摘要
目的:分析慢性骨病血瘀证的分布及变化规律。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,在万方数据库、中国知网、维普网检索这5种疾病的相关文献,检索时限从建库至2023年12月31日。从符合要求的文献中提取中医证型及证候表现并进行规范化处理后,分析慢性骨病血瘀证的分布及变化规律。结果:①文献检索及筛选结果。共检索到18255篇文献,经过逐层筛选最终纳入2929篇文献,其中颈椎病文献731篇、腰椎间盘突出症文献935篇、股骨头坏死文献301篇、膝骨关节炎文献658篇、骨质疏松症文献304篇。②证型分布和变化规律分析结果。共整理出20个血瘀证相关证型,出现频次位于前5位的分别为气滞血瘀、瘀血阻络、肾虚血瘀、气虚血瘀和痰瘀阻络。颈椎病早期、中期和晚期血瘀证相关证型占比分别为88.10%、59.56%、50.57%,腰椎间盘突出症早期、中期和晚期血瘀证相关证型占比分别为95.90%、83.67%、51.39%,股骨头坏死早期、中期和晚期血瘀证相关证型占比分别为69.44%、58.33%、50.67%,膝骨关节炎发作期、缓解期和康复期血瘀证相关证型占比分别为56.81%、98.35%、54.61%,骨质疏松症早期、中期和晚期血瘀证相关证型占比分别为97.62%、51.39%、83.97%。综合以上5种疾病的中医证型,慢性骨病早期、中期和晚期血瘀证相关证型占比分别为85.78%、74.21%、50.18%。③证候表现分布和变化规律分析结果。共整理出29种血瘀证相关证候表现,出现频次位于前5位的分别为痛处固定、痛处拒按、关节刺痛、舌有瘀斑或瘀点和舌暗紫。颈椎病早期、中期和晚期血瘀证相关证候表现占比分别为62.20%、40.55%、21.13%,腰椎间盘突出症早期、中期和晚期血瘀证相关证候表现占比分别为62.32%、59.25%、58.25%,股骨头坏死早期、中期和晚期血瘀证相关证候表现占比分别为50.90%、79.81%、50.63%,膝骨关节炎发作期、缓解期和康复期血瘀证相关证候表现占比分别为51.02%、65.02%、46.54%,骨质疏松症早期、中期和晚期血瘀证相关证候表现占比分别为54.40%、44.36%、66.74%。综合以上5种疾病的证候表现,慢性骨病早期、中期和晚期血瘀证相关证候表现占比分别为57.83%、62.46%、52.58%。④证候表现聚类分析结果。颈椎病、腰椎间盘突出症、股骨头坏死及骨质疏松症的血瘀证证候表现均聚为早期、中期和晚期3个亚类,膝骨关节炎的血瘀证证候表现聚为发作期、缓解期和康复期3个亚类。颈椎病早期、中期和晚期的血瘀证证候表现分别以痛处固定、颈部刺痛、肢体麻木等为主,腰椎间盘突出症早期、中期和晚期的血瘀证证候表现分别以痛处拒按、痛处固定、皮下瘀斑等为主,股骨头坏死早期、中期和晚期的血瘀证证候表现分别以髋部刺痛、静息痛、肌肉萎缩等为主,膝骨关节炎发作期、缓解期和康复期的血瘀证证候表现分别以痛有定处、关节刺痛、肌肤麻木等为主,骨质疏松症早期、中期和晚期的血瘀证证候表现分别以面色黧黑、腰背刺痛、痛处固定等为主。5种慢性骨病早期、中期和晚期的血瘀证证候表现分别以痛处固定、痛处拒按、肌肉萎缩等为主。结论:血瘀证贯穿于慢性骨病发生、发展的全过程,主要包括气滞血瘀、瘀血阻络、肾虚血瘀、气虚血瘀和痰瘀阻络等;在慢性骨病的早、中、晚期,血瘀证主要证候表现分别为痛处固定、痛处拒按、肌肉萎缩。随着疾病的发展,脊柱类慢性骨病血瘀证呈现逐渐减少的规律,关节类慢性骨病血瘀证呈现先增加后减少的规律,代谢类慢性骨病血瘀证呈现先减少后增加的规律,整体上慢性骨病血瘀证呈现先增加后减少的规律。
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.
作者
刘毓之
颜炎
陈卫衡
LIU Yuzhi;YAN Yan;CHEN Weiheng(Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China)
出处
《中医正骨》
2024年第7期28-43,54,共17页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
国家自然科学基金项目(82030122)。
关键词
辨证
慢性骨病
血瘀
证候
文献分析
syndrome differentiation
chronic osteopathy
blood stasis
syndrome complex
document analysis
作者简介
通讯作者:陈卫衡,E-mail:drchenweiheng@bucm.edu.cn。
