[1]赵睿晞,王人彦.张玉柱教授治疗腰椎间盘突出症的用药规律分析[J].中医正骨,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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张玉柱教授治疗腰椎间盘突出症的用药规律分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年08期
页码:
39-42
栏目:
调查研究
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:
赵睿晞1; 王人彦2
(1.杭州市富阳中医骨伤医院,浙江 杭州 311400; 2.浙江骨伤医院,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
关键词:
椎间盘移位;  腰椎;  中药疗法;  方剂分析; 计算机辅助;  数据挖掘
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  drug therapy(TCD);  formula anal comput assist;  data mining
摘要:
目的:分析富阳“张氏骨伤疗法”代表性传承人张玉柱教授治疗腰椎间盘突出症的用药规律。方法:收集2016年3月至2019年12月经张玉柱教授诊治的腰椎间盘突出症患者的病例资料,提取患者的诊断信息(包括诊断和中医证型)、处方信息(包括方剂组成、药物剂量)及治疗前后的日本骨科学会(Japanese Orthopedic Association,JOA)腰痛疾患评分。对原始数据进行规范处理,建立数据库。利用SPSS Clementine12.0软件进行数据挖掘,统计分析处方中药物的出现频次,采用关联规则分析方剂的组方规律,采用因子分析预测可能的新方组合。利用患者治疗前后的JOA腰痛疾患评分验证入选方剂治疗腰椎间盘突出症的临床疗效。结果:①用药频次分析结果。共纳入602例患者,涉及2109首方剂、73味中药。使用频次排在前10位的药物分别为川牛膝、狗脊、牛膝、泽兰、续断片、红花、豨莶草、炒杜仲、威灵仙、鹿角。②组方规律分析结果。将所有入选药物进行关联规则分析,共获得10个核心药物组合,分别为狗脊-豨莶草-续断片、川牛膝-独活、狗脊-豨莶草-牛膝、川牛膝-泽兰-续断片、狗脊-豨莶草-川牛膝、狗脊-豨莶草、狗脊-当归-炒杜仲、狗脊-炒杜仲、炒杜仲-枸杞子-狗脊、川牛膝-地龙。将用药频次前10位的中药与中医证型进行关联规则分析,得到5条关联规则,分别为川牛膝→湿热证、牛膝→肝肾亏虚证、狗脊→肝肾亏虚证、川牛膝→血瘀证、泽兰→血瘀证。③新方预测结果。通过因子分析,结合用药频次前10位的药物与中医证型的关联规则,共得到3首新方。④疗效验证结果。按照JOA腰痛疾患评分标准评定,纳入的602例腰椎间盘突出症患者中优199例、良254例、可90例、差59例,治疗有效率90.20%。结论:张玉柱教授治疗腰椎间盘突出症的用药特点为补行兼施、通经活络,常用药物包括活血化瘀药、祛风湿药、补虚药3类。
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