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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第36卷

期數(shù):

2024年02期

頁(yè)碼:

39-48,54

欄目:

文獻(xiàn)研究

出版日期:

2024-02-20

文章信息/Info

Title:

Core pathogenesis of chronic osteopathy:a modern articles-based study

作者:

顏炎; 梁志; 陳衛(wèi)衡

(北京中醫(yī)藥大學(xué)第三附屬醫(yī)院,北京 100029)

Author(s):

YAN Yan; LIANG Zhi; CHEN Weiheng

Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China

關(guān)鍵詞:

辨證;  慢性骨病;  病機(jī);  證素

Keywords:

syndrome differentiation;  chronic osteopathy;  pathogenesis;  syndrome element

摘要:

目的:分析慢性骨病的核心病機(jī)。方法:選取頸椎病、腰椎間盤突出癥、股骨頭壞死、膝骨關(guān)節(jié)炎及骨質(zhì)疏松癥5種慢性骨病,在中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)庫(kù)、維普網(wǎng)檢索這5種疾病的相關(guān)文獻(xiàn),檢索時(shí)限均為建庫(kù)至2022年12月31日。從符合要求的文獻(xiàn)中提取中醫(yī)證型并進(jìn)行規(guī)范化處理,按照《證素辨證學(xué)》中的標(biāo)準(zhǔn)將規(guī)范后的證型分解為證素,分析慢性骨病的核心病機(jī)。結(jié)果:①文獻(xiàn)檢索及篩選結(jié)果。共檢索到70 425篇文獻(xiàn),經(jīng)過(guò)逐層篩選最終納入6317篇文獻(xiàn),其中頸椎病文獻(xiàn)1331篇、腰椎間盤突出癥文獻(xiàn)1123篇、股骨頭壞死文獻(xiàn)1068篇、膝骨關(guān)節(jié)炎文獻(xiàn)1359篇、骨質(zhì)疏松癥文獻(xiàn)1436篇。②證型分布分析結(jié)果。共整理出頸椎病、腰椎間盤突出癥、股骨頭壞死、膝骨關(guān)節(jié)炎中醫(yī)證型各24個(gè),骨質(zhì)疏松癥中醫(yī)證型23個(gè),合并后共獲得5種慢性骨病的中醫(yī)證型39個(gè)。③證素分布分析結(jié)果。從5種慢性骨病的39個(gè)中醫(yī)證型中共提取出6個(gè)病位證素,出現(xiàn)頻次前3位的證素為腎、肝、脾,占比92.76%; 共提取出7個(gè)病性證素,出現(xiàn)頻次前5位的證素為虛、濕、寒、血瘀、熱,占比為92.12%。④證素聚類分析結(jié)果。頸椎病的證素共聚為3類,聚類1以“寒、濕、熱”為核心,聚類2以“血瘀、氣滯”為核心,聚類3以“虛”為核心; 腰椎間盤突出癥的證素共聚為3類,聚類1以“血瘀、氣滯”為核心,聚類2以“濕、寒、熱”為核心,聚類3以“虛”為核心; 股骨頭壞死的證素共聚為4類,聚類1以“寒、濕、熱”為核心,聚類2以“血瘀”為核心,聚類3以“虛”為核心,聚類4以“經(jīng)脈”為核心; 膝骨關(guān)節(jié)炎的證素共聚為3類,聚類1以“寒、濕、熱”為核心,聚類2以“血瘀、氣滯”為核心,聚類3以“虛”為核心; 骨質(zhì)疏松癥的證素共聚為3類,聚類1以“虛”為核心,聚類2以“寒、濕、血瘀”為核心,聚類3以“熱”為核心。綜合5種慢性骨病的證素,共聚為3類,聚類1以“濕、寒、熱”為核心,聚類2以“血瘀”為核心,聚類3以“虛”為核心。結(jié)論:寒、熱、瘀、濕、虛是慢性骨病的病性證素,反映了其發(fā)生、發(fā)展的內(nèi)在本質(zhì),是對(duì)慢性骨病病理狀態(tài)和病理變化的高度概括,體現(xiàn)了慢性骨病的核心病機(jī)。

Abstract:

Objective:To analyze the core pathogenesis of chronic osteopathy.Methods:All articles about cervical spondylosis(CS),lumbar disc herniation(LDH),femoral head necrosis(FHN),knee osteoarthritis(KOA),and osteoporosis(OP)included from database's inception to December 31,2022 were retrieved from China National Knowledge Infrastructure,Wanfang Database,and Vip Database.The articles were screened according to the inclusion and exclusion criteria,and the traditional Chinese medicine(TCM)syndrome types were extracted from the included articles and were normalized.The normalized and standardized syndrome types were decomposed into syndrome elements in accordance with the standards in the Differentiation of Syndrome Elements,based on which the core pathogenesis of the chronic osteopathy was analyzed.Results:①Seventy thousand four hundred and twenty-five articles were searched out.After screening,6317 articles were included in the final analysis,including 1331 CS articles,1123 LDH articles,1068 FHN articles,1359 KOA articles,and 1436 OP articles.②Twenty-four TCM syndrome types for each of CS,LDH,FHN,and KOA,and 23 TCM syndrome types for OP were sorted out.After merging,39 TCM syndrome types were obtained for the 5 chronic osteopathies.③Six syndrome elements of disease location were extracted out from the 39 TCM syndrome types of the 5 chronic osteopathies,among which the top 3 high-frequency ones were kidney(TCM),liver(TCM),and spleen(TCM),accounting for 92.76%; and 7 syndrome elements of disease nature were extracted out,among which the top 5 were deficiency,dampness,cold,blood stasis,and heat,accounting for 92.12%.④The syndrome elements of CS were clustered into 3 categories,with category 1 dominated by cold,dampness,and heat,category 2 by blood stasis and qi stagnation,and category 3 by deficiency.The syndrome elements of LDH were clustered into 3 categories,with category 1 dominated by blood stasis and qi stagnation,category 2 by dampness,cold,and heat,and category 3 by deficiency.The syndrome elements of FHN were clustered into 4 categories,with category 1 dominated by cold,dampness,and heat,category 2 by blood stasis,category 3 by deficiency,and category 4 by meridians.The syndrome elements of KOA were clustered into 3 categories,with category 1 dominated by cold,dampness,and heat,category 2 by blood stasis and qi stagnation,and category 3 by deficiency.The syndrome elements of OP were clustered into 3 categories,with category 1 dominated by deficiency,category 2 by cold,dampness,and blood stasis,and category 3 by heat.The syndrome elements of all the 5 diseases were clustered into 3 categories,with category 1 dominated by dampness,cold,and heat,category 2 by blood stasis,and category 3 by deficiency.Conclusion:Cold,heat,blood stasis,dampness,and deficiency as the syndrome elements of the disease nature reflect the intrinsic essence of the occurrence and development of chronic osteopathy.As the highly generalized pathological states and changes,these syndrome elements reflect the core pathogenesis of chronic osteopathy.

備注/Memo

備注/Memo:

基金項(xiàng)目:國(guó)家衛(wèi)生健康委員會(huì)規(guī)劃發(fā)展與信息化司“中西醫(yī)協(xié)同打造重大疾病/慢性疾病預(yù)防保健、治療康復(fù)一體化健康服務(wù)體系”項(xiàng)目(JKZGJBGG2331); 首都衛(wèi)生發(fā)展科研專項(xiàng)重點(diǎn)攻關(guān)項(xiàng)目(2022-1-7032)
通訊作者:陳衛(wèi)衡 E-mail:[email protected]

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更新日期/Last Update: 1900-01-01