基于《医学六要》补肝汤辨证加味治疗腰椎间盘突出症回顾分析

目的:分析基于明代医家张三锡《医学六要》补肝汤辨证加味在腰椎间盘突出症中的治疗价值,以此对《医学六要》补肝思想进行继承创新。方法:对湖南省中医药研究院附属医院、湘潭市中医医院、北京中医药大学深圳医院2008年8月—2019年12月采取张三锡补肝汤辨证加味治疗的9741例腰椎间盘突出症患者,进行回顾性分析。结果:优3791例,良3740例,可1228例,差982例,总有效率达89.92%。各疾病分型及中医证型疗效情况如下。①膨出型腰椎间盘突出症的临床疗效最好,其次为中央突出型,脱出游离型疗效相对最差;②突出物在a域以内者临床疗效最好、其次为在b域以内者,突出物达到d域者疗效相对最差;③以寒湿型和血瘀型的临床疗效最好,不在《中医病证诊断疗效标准》中列出的其他型疗效相对最差;④以单纯L5~S1为责任节段的临床疗效最好,双节段或多节段椎间盘突出者疗效相对最差;⑤以单纯出现下肢症状和(或)体征者临床疗效最好、其次为单纯腰部出现症状和(或)体征,腰部和腿部同时出现症状和(或)体征者疗效相对最差;⑥病程以≤7天者疗效最好,≥3年者疗效相对最差。基于《医学六要》补肝汤辨证加味在腰椎间盘突出症的治疗应用上安全有效。结论:基于《医学六要》补肝汤辨证加味可用于指导腰椎间盘突出症的临床治疗,应对该补肝思想进行深入研究和继承创新。

A Retrospective Analysis of Modified Bugan Tang According to Syndrome Differentiation for Lumbar Disc Herniation Based on Yixue Liuyao

Objective:To analyze the therapeutic value of modified Bugan tang according to syndrome differentiation on the treatment of lumbar disc herniation based on the Yixue Liuyao by ZHANG Sanxi,a Chinese medicine practioner in Ming Dynasty,so as to carry on the inheritance and innovation of the thought of tonifying the liver in this classic book.Methods:A retrospective analysis was performed on 9,741 patients with lumbar disc herniation who were treated with ZHANG Sanxi's modified Bugan tang according to syndrome differentiation from August 2008 to December 2019 in Hunan Academy of Traditional Chinese Medicine Affiliated Hospital,Xiangtan Hospital of Traditional Chinese Medicine and Shenzhen Hospital of Beijing University of Chinese Medicine.Results:There were 3,791 cases of excellent,3,740 cases of good,1,228 cases of normal,982 cases of poor;the total effective rate reached 89.92%.The therapeutic effect of each disease type and Chinese medicine syndrome type was as follows.①Bulging lumbar disc herniation had the best clinical effect,followed by central herniation,and free herniation had the worst effect.②Protrusions in domain A had the best clinical effect,followed by protrusions in domain B,and protrusions in domain D had the worst clinical effect.③The cold and dampness type and blood stasis type had the best clinical effect,and the other types not listed in the Diagnostic Effect Criteria for Chinese Medicine Diseases and Syndromes had the worst effect.④The clinical effect of L5-S1 as the responsible segment was the best,while the effect was the worst in patients with double or multi-segment intervertebral disc protrusion.⑤Patients with symptoms and/or signs of lower extremities had the best effect,followed by those with symptoms and/or signs of waist,and those with symptoms and/or signs of waist and lower extremities had the worst effect.⑥Patients with disease duration for seven days and more than seven days had the best curative effect,while patients with duration for three years and more than three years had the worst curative effect.Based on the Yixue Liuyao,modified Bugan tang according to syndrome differentiation was safe and effective in the treatment of lumbar disc herniation.Conclusion:Based on the Yixue Liuyao,modified Bugan tang according to syndrome differentiation can be used to guide the clinical treatment of lumbar disc herniation,and the thought of tonifying the liver should be further studied,inherited and innovated.