摘要
目的:分析慢性骨病的核心病机.方法:选取颈椎病、腰椎间盘突出症、股骨头坏死、膝骨关节炎及骨质疏松症5种慢性骨病,在中国知网、万方数据库、维普网检索这5种疾病的相关文献,检索时限均为建库至2022年12月31日.从符合要求的文献中提取中医证型并进行规范化处理,按照《证素辨证学》中的标准将规范后的证型分解为证素,分析慢性骨病的核心病机.结果:①文献检索及筛选结果.共检索到70 425篇文献,经过逐层筛选最终纳入6317篇文献,其中颈椎病文献1331篇、腰椎间盘突出症文献1123篇、股骨头坏死文献1068篇、膝骨关节炎文献1359篇、骨质疏松症文献1436篇.②证型分布分析结果.共整理出颈椎病、腰椎间盘突出症、股骨头坏死、膝骨关节炎中医证型各24个,骨质疏松症中医证型23个,合并后共获得5种慢性骨病的中医证型39个.③证素分布分析结果.从5种慢性骨病的39个中医证型中共提取出6个病位证素,出现频次前3位的证素为肾、肝、脾,占比92.76％;共提取出7个病性证素,出现频次前5位的证素为虚、湿、寒、血瘀、热,占比为92.12％.④证素聚类分析结果.颈椎病的证素共聚为3类,聚类1以"寒、湿、热"为核心,聚类2以"血瘀、气滞"为核心,聚类3以"虚"为核心;腰椎间盘突出症的证素共聚为3类,聚类1以"血瘀、气滞"为核心,聚类2以"湿、寒、热"为核心,聚类3以"虚"为核心;股骨头坏死的证素共聚为4类,聚类1以"寒、湿、热"为核心,聚类2以"血瘀"为核心,聚类3以"虚"为核心,聚类4以"经脉"为核心;膝骨关节炎的证素共聚为3类,聚类1以"寒、湿、热"为核心,聚类2以"血瘀、气滞"为核心,聚类3以"虚"为核心;骨质疏松症的证素共聚为3类,聚类1以"虚"为核心,聚类2以"寒、湿、血瘀"为核心,聚类3以"热"为核心.综合5种慢性骨病的证素,共聚为3类,聚类1以"湿、寒、热"为核心,聚类2以"血瘀"为核心,聚类3以"虚"为核心.结论:寒、热、瘀、湿、虚是慢性骨病的病性证素,反映了其发生、发展的内在本质,是对慢性骨病病理状态和病理变化的高度概括,体现了慢性骨病的核心病机.
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(KO A),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 arti-cles.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 cate-gories,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 ele-ments of KO A 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 defi-ciency,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.
基金项目
国家卫生健康委员会规划发展与信息化司项目(JKZGJBGG2331)
首都卫生发展科研专项重点攻关项目(2022-1-7032)
维普
万方数据