【摘要】 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1522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。更多还原

【Abstract】 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 Astragali and Fructus Psoraleae. Among drugs of activating blood and removing blood stasis prepared rhizome of Radix Rehmanniae 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 for 1.09% 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.更多还原