目的:针对西药在治疗骨质疏松症方面有毒副作用大、远期疗效不肯定、价格昂贵等缺点,探索中医中药的用药规律及如何发挥其在防治骨质疏松症中的用药优势.方法:对1979/2002年的相关资料进行了收集,并对其中疗效确切的208首专家、名医的方剂,共1 522味次,统计起使用频次,并着重分析了其中出现频率较高的127味中药.根据骨质疏松症肾阳虚兼脾气虚弱的主要病理特点,结合标本虚实,对它们的使用、组配及性味归经进行了统计学分析,以揭示其用药规律.结果:[1]在治疗骨质疏松症时当以补益肝肾,养血生精,强筋壮骨为主,佐以活血祛瘀,通络止痛,祛风除湿为原则.涉及有补益药、活血祛瘀药、清热药、祛风湿药、理气药、利水渗湿药、消食药、平肝熄风药等十余类中药,其中补益药和活血祛瘀药的使用频率最高、所占比例最大,分别为69.71%和15.67%.在补益药中,又以淫羊藿、杜仲、黄芪、补骨脂等的使用频率最高,均在50/422次以上.在活血祛瘀药中,以熟地、当归、丹参等的使用频率较高.[2]治疗骨质疏松症中药的药性以温为主,辅以平性,药味以甘、辛为主,辅以苦、咸,药物归经以肝为主,辅以心、脾、肺.从使用频次最高的16味中药的功能主要为补肝益肾,强筋健骨,活血止痛.其中有关淫羊藿、熟地、黄芪、杜仲、补骨脂应用于治疗骨质疏松症方面均有大量的文献报道,通过临床实验和动物实验证明它们具有激素样作用,和抗菌、消炎、镇痛、舒张平滑肌、抑制血小板聚集、扩张血管、提高免疫功能等作用.[3]治疗骨质疏松症以本虚为主,以标实为辅,标本兼顾.参与治疗骨质疏松症的1522味次中药中补阳药为首选,共45味,占40.04%,皆归肾经;补阴药18味占32.73%,共使用403味次,占补益药使用的38.24%.主归肾、肝两经,涉及脾脏;补气药10味,占18.18%,共使用189味次,占补益药使用味次的17.93%.归属脾经.补血药共6味,占补益药的1.09%,共使用了40次,占3.79%,在治疗上应考虑选本类药物佐以补血.结论:在治疗骨质疏松症上应以补虚为主,化瘀为辅,主辅兼顾,并且提出了补肾益精、补肾益肝、补骨健脾和补肾活血等方法.中药首选补阳药,其次补阴药,佐以补气药、补血药.
目的:針對西藥在治療骨質疏鬆癥方麵有毒副作用大、遠期療效不肯定、價格昂貴等缺點,探索中醫中藥的用藥規律及如何髮揮其在防治骨質疏鬆癥中的用藥優勢.方法:對1979/2002年的相關資料進行瞭收集,併對其中療效確切的208首專傢、名醫的方劑,共1 522味次,統計起使用頻次,併著重分析瞭其中齣現頻率較高的127味中藥.根據骨質疏鬆癥腎暘虛兼脾氣虛弱的主要病理特點,結閤標本虛實,對它們的使用、組配及性味歸經進行瞭統計學分析,以揭示其用藥規律.結果:[1]在治療骨質疏鬆癥時噹以補益肝腎,養血生精,彊觔壯骨為主,佐以活血祛瘀,通絡止痛,祛風除濕為原則.涉及有補益藥、活血祛瘀藥、清熱藥、祛風濕藥、理氣藥、利水滲濕藥、消食藥、平肝熄風藥等十餘類中藥,其中補益藥和活血祛瘀藥的使用頻率最高、所佔比例最大,分彆為69.71%和15.67%.在補益藥中,又以淫羊藿、杜仲、黃芪、補骨脂等的使用頻率最高,均在50/422次以上.在活血祛瘀藥中,以熟地、噹歸、丹參等的使用頻率較高.[2]治療骨質疏鬆癥中藥的藥性以溫為主,輔以平性,藥味以甘、辛為主,輔以苦、鹹,藥物歸經以肝為主,輔以心、脾、肺.從使用頻次最高的16味中藥的功能主要為補肝益腎,彊觔健骨,活血止痛.其中有關淫羊藿、熟地、黃芪、杜仲、補骨脂應用于治療骨質疏鬆癥方麵均有大量的文獻報道,通過臨床實驗和動物實驗證明它們具有激素樣作用,和抗菌、消炎、鎮痛、舒張平滑肌、抑製血小闆聚集、擴張血管、提高免疫功能等作用.[3]治療骨質疏鬆癥以本虛為主,以標實為輔,標本兼顧.參與治療骨質疏鬆癥的1522味次中藥中補暘藥為首選,共45味,佔40.04%,皆歸腎經;補陰藥18味佔32.73%,共使用403味次,佔補益藥使用的38.24%.主歸腎、肝兩經,涉及脾髒;補氣藥10味,佔18.18%,共使用189味次,佔補益藥使用味次的17.93%.歸屬脾經.補血藥共6味,佔補益藥的1.09%,共使用瞭40次,佔3.79%,在治療上應攷慮選本類藥物佐以補血.結論:在治療骨質疏鬆癥上應以補虛為主,化瘀為輔,主輔兼顧,併且提齣瞭補腎益精、補腎益肝、補骨健脾和補腎活血等方法.中藥首選補暘藥,其次補陰藥,佐以補氣藥、補血藥.
목적:침대서약재치료골질소송증방면유독부작용대、원기료효불긍정、개격앙귀등결점,탐색중의중약적용약규률급여하발휘기재방치골질소송증중적용약우세.방법:대1979/2002년적상관자료진행료수집,병대기중료효학절적208수전가、명의적방제,공1 522미차,통계기사용빈차,병착중분석료기중출현빈솔교고적127미중약.근거골질소송증신양허겸비기허약적주요병리특점,결합표본허실,대타문적사용、조배급성미귀경진행료통계학분석,이게시기용약규률.결과:[1]재치료골질소송증시당이보익간신,양혈생정,강근장골위주,좌이활혈거어,통락지통,거풍제습위원칙.섭급유보익약、활혈거어약、청열약、거풍습약、리기약、이수삼습약、소식약、평간식풍약등십여류중약,기중보익약화활혈거어약적사용빈솔최고、소점비례최대,분별위69.71%화15.67%.재보익약중,우이음양곽、두중、황기、보골지등적사용빈솔최고,균재50/422차이상.재활혈거어약중,이숙지、당귀、단삼등적사용빈솔교고.[2]치료골질소송증중약적약성이온위주,보이평성,약미이감、신위주,보이고、함,약물귀경이간위주,보이심、비、폐.종사용빈차최고적16미중약적공능주요위보간익신,강근건골,활혈지통.기중유관음양곽、숙지、황기、두중、보골지응용우치료골질소송증방면균유대량적문헌보도,통과림상실험화동물실험증명타문구유격소양작용,화항균、소염、진통、서장평활기、억제혈소판취집、확장혈관、제고면역공능등작용.[3]치료골질소송증이본허위주,이표실위보,표본겸고.삼여치료골질소송증적1522미차중약중보양약위수선,공45미,점40.04%,개귀신경;보음약18미점32.73%,공사용403미차,점보익약사용적38.24%.주귀신、간량경,섭급비장;보기약10미,점18.18%,공사용189미차,점보익약사용미차적17.93%.귀속비경.보혈약공6미,점보익약적1.09%,공사용료40차,점3.79%,재치료상응고필선본류약물좌이보혈.결론:재치료골질소송증상응이보허위주,화어위보,주보겸고,병차제출료보신익정、보신익간、보골건비화보신활혈등방법.중약수선보양약,기차보음약,좌이보기약、보혈약.
AIM: To explore the patterns of the usage of traditional Chinese medicines in prevention and treatment of osteoporosis (OP) so as to give full play of their superiority, in view of the drawbacks of the severe toxic side-effect,the doubtful long-term therapeutic effect and the expensive drug cost in the western study of therapy of OP.METHODS: To study the patterns of the use of traditional Chinese medicines in prevention and treatment of OP, correlative data between 1979 and 2002 were collected, and statistical analysis was performed on 208 prescriptions (totaling 1 522 counts of herbs) of confirmed efficacy,which were prescribed by experts and renowned Chinese medical practitioners. Special attention was placed on the 127 herbs that were prescribed most frequently. Their uses and collocations were analyzed with the aim to reveal their medical regularities.RESULTS: [1] In treating OP, the principle should be using drugs that were able to nourish liver and kidney, cultivating blood and essence, and strengthening sinews and bones as the mainstay, and supplementing them with drugs that were able to activate blood and remove blood stasis, dredge collaterals to relieve pain, and dispel wind and eliminate dampness. More than 10 classes of drugs had been used, including tonics, drugs that activated blood and removed blood stasis, drugs that cleared excess heat, drugs that cleared excess wind and dampness, drugs that regulated flow of qi,drugs that eliminated dampness through diuresis, drugs for indigestion, and drugs that soothed liver and stopped endopathic wind. The tonics and drugs activating blood and removing blood stasis were used most frequently, accounting for 69.71% and 15.67% respectively. Among the tonics, the most frequently used (＞ 50 in 422 counts) were Herba Epimedii, Cortex Eucommiae, Radix Astrag ali and Fructus Psoraleae. Among drugs of activating blood and removing blood stasis, prepared rhizome of RadixRehmanniae, Radix Angelicae sinensis and Radix Salviae Miltiorrhizae were used most frequently. [2] It was showed that the property of herbs used to treat OP was mainly warming, and a small number of them calming character. Flavour of the drugs was chiefly sweet and pungent, and a small number of them had bitter and salty flavours; Channel tropism of the drugs was classified under liver primarily, and a small number of them classified under heart, spleen and lung. The main functions of the most frequently used 16 herbs were chiefly tonifying liver and kidney, strengthening sinews and bone, activating blood and alleviating pain. There were many literatures reporting Herba Epimedii, Radix Rehmanniae, Radix Astragali, Cortex Eucommia, and Fructus Psoraleae about their applications in the treatment of OP. Through clinical trials and animal studies, it was proved that these herbs had steroid-like actions, and antibacterial, anti-inflammatory,pain-killing, smooth-muscles relaxing, anti-platelet aggregation, vasodilation, enhancing immune system actions, etc. [3] Treatments were on the basis of rectifying deficiency as the primary, and rectifying excess as the secondary. Totally 45 kinds of yang tonic, accounting for 40.04% were selected firstly. This category of all the herbs was classified under the channel tropism of kidney. Of 18 kinds of yin tonic, accounting for 32.73%, amounted to 403 herb counts (38.24% of the total employment of tonic). This kind of drugs was classified under the kidney and liver channel tropism. Ten kinds of qi tonics, accounting for 18.18%, amounted to 189 herb counts(17.93% of the total employment of tonic). This kind of drugs was classified under the spleen channel tropism. Six kinds of blood tonics, accounting for1.09%, amounted to 40 herb counts (3.79% of the total employment of tonic). Therapy should be supplemented with herbs that enrich blood.CONCLUSION: Treatment of OP should place prime emphasis on replenishing deficiency, and supplementing it with removal of blood stasis. It is also advocated that replenishing deficiency of kidney is beneficial to producing essence and nourishing liver; replenishing deficiency of bone is beneficial to invigorating the spleen and activating blood and so on. Yang tonic is selected firstly, then yin tonic, qi tonic and blood tonic.
