點(diǎn)為補(bǔ)行兼施、通經(jīng)活絡(luò),常用藥物包括活血化瘀藥、祛風(fēng)濕藥、補(bǔ)虛藥3類。
Abstract:
Objective:To analyze the clinical medication rules of Professor ZHANG Yuzhu,the representative inheritor of Zhang’s Orthopedics therapy in Fuyang,in treatment of lumbar disc herniation(LDH).Methods:The medical records of LDH patients who were diagnosed and treated by Professor ZHANG Yuzhu from March 2016 to December 2019 were collected,and the diagnostic information(including diagnosis and TCM syndrome types),prescription information(including prescription composition and dosages)and the Japanese Orthopaedic Association(JOA)low back pain scores measured before and after the treatment were extracted and were normalized for building a database.The data mining was conducted by using SPSS Clementine12.0 software,followed by statistics and analysis on the occurrence frequency of herbs in prescriptions.The prescription rules were analyzed based on association rules,and the new prescription combinations were predicted by using factor analysis.The clinical curative effects of the included prescriptions aimed at treating LDH were verified by using pre- and post-treatment JOA low back pain scores.Results:Six hundred and two patients were included in the final analysis,involving 2109 prescriptions and 73 herbs,among which,the top 10 herbs with high occurrence frequency included Radix Cyathulae,Rhizoma Cibotii,Radix Achyranthis Bidentatae,Herba Lycopi,Radix Dipsaci,Flos Carthami,Herba Siegesbeckiae,Parched Cortex Eucommiae,Radix Clematidis,Cornu Cervi in turn.The association rule analysis on all the included herbs generated 10 core herb combinations,namely Rhizoma Cibotii-Herba Siegesbeckiae-Radix Dipsaci,Radix Cyathulae-Radix Angelicae Pubescentis,Rhizoma Cibotii-Herba Siegesbeckiae-Radix Achyranthis Bidentatae,Radix Cyathulae-Herba Lycopi-Radix Dipsaci,Rhizoma Cibotii-Herba Siegesbeckiae-Radix Cyathulae,Rhizoma Cibotii-Herba Siegesbeckiae,Rhizoma Cibotii-Radix Angelicae Sinensis-Parched Cortex Eucommiae,Rhizoma Cibotii-Parched Cortex Eucommiae,Parched Cortex Eucommiae-Fructus Lycii-Rhizoma Cibotii and Radix Cyathulae-Lumbricus.Five association rules were obtained by analyzing the TCM syndrome types and the top 10 herbs with high occurrence frequency,namely Radix Cyathulae→Dampness-heat syndrome,Radix Achyranthis Bidentatae→Liver-kidney deficiency syndrome,Rhizoma Cibotii→Liver-kidney deficiency syndrome,Radix Cyathulae→Blood stasis syndrome,Herba Lycopi→Blood stasis syndrome.Three new prescriptions were dug out through factor analysis and association rules between the TCM syndrome types and the top 10 herbs with high usage frequency.The clinical curative effects were evaluated according to JOA low back pain scoring standards.In the 602 LDH patients,199 ones obtained an excellent result,254 good,90 fair and 59 poor.The effective rate was 90.20%.Conclusion:Professor ZHANG Yuzhu mainly focuses on combinat reinforcing-promoting as well as unblocking meridian and activating collaterals in treatment of LDH,and his commonly used herbs include the ones for activating blood and removing stasis,expelling wind-dampness and reinforcing deficiency.

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更新日期/Last Update: 1900-01-01