胆石症的中医证候分布规律及其相关方药干预研究

Study on the Distribution Pattern of TCM Syndromes of Cholelithiasis and Its Related Prescription Intervention

摘要: 目的：通过文献分析探讨胆石症的中医证型、证候分布及相关方药运用规律，为临床运用中医药辨治本病提供参考。方法：检索建库至2024年12月1日中国知网(CNKI)、中文科技期刊数据库(VIP)、万方(Wanfang)、中国生物医学数据库中中医药论治胆石症的相关文献，并用软件统计分析胆石症的中医证型、证候、方药使用频次，并对高频药物进行聚类分析。结果：共纳入文献116篇，获得中医证型17种，最常见的5个证型为肝胆湿热证、肝郁气滞证、脓毒蕴结证、痰瘀互阻证、肝阴不足证。共出现中药112味，最多为清热药，其次为理气药，出现频次最多的前5味中药为柴胡、郁金、黄芩、金钱草、甘草。聚类分析发现5组具有关联性的药物组合。结论：胆石症患者中医证型分布以肝胆湿热型最为常见，其次为肝郁气滞证。遣方用药时多运用清热、利胆化石之法，兼顾气滞、血瘀、痰结、脓毒等病理因素，灵活运用理气、活血、化痰等治法。临证需对症加减，病证结合。

Abstract: Objective: To explore the TCM syndromes, syndrome distribution, and related prescriptions of cholelithiasis through literature analysis and to provide a reference for the clinical application of traditional Chinese medicine in the treatment of this disease. Methods: Relevant literature on the treatment of cholelithiasis with traditional Chinese medicine from the establishment of the database to December 1, 2024, were retrieved from China National Knowledge Infrastructure, Chinese Science and Technology Journal Database, Wanfang, and China Biomedical Database. The frequency of TCM syndromes, syndromes, and prescriptions of cholelithiasis was statistically analyzed by software, and cluster analysis of high-frequency drugs was carried out. Results: A total of 116 articles were included in the literature, and 17 TCM syndromes were obtained. The five most common syndromes were liver and gallbladder damp-heat syndrome, liver depression and qi stagnation syndrome, sepsis accumulation syndrome, phlegm and blood stasis syndrome, and liver yin deficiency syndrome. There were 112 kinds of traditional Chinese medicine, most of which were heat-clearing drugs, followed by qi-regulating drugs. The top five traditional Chinese medicines with the highest frequency were Bupleurum, Turmeric, Scutellaria, Lysima, and Licorice. Cluster analysis found 5 groups of related drug combinations. Conclusion: The distribution of TCM syndromes in patients with cholelithiasis is most common in liver and gallbladder damp-heat syndrome, followed by liver depression and qi stagnation syndrome. The method of clearing heat and promoting gallbladder fossils is often used in the prescription, taking into account the pathological factors such as qi stagnation, blood stasis, phlegm, and sepsis, and flexibly using the methods of regulating qi, activating blood and resolving phlegm. Clinical need symptomatic addition and subtraction, combining of disease and syndrome.