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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07期

頁碼:

28-43,54

欄目:

文獻研究

出版日期:

2024-07-20

文章信息/Info

Title:

The distribution and change rule of blood stasis syndrome in chronic osteopathy:a modern articles-based study

作者:

劉毓之; 顏炎; 陳衛(wèi)衡

北京中醫(yī)藥大學第三附屬醫(yī)院,北京 100029

Author(s):

LIU Yuzhi; YAN Yan; CHEN Weiheng

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

關鍵詞:

辨證;  慢性骨病;  血瘀;  證候;  文獻分析

Keywords:

syndrome differentiation;  chronic osteopathy;  blood stasis;  syndrome complex;  document analysis

摘要:

目的:分析慢性骨病血瘀證的分布及變化規(guī)律。方法:選取頸椎病、腰椎間盤突出癥、股骨頭壞死、膝骨關節(jié)炎及骨質(zhì)疏松癥5種慢性骨病,在萬方數(shù)據(jù)庫、中國知網(wǎng)、維普網(wǎng)檢索這5種疾病的相關文獻,檢索時限從建庫至2023年12月31日。從符合要求的文獻中提取中醫(yī)證型及證候表現(xiàn)并進行規(guī)范化處理后,分析慢性骨病血瘀證的分布及變化規(guī)律。結(jié)果:①文獻檢索及篩選結(jié)果。共檢索到18 255篇文獻,經(jīng)過逐層篩選最終納入2929篇文獻,其中頸椎病文獻731篇、腰椎間盤突出癥文獻935篇、股骨頭壞死文獻301篇、膝骨關節(jié)炎文獻658篇、骨質(zhì)疏松癥文獻304篇。②證型分布和變化規(guī)律分析結(jié)果。共整理出20個血瘀證相關證型,出現(xiàn)頻次位于前5位的分別為氣滯血瘀、瘀血阻絡、腎虛血瘀、氣虛血瘀和痰瘀阻絡。頸椎病早期、中期和晚期血瘀證相關證型占比分別為88.10%、59.56%、50.57%,腰椎間盤突出癥早期、中期和晚期血瘀證相關證型占比分別為95.90%、83.67%、51.39%,股骨頭壞死早期、中期和晚期血瘀證相關證型占比分別為69.44%、58.33%、50.67%,膝骨關節(jié)炎發(fā)作期、緩解期和康復期血瘀證相關證型占比分別為56.81%、98.35%、54.61%,骨質(zhì)疏松癥早期、中期和晚期血瘀證相關證型占比分別為97.62%、51.39%、83.97%。綜合以上5種疾病的中醫(yī)證型,慢性骨病早期、中期和晚期血瘀證相關證型占比分別為85.78%、74.21%、50.18%。③證候表現(xiàn)分布和變化規(guī)律分析結(jié)果。共整理出29種血瘀證相關證候表現(xiàn),出現(xiàn)頻次位于前5位的分別為痛處固定、痛處拒按、關節(jié)刺痛、舌有瘀斑或瘀點和舌暗紫。頸椎病早期、中期和晚期血瘀證相關證候表現(xiàn)占比分別為62.20%、40.55%、21.13%,腰椎間盤突出癥早期、中期和晚期血瘀證相關證候表現(xiàn)占比分別為62.32%、59.25%、58.25%,股骨頭壞死早期、中期和晚期血瘀證相關證候表現(xiàn)占比分別為50.90%、79.81%、50.63%,膝骨關節(jié)炎發(fā)作期、緩解期和康復期血瘀證相關證候表現(xiàn)占比分別為51.02%、65.02%、46.54%,骨質(zhì)疏松癥早期、中期和晚期血瘀證相關證候表現(xiàn)占比分別為54.40%、44.36%、66.74%。綜合以上5種疾病的證候表現(xiàn),慢性骨病早期、中期和晚期血瘀證相關證候表現(xiàn)占比分別為57.83%、62.46%、52.58%。④證候表現(xiàn)聚類分析結(jié)果。頸椎病、腰椎間盤突出癥、股骨頭壞死及骨質(zhì)疏松癥的血瘀證證候表現(xiàn)均聚為早期、中期和晚期3個亞類,膝骨關節(jié)炎的血瘀證證候表現(xiàn)聚為發(fā)作期、緩解期和康復期3個亞類。頸椎病早期、中期和晚期的血瘀證證候表現(xiàn)分別以痛處固定、頸部刺痛、肢體麻木等為主,腰椎間盤突出癥早期、中期和晚期的血瘀證證候表現(xiàn)分別以痛處拒按、痛處固定、皮下瘀斑等為主,股骨頭壞死早期、中期和晚期的血瘀證證候表現(xiàn)分別以髖部刺痛、靜息痛、肌肉萎縮等為主,膝骨關節(jié)炎發(fā)作期、緩解期和康復期的血瘀證證候表現(xiàn)分別以痛有定處、關節(jié)刺痛、肌膚麻木等為主,骨質(zhì)疏松癥早期、中期和晚期的血瘀證證候表現(xiàn)分別以面色黧黑、腰背刺痛、痛處固定等為主。5種慢性骨病早期、中期和晚期的血瘀證證候表現(xiàn)分別以痛處固定、痛處拒按、肌肉萎縮等為主。結(jié)論:血瘀證貫穿于慢性骨病發(fā)生、發(fā)展的全過程,主要包括氣滯血瘀、瘀血阻絡、腎虛血瘀、氣虛血瘀和痰瘀阻絡等; 在慢性骨病的早、中、晚期,血瘀證主要證候表現(xiàn)分別為痛處固定、痛處拒按、肌肉萎縮。隨著疾病的發(fā)展,脊柱類慢性骨病血瘀證呈現(xiàn)逐漸減少的規(guī)律,關節(jié)類慢性骨病血瘀證呈現(xiàn)先增加后減少的規(guī)律,代謝類慢性骨病血瘀證呈現(xiàn)先減少后增加的規(guī)律,整體上慢性骨病血瘀證呈現(xiàn)先增加后減少的規(guī)律。

Abstract:

Objective:To analyze the distribution and change rule of blood stasis syndrome in 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 31,2023 were retrieved from Wanfang Database,China National Knowledge Infrastructure,and Vip Database.The eligible articles were screened according to the inclusion and exclusion criteria,and the traditional Chinese medicine(TCM)syndrome types and syndrome manifestations were extracted from the included articles and were normalized,based on which the distribution and change rule of blood stasis syndrome in chronic osteopathy were analyzed.Results:①Eighteen thousand two hundred and fifty-five articles were searched out.After screening,2929 articles were included in the final analysis,including 731 CS articles,935 LDH articles,301 FHN articles,658 KOA articles,and 304 OP articles.②Twenty blood stasis syndrome-related TCM syndrome types were sorted out,among which the top 5 ones with a high occurrence frequency were qi-stagnation and blood-stasis syndrome,static blood blocking collaterals syndrome,kidney-deficiency and blood-stasis syndrome,qi-deficiency and blood-stasis syndrome as well as phlegm-blood stasis blocking collaterals syndrome.The blood stasis syndrome-related TCM syndrome types accounted for 88.10%,59.56% and 50.57% in the early,middle and late stage of CS,respectively; 95.90%,83.67% and 51.39% in the early,middle and late stage of LDH,respectively; 69.44%,58.33% and 50.67% in the early,middle and late stage of FHN,respectively; 56.81%,98.35% and 54.61% in the early,middle and late stage of KOA,respectively; and 97.62%,51.39% and 83.97% in the early,middle and late stage of OP,respectively.After merging the TCM syndrome types of the 5 chronic osteopathies,the proportions of the blood stasis syndrome-related TCM syndrome types were 85.8%,74.21%,and 50.18% in early,middle and late stages of chronic osteopathy,respectively.③Twenty-nine blood stasis syndrome-related syndrome manifestations were sorted out,among which the fixed pain-site,refusing press at pain-site,joint stabbing pain,ecchymosis or petechiae and a dark purple presented in tongue appeared more frequently.The blood stasis syndrome-related syndrome manifestations accounted for 62.20%,40.55% and 21.13% in the early,middle and late stage of CS,respectively; 62.32%,59.25% and 58.25% in the early,middle and late stage of LDH,respectively; 50.90%,79.81% and 50.63% in the early,middle and late stage of FHN,respectively; 51.02%,65.02% and 46.54% in the early,middle and late stage of KOA,respectively; and 54.40%,44.36% and 66.74% in the early,middle and late stage of OP,respectively.After merging the syndrome manifestations of the 5 chronic osteopathies,the proportions of the blood stasis syndrome-related syndrome manifestations were 57.83%,62.46%,and 52.58% in early,middle and late stages of chronic osteopathy,respectively.④The results of cluster analysis showed that the blood stasis syndrome-related syndrome manifestations of CS,LDH,FHN and OP were clustered into three sub-categories,that was early stage,middle stage,and late stage; and the blood stasis syndrome-related syndrome manifestations of KOA were clustered into onset stage,remission stage,and rehabilitation stage,with CS dominated by fixed pain-site,neck stabbing pain,and limb numbness in the early,middle,and late stage,respectively; LDH by refusing press at pain-site,fixed pain-site,and subcutaneous ecchymosis in the early,middle,and late stage,respectively; FHN by hip stabbing pain,rest pain,and muscular atrophy in the early,middle,and late stage,respectively; KOA by fixed pain-site,joint stabbing pain,and skin numbness in the onset,remission,and rehabilitation stage,respectively; and OP by dark complexion,low back stabbing pain,and fixed pain-site in the early,middle,and late stage,respectively.The blood stasis syndrome-related syndrome manifestations of the 5 chronic osteopathies were dominated by fixed pain-site,refusing press at pain-site,and muscular atrophy in the early,middle,and late stage,respectively.Conclusion:Blood stasis syndrome exists throughout the entire course of onset and development of chronic osteopathy,and it mainly includes qi-stagnation and blood-stasis syndrome,static blood blocking collaterals syndrome,kidney-deficiency and blood-stasis syndrome,qi-deficiency and blood-stasis syndrome as well as phlegm-blood stasis blocking collaterals syndrome.In the early,middle and late stage of chronic osteopathy,the blood stasis syndrome mainly manifests as fixed pain-site,refusing press at pain-site,and muscular atrophy,respectively.With the development of the disease,the blood stasis syndrome of spine-related chronic osteopathy shows a pattern of gradual decrease,the blood stasis syndrome of joint-related chronic osteopathy shows a pattern of increasing firstly and decreasing subsequently,and the blood stasis syndrome of metabolism-related chronic osteopathy shows a pattern of decreasing firstly and increasing subsequently.On the whole,the blood stasis syndrome of chronic osteopathy presents a pattern of increasing at first and then decreasing.

備注/Memo

備注/Memo:

基金項目:國家自然科學基金項目(82030122)
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