魏品康教授防治化疗导致恶心呕吐用药规律研究

目的总结魏品康教授防治化疗导致恶心呕吐学术思想和临床用药规律。方法以"化疗"、"呕吐"作为关键词,从魏品康病例数据库中筛取2006年1月—2010年10月化疗导致恶心呕吐病例143例,处方143首,采用SPSS13.0软件,按中药功能、药性、药味、归经及药对进行频数和聚类分析。结果共计使用中药144味,2353频次。使用频率>5%的有6类,由高至低为理气药(17.81%)、化痰药(13.51%)、补气药(8.07%)、消食药(7.44%)、平肝熄风药(7.05%)、温里药(5.01%),累计频率58.89%。单药使用>20频次的中药有31味,累计频率77.31%,其中理气药6味,平肝熄风药4味,化痰药3味,外用药及其他2味,补气药2味,温里药2味,活血祛瘀药2味,利水渗湿药、攻下药、补血药、辛温解表药、辛凉解表药、收涩药、芳香化湿药、安神药、清热燥湿药和消食药各1味。半夏127频次中姜半夏为83(65.35%),大黄89频次中制大黄为85(95.51%)。按药味分析,温性药使用频率最高(43.99%)。按药性分析,共计3677频次,其中辛味药最高(34.76%),其次为苦味(32.06%)、甘味(18.22%),三者累计频率为85.04%。所有中药归经共计6627频次,频次>1000的药物由高到低依次归脾、胃、肝、肺经,累计频率为71.34%。常见药对有枳壳与枳实、丁香与柿蒂、沉香与蟾皮、全蝎与蜈蚣、地龙与守宫、半夏与天南星、黄连与乌贼骨、桂枝与白芍、佛手与香橼、柴胡与郁金、龙骨与牡蛎、白术与茯苓等。结论魏品康教授以消痰和胃为基本治则防治化疗导致的恶心呕吐,重视痰阻与滞留导致的胃肠代谢障碍,理气同时着重消痰化积和消食导滞。

英文摘要:

Objective To summarize the herbal medication by Professor WEI Pin-kang’s prescriptions in treating chemotherapy induced nausea and vomiting(CINV).Methods On the basis of outpatient and inpatients’ medical records concerning CINV from case-database(Key words:chemotherapy and vomiting),data of 143 patients and 143 effective prescriptions were collected.The herbs and those category,nature,flavor and meridian distribution were summarized by frequency method using SPSS 13.0 Software.The couple herbs were analyzed by hierarchical cluster analysis.Results A total of 144 herbs were used(2 353 frequencies).Six groups of herbs [frequency>5%,cumulative relative frequency(CRF) 58.89%] were used frequently as follow:the herbs for regulating qi(17.81%),resolving phlegm(13.51%),invigorating qi(8.07%),relieving food retention(7.44%),calming Gan to stop endogenous wind(7.05%),and warming the interior(5.01%).The most frequently used herbs(>20 frequencies,CRF 77.31%) had 31 species as follow:the herbs for regulating qi(6 species),calming Gan to stop endogenous wind(4 species),resolving phlegm(3 species),external application(2 species),invigorating qi(2 species),warming the interior(2 species),activating blood and removing blood stasis(2 species),promoting diuresis and resolving dampness(1 species),purgation(1 species),invigorating blood(1 species),relieving exterior syndrome with pungent-warm property(1 species),relieving exterior syndrome with pungent-cool property(1 species),astringent(1 species),resolving dampness with aromatic property(1 species),calming the mind(1 species),eliminating heat and dampness(1 species),relieving food retention(1 species).Frequency of Rhizoma Pinelliae was 127 including Rhizoma Pinelliae(processed with ginger) 83(65.35%).Frequency of prepared Radix et Rhizoma Rhei was 85(95.51% of Preapraed Rhizoma Rhei).These herbs were mostly of warm nature(43.99%).The total frequency of herb-nature was 3 677 and the pungent(34.76%),bitter(32.06%) and sweet herbs(18.22%) were most frequently used(CRF 85.04%).The total frequency of meridian distribution was 6 627 and these herbs were mostly attributed to Pi,Wei,Gan,and Fei meridians(CRF 71.34%).The most frequently used couple-herbs included Rhizoma Pinelliae and Rhizoma Atisaematis,Fructus Aurantii Immaturus and Submature Bitter Orange,Flos Caryophylli and Calyx Kaki,Rhizoma Coptidis and Os Sepiae,Rumulus Ginnamomi and Radix Paeoniae,Fructus Citri Sarcodactylis and Fructus Citri,aloeswood and toad skin,scorpion and centipede,earth worm and Gekko Swinhoana,bupleurum root and curcumae,fossilia ossis mastodi and oyster,large head atractylodes and poria,and so on.Conclusions Professor WEI Pin-kang regarded the therapy of dissolving phlegm and regulating Wei as the fundamental treatment of CINV.He emphasized gastrointestinal metabolic disorders induced by phlegm and stagnation related to chemotherapeutics.He laid equal emphasis on regulating qi,dissolving phlegm,and removing stagnation.

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