柴胡对腰椎间盘突出症治疗的回顾性研究和初步探索
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摘要
背景
中国古代并无腰椎间盘突出症其名,但有类似腰椎间盘突出症的症状体征描述记载。直到隋朝,出现对腰椎间盘突出症的症状体征描述。西方学者在希波克拉底时代已经将推拿牵引术用于治疗腰骶痛,直到1934年,Mixter, Barr报告手术切除突出的腰椎间盘获得成功,我国现代对腰椎间盘突出症治疗的报道始于1946年。腰椎间盘突出症症状区沿神经走行呈区域性分布,我国最常见的非中央型腰4/5腰椎间盘突出症,疼痛放射路径为骶髂部、髋部、大腿和小腿后外侧,麻木部位小腿外侧或足背包括足拇指,非中央型腰5/骶1椎间盘突出疼痛放射路径为骶髂部、髋部、大腿、小腿、足跟、足外侧,麻木部位为小腿和足外侧,包括外侧三足趾。与中医足少阳胆经、足厥阴肝经走行路线大致相符。足厥阴肝经与足少阳胆经互为表里,经气相通。从肝论治气滞血瘀型腰椎间盘突出症的方法为临床常用,药理研究显示,柴胡具有抗炎、镇痛作用。临床有疏肝行气,引药入肝胆两经,改善情绪的作用,从而推论在治疗腰椎间盘突出症的方药中加用柴胡,可以提高临床疗效。
目的
回顾性的调查临床中柴胡在腰椎间盘突出症病例中的使用情况。总结中药柴胡的用药规律
初步探索受试者接受柴胡加入方剂治疗血瘀型非中央型腰椎间盘突出症患者的临床疗效,从而对柴胡在腰椎间盘突出症治疗中的地位进行探讨,并对中医药在腰椎间盘突出症患者治疗方面探讨。
方法
对2007年1月至2010年5月广东省中医院珠海医院骨二科患腰椎间盘突出症的住院病人的归档病历进行关于柴胡的回顾性研究。其中在所用应用柴胡的方剂中,对证型进行统计,对包含“气滞血瘀”、“瘀血阻络”证型汇总为“血瘀证”,对其他证型或兼有其他证型的汇总为“非血瘀证”。在所有病例中,对含有“瘀”字证型病例数进行汇总统计。采用Microsoft Office Excel 2003及SPSS16.0统计软件对结果进行统计。采用秩和检验和卡方检验对结果进行检验。
同时探索性的选取广州中医药大学及其附属的第二临床医学院珠海医院住院病例,参照1994年国家中医药管理局发布的中华人民共和国中医药行业标准-中医病症诊断疗效标准之腰椎间盘突出症的诊断标准。采用随机对照、单盲临床设计方法。选取完成合格的血瘀型非中央型腰椎间盘突出症临床病例18例,将合格受试者以1：1的比例分配至观察组和对照组,每组各9例。对18例患者经过3天中药+综合保守治疗疗程结束后进行疗效评价,疗效评价为日本矫形外科学会(JOA)腰痛疾患治疗成绩评定标准量表(简称JOA量表)。采用Microsoft Office Excel 2003及SPSS16.0统计软件对结果进行统计,然后剔除有西药影响的病例,再次对结果进行统计。
结果
对临床回顾性病例统计结果发现,总病例数1373例,应用含柴胡方剂治疗方案的病例数共209例,应用含柴胡方剂的病例约占总病例数的15.22%。在应用柴胡的病例中,单纯血瘀证的患者病例数为173例,比例约为82.8%,非瘀血证的患者病例数为36例,占17.22%。含有瘀血症候的病例数位205例,占总病例数98.09%。
初步探索结果：试验组(柴胡组)与对照组(非柴胡组)治疗后应用JOA量表评分及VAS评分比较,无统计学意义(P>0.05)。对剔除西药影响的病例后对应用JOA量表评分及VAS评分结果进行统计,无统计学意义(P>0.05)。两组病例病程比较,无统计学意义(P>0.05)。两组治疗前后比较,症状有不同程度的改善。
结论
对临床回顾性统计,柴胡在治疗腰椎间盘突出症的所有病证中,对血瘀证型或兼有血瘀证的证型的使用是被临床医师所认可的。柴胡在大多数治疗腰椎间盘突出者的方剂中的地位为佐使地位。
探索性研究发现,应用JOA量表评分及VAS评分,柴胡组与未加柴胡组治疗效果相同。应用JOA量表及VAS评分对柴胡的加减疗效评价不够充分,需要建立新的量表对柴胡治疗腰椎间盘突出症的疗效进行评价。
Background Prolapse of lumbar intervertebral disc (PLID) is not be realized in Chinese history.It was not discribed untill Sui Dynasty. The mssage and traction was used to treat it in time of Hippcrates. The first PLID-operation of the world was reported in 1934. The first PLID-operation was reported in 1946 in China. The symptom of the low back of PLID is coincident to liver channeland gallbladder meridian. The qi function of the two meridian channel can be exchanged.And to treat the PLID by the herb meridial distribution of liver channel.The radix bupleuri is meridial disribute to the liver channel, which can dispersing stagnated liver qi for promoting bile flow, and guid the medicine to the liver channel and gallbladder meridian, regulate the emotional. One of the pharmacological actions of it is antiinflammatory and abirritation. Then it come to a conclusion:it could improve the effect of the formulas of Chinese medicine to treat the PLID.
Objectives To make a retrospective research to the radix bupleuri's apply in the clinic and summarize the expeirience of it. Then, to objectively assess the clinical effect of the eccentral type of prolapse of lumbar intervertebral disc blood stasis syndrome which be treat by the formulas of Chinese medicine with radix bupleuri, and discuss the effect of the traditional Chinese medicine to the prolapse of lumbar intervertebral disc and the weight of the radix bupleuri in it.
Methods Make statistic to the in-patients with PLID in orthopaedic ward 2 of GuangDong Province Hospital Of Traditional Chinese Medicine ZHUHAI BRANCH from January,2007 to May,2010 on file. Statistic analized the result with Statistical Product and Service Solutions (SPSS)16.0 and Microsoft Office Excel 2003, and did it by chi-square test and rank sum test. Make Clustering analysis to the syndrome.To access the clinical effect of 18 qualified in-patients in GuangDong Province Hospital of Traditional Chinese Medicine ZHUHAI BRANCH, and treat them with RCT design, which were devided into to groups by 1:1.They were treated by 3 days of the formulas of Chinese medicine and the combined conservative therapy, by assessment standards questionnaire of treatment results of low back pain disease of Japanese Orthopedic Association (JOA questionnaire), and visual analogue scales (VAS).Statistic analized the result with Statistical Product and Service Solutions (SPSS)16.0 and Microsoft Office Excel 2003,and did it again with the result which were eliminated the influnced cases by the other medicine. Result The course of disease is not statistically significan. (P>0.05) And the number of the case is totally 1373. radix buleuri was appled in 15.22% case (209) plan. There are 173 case with blood stasis-only, while account for 82.8% of the number of case with radix bupleuri. And 36 case with no-blood stasis, while account for 17.22% of the number of case with radix bupleuri. The number of cases mixed with blood stasis is 205, which account for 98.09% of the radix bupleuri-case.
The result of the desk study:the treatment group (with radix bupleuri) and control group (without radix bupleuri) is not statistically significant by JOA questionnaire and VAS. (P>0.05) Then statistic by the SPSS (Statistical Product and Service Solutions).While the cases which were influnced by the other medicine were eliminated. The result of the rest of treatment group (with radix bupleuri) and control group (without radix bupleuri) is not statistically significant by JOA questionnaire VAS. (P>0.05)
Conclusion The retrospective review shows that the radix bupleuri as assistant is the admitted herb to treat the blood stasis of PLID by clinician. Howerver, the clinical effect of treatment group (with radix bupleuri) and control group (without radix bupleuri) is identical.While the JOA questionnaire and the VAS is probably not assess the herb completely. It need a new scale to do it.
中国古代并无腰椎间盘突出症其名,但有类似腰椎间盘突出症的症状体征描述记载。直到隋朝,出现对腰椎间盘突出症的症状体征描述。西方学者在希波克拉底时代已经将推拿牵引术用于治疗腰骶痛,直到1934年,Mixter, Barr报告手术切除突出的腰椎间盘获得成功,我国现代对腰椎间盘突出症治疗的报道始于1946年。腰椎间盘突出症症状区沿神经走行呈区域性分布,我国最常见的非中央型腰4/5腰椎间盘突出症,疼痛放射路径为骶髂部、髋部、大腿和小腿后外侧,麻木部位小腿外侧或足背包括足拇指,非中央型腰5/骶1椎间盘突出疼痛放射路径为骶髂部、髋部、大腿、小腿、足跟、足外侧,麻木部位为小腿和足外侧,包括外侧三足趾。与中医足少阳胆经、足厥阴肝经走行路线大致相符。足厥阴肝经与足少阳胆经互为表里,经气相通。从肝论治气滞血瘀型腰椎间盘突出症的方法为临床常用,药理研究显示,柴胡具有抗炎、镇痛作用。临床有疏肝行气,引药入肝胆两经,改善情绪的作用,从而推论在治疗腰椎间盘突出症的方药中加用柴胡,可以提高临床疗效。
目的
回顾性的调查临床中柴胡在腰椎间盘突出症病例中的使用情况。总结中药柴胡的用药规律
初步探索受试者接受柴胡加入方剂治疗血瘀型非中央型腰椎间盘突出症患者的临床疗效,从而对柴胡在腰椎间盘突出症治疗中的地位进行探讨,并对中医药在腰椎间盘突出症患者治疗方面探讨。
方法
对2007年1月至2010年5月广东省中医院珠海医院骨二科患腰椎间盘突出症的住院病人的归档病历进行关于柴胡的回顾性研究。其中在所用应用柴胡的方剂中,对证型进行统计,对包含“气滞血瘀”、“瘀血阻络”证型汇总为“血瘀证”,对其他证型或兼有其他证型的汇总为“非血瘀证”。在所有病例中,对含有“瘀”字证型病例数进行汇总统计。采用Microsoft Office Excel 2003及SPSS16.0统计软件对结果进行统计。采用秩和检验和卡方检验对结果进行检验。
同时探索性的选取广州中医药大学及其附属的第二临床医学院珠海医院住院病例,参照1994年国家中医药管理局发布的中华人民共和国中医药行业标准-中医病症诊断疗效标准之腰椎间盘突出症的诊断标准。采用随机对照、单盲临床设计方法。选取完成合格的血瘀型非中央型腰椎间盘突出症临床病例18例,将合格受试者以1：1的比例分配至观察组和对照组,每组各9例。对18例患者经过3天中药+综合保守治疗疗程结束后进行疗效评价,疗效评价为日本矫形外科学会(JOA)腰痛疾患治疗成绩评定标准量表(简称JOA量表)。采用Microsoft Office Excel 2003及SPSS16.0统计软件对结果进行统计,然后剔除有西药影响的病例,再次对结果进行统计。
结果
对临床回顾性病例统计结果发现,总病例数1373例,应用含柴胡方剂治疗方案的病例数共209例,应用含柴胡方剂的病例约占总病例数的15.22%。在应用柴胡的病例中,单纯血瘀证的患者病例数为173例,比例约为82.8%,非瘀血证的患者病例数为36例,占17.22%。含有瘀血症候的病例数位205例,占总病例数98.09%。
初步探索结果：试验组(柴胡组)与对照组(非柴胡组)治疗后应用JOA量表评分及VAS评分比较,无统计学意义(P>0.05)。对剔除西药影响的病例后对应用JOA量表评分及VAS评分结果进行统计,无统计学意义(P>0.05)。两组病例病程比较,无统计学意义(P>0.05)。两组治疗前后比较,症状有不同程度的改善。
结论
对临床回顾性统计,柴胡在治疗腰椎间盘突出症的所有病证中,对血瘀证型或兼有血瘀证的证型的使用是被临床医师所认可的。柴胡在大多数治疗腰椎间盘突出者的方剂中的地位为佐使地位。
探索性研究发现,应用JOA量表评分及VAS评分,柴胡组与未加柴胡组治疗效果相同。应用JOA量表及VAS评分对柴胡的加减疗效评价不够充分,需要建立新的量表对柴胡治疗腰椎间盘突出症的疗效进行评价。
Background Prolapse of lumbar intervertebral disc (PLID) is not be realized in Chinese history.It was not discribed untill Sui Dynasty. The mssage and traction was used to treat it in time of Hippcrates. The first PLID-operation of the world was reported in 1934. The first PLID-operation was reported in 1946 in China. The symptom of the low back of PLID is coincident to liver channeland gallbladder meridian. The qi function of the two meridian channel can be exchanged.And to treat the PLID by the herb meridial distribution of liver channel.The radix bupleuri is meridial disribute to the liver channel, which can dispersing stagnated liver qi for promoting bile flow, and guid the medicine to the liver channel and gallbladder meridian, regulate the emotional. One of the pharmacological actions of it is antiinflammatory and abirritation. Then it come to a conclusion:it could improve the effect of the formulas of Chinese medicine to treat the PLID.
Objectives To make a retrospective research to the radix bupleuri's apply in the clinic and summarize the expeirience of it. Then, to objectively assess the clinical effect of the eccentral type of prolapse of lumbar intervertebral disc blood stasis syndrome which be treat by the formulas of Chinese medicine with radix bupleuri, and discuss the effect of the traditional Chinese medicine to the prolapse of lumbar intervertebral disc and the weight of the radix bupleuri in it.
Methods Make statistic to the in-patients with PLID in orthopaedic ward 2 of GuangDong Province Hospital Of Traditional Chinese Medicine ZHUHAI BRANCH from January,2007 to May,2010 on file. Statistic analized the result with Statistical Product and Service Solutions (SPSS)16.0 and Microsoft Office Excel 2003, and did it by chi-square test and rank sum test. Make Clustering analysis to the syndrome.To access the clinical effect of 18 qualified in-patients in GuangDong Province Hospital of Traditional Chinese Medicine ZHUHAI BRANCH, and treat them with RCT design, which were devided into to groups by 1:1.They were treated by 3 days of the formulas of Chinese medicine and the combined conservative therapy, by assessment standards questionnaire of treatment results of low back pain disease of Japanese Orthopedic Association (JOA questionnaire), and visual analogue scales (VAS).Statistic analized the result with Statistical Product and Service Solutions (SPSS)16.0 and Microsoft Office Excel 2003,and did it again with the result which were eliminated the influnced cases by the other medicine. Result The course of disease is not statistically significan. (P>0.05) And the number of the case is totally 1373. radix buleuri was appled in 15.22% case (209) plan. There are 173 case with blood stasis-only, while account for 82.8% of the number of case with radix bupleuri. And 36 case with no-blood stasis, while account for 17.22% of the number of case with radix bupleuri. The number of cases mixed with blood stasis is 205, which account for 98.09% of the radix bupleuri-case.
The result of the desk study:the treatment group (with radix bupleuri) and control group (without radix bupleuri) is not statistically significant by JOA questionnaire and VAS. (P>0.05) Then statistic by the SPSS (Statistical Product and Service Solutions).While the cases which were influnced by the other medicine were eliminated. The result of the rest of treatment group (with radix bupleuri) and control group (without radix bupleuri) is not statistically significant by JOA questionnaire VAS. (P>0.05)
Conclusion The retrospective review shows that the radix bupleuri as assistant is the admitted herb to treat the blood stasis of PLID by clinician. Howerver, the clinical effect of treatment group (with radix bupleuri) and control group (without radix bupleuri) is identical.While the JOA questionnaire and the VAS is probably not assess the herb completely. It need a new scale to do it.
引文
[1]赵定麟.现代骨科学.北京：科学出版社,2004,1,1版：1303-1319.
[2]Mixter, Barr Mixter WJ. Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. New Engl J Med。1934,211:210-215.
[3]宋跃明.脊柱外科生物力学研究概况.中国脊柱脊髓杂志.1992,2：.93-96.
[4]Farfan HF, Huberdeau RM, Dubow HI. Lumbar intervertebral disc degeneration J Bone Joint surg.1972; 54A:492.
[5]Haher TR, et al. The Contribution of the Three Columns of the Spine to Rotational Stability:A Biomechanical Model.Spine,1989,14:663.
[6]郭世绂.骨科临床解剖学.济南：山东科学技术出版社,2001,1,1版：160-229
[7]胡有谷.腰椎间盘突出症.北京：人民卫生出版社,1995,2,2版：67-255.
[8]冯亮,椎间盘退变发生机理的研究进展生物医学工程学杂志2004,21(5)：867-870.
[9]任先军,彭城,梅芳瑞.椎体终板形态与椎间盘营养的关系.中国矫形外科杂志.2002,6(7)：705.
[10]郑平,朱青安,吕家峰,等.胸腰椎脊柱韧带拉伸性能的实验研究.中国临床解剖学杂志.1998,16：171-173.
[11]柏树令,应大君.系统解剖学,北京：人民卫生出版社.2001,9：451
[12]陶甫,秦学敏,郭世绂.从腰部脊神经后支的解剖探讨腰腿痛的机制.中华骨科杂志,1982,2：528
[13]Murphy, RW. Nerve roots and spinal nerve in degenerative disc disease. Clinical Orthopaedics and Related Research.1977 (129):46.
[14]Mashall L, Treathewie ER. chamical irrigation of the nerve root in disc prolapse lancet 1973,3:320.
[15]Saal JS, Franson RC, Dobrow R, etc High levels of inflammatory phospholipase A2 activity in lumbar disc herniations.Spine (Phila Pa 1976). 1990 Jul;15(7):674-8.
[16]Gertzbein SD et al. Auto immunity in degenerative disc disease of the lumbar spine, Orthopedic Clinics of North America,1975,6:67.
[17]侯树勋,研究椎间盘源性腰痛的重要性中国疼痛医学杂志2006,12,(3)：132.
[18]宣蛰人.软组织外科理论与实践[M].北京：人民军医出版社,1994：8,27,33,138,148.
[19]Takahashi H, Sugum T, Okazima Y, et al. Inflammatory cytokines in the herniated disc of the lumbar[J]. Spine,1996,21:218-224.
[20]Cavanaugh JM. Neural Mechanisms of Idiopathic Low Back Pai [M]. In:Weinstein JN, Gordon SL, eds. Low Back Pain:A Scientific and Clinical Eveiew Rosemem. IL: AAOS.1996:583-605.
[21]刘梅,洪永锋.腰椎间盘突出症的分期治疗疗效观察.安徽卫生职业技术学院学报.2007(6)：67-68.
[22]程大文,尉池以浩,曹长贵.腰椎间盘突出症中医分型的CT诊断研究.江苏中医药.2006(5)：30-31.
[23]胡有谷,椎间盘源性腰痛中国脊柱脊髓杂志2004(6)：327.
[24](美)布朗(Brown, D. E.),(美)纽曼(NeMmnnn, R. D.).骨科学.张佐伦等译.北京：海洋出版社.2001.1,2版：290.
[25]戴秀娟.预防腰椎间盘突出加强腰背肌锻炼.健康博览.2008(3)：21.
[26]刘波,赵卫侠,蒋庆新等.反悬牵引下腰背运动治疗腰椎问盘突出症的临床疗效观察.中国中医骨伤科杂志.2008,3：3-5.
[27]Graves JE. Limited range-of-motion lumbar extension strength training[J]. Med Sci spots Exere,1992,24:128.
[28]黄国付,张红星,张唐法.夹脊平衡电针治疗腰椎间盘突出症的临床疗效观察.湖南中医药大学学报2008(1)：70-71.
[29]董福仁.以针刀为主综合治疗腰椎间盘突出症216例疗效分析.中国医药导报2008(7)：52-53.
[30]刘萍,孙振杰,姚丽华.针灸配合走罐治疗腰椎间盘突出症158例.中国中医药科技.2008,3(2)：150-151.
[31]赵雪霞. “太汲神”综合辨证疗法配合穴位注射治疗腰椎间盘突出症.中国社区医师.2007(24)：39.
[32]徐萍,刘雁.腰部点式近红外线照射治疗腰椎间盘突出症.中国临床康复.2003,05(11)：1728.
[33]朱文,石秀秀,耿凌,等.SEP脉冲电刺激配合中药离子导入治疗腰椎间盘突出症102例中国骨肿瘤骨病2008,2(1)：40.
[34]高志伟手法治疗腰突症及机理.按摩与导引.2005,4(4)：31.
[35]郭郡浩.从生物力学角度分析腰椎斜扳法对椎间盘的影响.按摩与导引.2000,1(1)：6.
[36]韦龙华,黄锦益,韦克,等.甲强龙复合液骶管阻滞治疗腰椎间盘突出引起腰腿痛150例效果观察.右江医学.2009(5)：578-579.
[37]马友盟,李远明,吴兵,等手法配合硫酸氨基葡萄糖治疗腰椎间盘突出症.广东医学.2008,6(6)：986-987.
[38]唐鑫,李书振.中医药辨证治疗腰椎间盘突出症68例.辽宁中医药大学学报.2008(3)：89-90.
[39]戴学平.独活寄生汤治疗腰椎间盘突出症107例.实用中医内科杂志.2008(3)：57.
[40]卢春枝.熏蒸治疗腰椎间盘突出症.医药论坛杂志.2008(1)：72
[41]王智汉.腰腿痛从肝论治128例疗效分析.浙江中西医结合杂志,2003,13(3)：163-164.
[42]王利胜.中药的定向“载体”一药引.陕西中医1995(4)：183-184.
[43]Theresa MA, Pieter RC. Drug delivery system:Entering the mainstream[J]. Science,2004,303(5665):1818。
[44]高建伟,倪亚平.小柴胡汤是治疗抑郁症的良方.实用中医内科杂志.2008,(4)：74-75.
[45]谢振东.小柴胡汤治疗胆汁反流性胃炎的临床分析.光明中医.2008(4)：520.
[46]付继学,王著敏.小柴胡汤加味治疗梅尼埃病38例.中医研究.2008(9)：64-65。
[47]马兴友.小柴胡汤联合干扰素治疗慢性丙型病毒性肝炎疗效观察.辽宁中医药大学学报.2008(12),106-107.
[48]远山,冯琳,段海楠,等.金郁小柴胡汤治疗慢性胆囊炎45例.陕西中医.2008(4)：462-463.
[49]张刚柱.中西医结合治疗急性胆道感染60例.河南中医院学报.2008(2)：69.
[50]蒋建春,林伟,张刚,等.加味大柴胡汤治疗妊娠合并轻型急性胰腺炎疗效观察.华西医学.2008(2)：932-933.
[51]曹灵永.柴胡桂枝汤治疗纤维肌痛综合征的探讨.浙江中医杂志.2010(3)：216.
[52]王宏伟.从肝论治难治性癫痫34例临床观察.新中医.1999(4)：17-18.
[53]张春,肖方旗.柴胡桂枝汤治疗更年期综合征56例.国医论坛.2003(6)：10.
[54]王顺民.柴胡桂枝干姜汤治疗肝炎后综合征56例.实用中医内科杂志.2005(6)：556.
[55]武志平,闫桂玲.炙甘草汤合柴胡桂枝干姜汤治疗心律失常32例.新中医.2002(8)：56.
[56]庞宗然,刘宝山.柴胡桂枝干姜汤加减治疗腹泻型肠易激综合征86例疗效观察.河北中医.2002(2)：126-127.
[57]范海涛.柴胡桂枝干姜汤治疗乳腺增生症30例体会.中华医学与健康.2006(1)：63.
[58]杨明.四逆散配合针灸治疗胆汁反流性胃炎疗效观察.中国中医药信息杂志.2008(6)：74-75.
[59]黄宏敏.地黄饮子合四逆散治疗中风后抑郁症38例.辽宁中医杂志.2008(6)：890-891.
[60]鲍淑娟,冯晶.丹栀逍遥散加减治疗心脏神经官能症32例.长春中医药大学学报.2009(6)：862.
[61]丁泳,毛水全.脾胃逍遥散治疗便秘型肠易激综合征64例疗效观察.中国中医药科技.2010(1)：73-74.
[62]麦庆春,陈大宇,余伟吉,等.复元活血治疗腰椎间盘突出症气滞血瘀型50例疗效观察.黑龙江医药科学.2008(1)：66.
[63]符斌华,陈雄林.普济消毒饮治疗流行性腮腺炎60例疗效观察.九江医学.2009(4)：28.
[64]张少聪,陈晓峰,郑进福.补中益气汤治疗月经病研究进展.中国医药导报.2009(1)：149-151.
[65]鲁文涛,韩丽华.补中益气汤加味治疗急性心肌梗死后非感染性发热48例.新中医.2008(9)：85.
[66]唐清珠,顾成义.STARR术加补中益气汤治疗盆底松弛综合征所致顽固性便秘34例.中医药导报.2009(8)：45-46.
[67]王占云.补中益气汤治疗慢性结肠炎120例疗效观察.当代医学.2010(12)：153.
[68]陆毓庆.补中益气汤治疗梅尼埃病48例疗效观察.中国医药卫生.2007(9)：84-85.
[69]曹建恒.补中益气汤加味治疗腰椎间盘突出症52例.陕西中医.2005(4)：328-329.
[70]Kim SH, Lee SE, Oh H, et al.The radioprotective effects of bu-zhong-yi-qi-tang:a prescription of traditional Chinese medicine. Am J Chin Med.2002,30(1):127-37.
[71]Fuwa T, Tani T. Crude drugs for curing internal injury (NeiShang) caused by improper diet or fatigue in "NeiWaiShangBianHuoLun" and "PiWeiLun" Yakushigaku Zasshi.2006,41(1):1-8.
[72]冯卫,邱启霞.柴胡疏肝散加减治疗慢性消化不良89例.河南中医.2008(4)：64-65.
[73]冯志成.柴胡疏肝散联合盐酸曲唑酮治疗肝郁型阳痿26例疗效观察.广东医学.2008(4)：675-676.
[74]陈志宏.正柴胡饮颗粒治疗外感发热的疗效观察.上海中医药杂志.2006(4)：22-23.
[75]张玉英.柴葛解肌汤加减治疗小儿急性上感发热疗效观察.甘肃中医学院学报.2008(3)：39-40.
[76]李开梅,庄晓婵.中西医结合治疗流行性出血热2例.河南中医.2007(7)：74-75.
[77]林深怀,蔡熙.柴葛解肌汤合黄芪桂枝五物汤治疗颈椎病36例.内蒙古中医药.2010(3)：35.
[78]李元玉.血府逐瘀汤在外伤科临床应用.中国中医骨伤科杂志.2008(4)：49.
[79]韩雪华.血府逐瘀汤对80例心肌缺血患者心电图的影响.中国医学创新.2010(10)：177-178.
[79]朱鸿义.血府逐瘀汤加减治疗血管神经性头痛.中国中医急症.2010(2)：319-320.
[80]韩辉,杨文明,韩明向.加减血府逐瘀汤治疗脑卒中后抑郁症的随机对照临床研究.中医新药与临床药理.2010(1)86-88.
[81]吴菁,王晶.血府逐瘀汤联合西药治疗老年性便秘28例.实用中医药杂志.2008(11)：711.
[82]金晶.血府逐瘀汤临床治验举隅.浙江中医杂志.2010(1)：66-67.
[83]郑新安.柴胡达原饮治疗温病发热82例.河南中医学院学报.2007(4)：57.
[84]田利鲜.柴胡的药理作用和临床运用.湖北中医杂志,2008(1)：59.
[85]Chen E, Chen J, Cao SL, et al. Preparation of nasal temperature-sensitive in situ gel of Radix Bupleuri and evaluation of the febrile response mechanism. Drug Dev Ind Pharm.2010,4,36(4):490-6.)
[86]Abe H, Sakaguchi M, Arichi S. Pharmacological studies on a prescription containing Bupleuri Radix (Ⅳ). Effects of saikosaponin on the anti-inflammatory action of glucocorticoid. Nippon Yakurigaku Zasshi.1982 8,80(2):155-61.
[87]Kwon S, Lee B, Kim M, et al.Antidepressant-like effect of the methanolic extract from Bupleurum falcatum in the tail suspension test. Prog Neuropsychopharmacol Biol Psychiatry.2010,3,17,34(2):265-70.
[88]Willimott S, Barker J, Jones LA, et al. An in vitro based investigation of the cytotoxic effect of water extracts of the Chinese herbal remedy LD on cancer cells.2009,9,28,3:12.)
[89]Kang SJ, Lee YJ, Kim BM, Kim YJ, Woo HD, Jeon HK, Chung HW. Effect of Bupleuri Radix extracts on the toxicity of 5-fluorouracil in HepG2 hepatoma cells and normal human lymphocytes.Basic Clin Pharmacol Toxicol.2008,10,103(4):305-13.
[90]Yamakage M, Hattori J, Satoh J, Namiki A.. Effects of the Chinese herbal medicines Bupleuri radix, Ginseng radix, and Zingiberis rhizoma on lymphatic vessel activity in rats. Am J Chin Med.2006,34(6):1063-8
[91]Testai L, Silvio C, Ammar B, Luisa P, Vincenzo C, Martinotti EVasorelaxant effects of the chloroformic crude extract of Bupleurum fruticosum L. (Umbelliferae) roots on rat thoracic aorta. J Ethnopharmacol.2005,1, 4,96(1-2):93-7.
[92]Moga MM.. Alternative treatment of gallbladder disease. Med Hypotheses. 2003,1; 60(1):143-7.
[93]Wang Z, Li H, Xu H, et al. Beneficial effect of Bupleurum polysaccharides on autoimmune disease induced by Campylobacter jejuni in BALB/c mice. J Ethnopharmacol.2009,6,30,124(3):481-7.
[94]郭继贤,潘胜利.中国柴胡属19种植物挥发油化学成分的研究[J].上海医科大学学报,1990,17(4)：278.
[95]Matsumoto T, Sun XB, Hanawa T, Kodaira H, Ishii K, Yamada H. Effect of the antiulcer polysaccharide fraction from Bupleurum falcatum L. on the healing of gastric ulcer induced by acetic acid in rats. Phytother Res.2002,2,16(1):91-3.
[96]阴健,郭力弓.现代中药研究与临床应用[M].北京：学苑出版社.1993：542.
[97]谢东浩,蔡宝昌,安益强,等.柴胡皂苷类化学成分及药理作用研究进展.南京中医药大学学报2007,1(1)：63-65.
[98]Dobashi I, Tozawa F, Horiba N, et al. Central administrationof saikosaponin-d increases corticotropin-releasing factor mRNA levels in the rat hypothalamus[J]. Neuresci Lett,1995,197(3):235.
[99]周秋丽,张志强.柴胡皂苷和甘草甜素抑制Na+-K+-ATP酶活性的构效关系[J].药学学报,1996,31(7)：496.
[100]Kita T [Kampo medicine for the pain and the psychosomatic disorder--diagnosis and treatment] Masui.2007,11,56 Suppl:S179-84.)
[101]唐伟军,卢新华,周大现,等.柴胡镇痛效应的研究.湖南中医杂志,2003,7：52：
[102]杨雄志,曹岚,黄璐明.中药材纯度必须引起高度重视和严格监管.中国中医药信息杂志.2005,12(8)：85-87.
[103]费哲通.西乐葆,痛定思痛的选择：消炎止痛药心血管事件风波始末[N／0L].人民网,2005,04(26)：4[2010-04-19].http://health, people.com. cn/GB/26466/46586/46588/3350325. html
[104]吴红卫,刘冬生,王建军.中药治疗腰椎间盘突出症的用药分析.光明中医.2008,1(1)：94
[105]王殿俊.微循环与中医中药研究.微循环学杂志,1999(2)：1-2.
[106]Villemure and Bushnell, J Neurosci,2009,29:705-715.
[107]汤宏.自拟活血利湿汤为主治疗腰椎间盘突出症78例.安徽中医学院学报.2003,12(6)：23-24.
[108]吴红卫,刘冬生,王建军.中药治疗腰椎间盘突出症的用药分析.光明中医.2008,1(1)：94.
[2]Mixter, Barr Mixter WJ. Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. New Engl J Med。1934,211:210-215.
[3]宋跃明.脊柱外科生物力学研究概况.中国脊柱脊髓杂志.1992,2：.93-96.
[4]Farfan HF, Huberdeau RM, Dubow HI. Lumbar intervertebral disc degeneration J Bone Joint surg.1972; 54A:492.
[5]Haher TR, et al. The Contribution of the Three Columns of the Spine to Rotational Stability:A Biomechanical Model.Spine,1989,14:663.
[6]郭世绂.骨科临床解剖学.济南：山东科学技术出版社,2001,1,1版：160-229
[7]胡有谷.腰椎间盘突出症.北京：人民卫生出版社,1995,2,2版：67-255.
[8]冯亮,椎间盘退变发生机理的研究进展生物医学工程学杂志2004,21(5)：867-870.
[9]任先军,彭城,梅芳瑞.椎体终板形态与椎间盘营养的关系.中国矫形外科杂志.2002,6(7)：705.
[10]郑平,朱青安,吕家峰,等.胸腰椎脊柱韧带拉伸性能的实验研究.中国临床解剖学杂志.1998,16：171-173.
[11]柏树令,应大君.系统解剖学,北京：人民卫生出版社.2001,9：451
[12]陶甫,秦学敏,郭世绂.从腰部脊神经后支的解剖探讨腰腿痛的机制.中华骨科杂志,1982,2：528
[13]Murphy, RW. Nerve roots and spinal nerve in degenerative disc disease. Clinical Orthopaedics and Related Research.1977 (129):46.
[14]Mashall L, Treathewie ER. chamical irrigation of the nerve root in disc prolapse lancet 1973,3:320.
[15]Saal JS, Franson RC, Dobrow R, etc High levels of inflammatory phospholipase A2 activity in lumbar disc herniations.Spine (Phila Pa 1976). 1990 Jul;15(7):674-8.
[16]Gertzbein SD et al. Auto immunity in degenerative disc disease of the lumbar spine, Orthopedic Clinics of North America,1975,6:67.
[17]侯树勋,研究椎间盘源性腰痛的重要性中国疼痛医学杂志2006,12,(3)：132.
[18]宣蛰人.软组织外科理论与实践[M].北京：人民军医出版社,1994：8,27,33,138,148.
[19]Takahashi H, Sugum T, Okazima Y, et al. Inflammatory cytokines in the herniated disc of the lumbar[J]. Spine,1996,21:218-224.
[20]Cavanaugh JM. Neural Mechanisms of Idiopathic Low Back Pai [M]. In:Weinstein JN, Gordon SL, eds. Low Back Pain:A Scientific and Clinical Eveiew Rosemem. IL: AAOS.1996:583-605.
[21]刘梅,洪永锋.腰椎间盘突出症的分期治疗疗效观察.安徽卫生职业技术学院学报.2007(6)：67-68.
[22]程大文,尉池以浩,曹长贵.腰椎间盘突出症中医分型的CT诊断研究.江苏中医药.2006(5)：30-31.
[23]胡有谷,椎间盘源性腰痛中国脊柱脊髓杂志2004(6)：327.
[24](美)布朗(Brown, D. E.),(美)纽曼(NeMmnnn, R. D.).骨科学.张佐伦等译.北京：海洋出版社.2001.1,2版：290.
[25]戴秀娟.预防腰椎间盘突出加强腰背肌锻炼.健康博览.2008(3)：21.
[26]刘波,赵卫侠,蒋庆新等.反悬牵引下腰背运动治疗腰椎问盘突出症的临床疗效观察.中国中医骨伤科杂志.2008,3：3-5.
[27]Graves JE. Limited range-of-motion lumbar extension strength training[J]. Med Sci spots Exere,1992,24:128.
[28]黄国付,张红星,张唐法.夹脊平衡电针治疗腰椎间盘突出症的临床疗效观察.湖南中医药大学学报2008(1)：70-71.
[29]董福仁.以针刀为主综合治疗腰椎间盘突出症216例疗效分析.中国医药导报2008(7)：52-53.
[30]刘萍,孙振杰,姚丽华.针灸配合走罐治疗腰椎间盘突出症158例.中国中医药科技.2008,3(2)：150-151.
[31]赵雪霞. “太汲神”综合辨证疗法配合穴位注射治疗腰椎间盘突出症.中国社区医师.2007(24)：39.
[32]徐萍,刘雁.腰部点式近红外线照射治疗腰椎间盘突出症.中国临床康复.2003,05(11)：1728.
[33]朱文,石秀秀,耿凌,等.SEP脉冲电刺激配合中药离子导入治疗腰椎间盘突出症102例中国骨肿瘤骨病2008,2(1)：40.
[34]高志伟手法治疗腰突症及机理.按摩与导引.2005,4(4)：31.
[35]郭郡浩.从生物力学角度分析腰椎斜扳法对椎间盘的影响.按摩与导引.2000,1(1)：6.
[36]韦龙华,黄锦益,韦克,等.甲强龙复合液骶管阻滞治疗腰椎间盘突出引起腰腿痛150例效果观察.右江医学.2009(5)：578-579.
[37]马友盟,李远明,吴兵,等手法配合硫酸氨基葡萄糖治疗腰椎间盘突出症.广东医学.2008,6(6)：986-987.
[38]唐鑫,李书振.中医药辨证治疗腰椎间盘突出症68例.辽宁中医药大学学报.2008(3)：89-90.
[39]戴学平.独活寄生汤治疗腰椎间盘突出症107例.实用中医内科杂志.2008(3)：57.
[40]卢春枝.熏蒸治疗腰椎间盘突出症.医药论坛杂志.2008(1)：72
[41]王智汉.腰腿痛从肝论治128例疗效分析.浙江中西医结合杂志,2003,13(3)：163-164.
[42]王利胜.中药的定向“载体”一药引.陕西中医1995(4)：183-184.
[43]Theresa MA, Pieter RC. Drug delivery system:Entering the mainstream[J]. Science,2004,303(5665):1818。
[44]高建伟,倪亚平.小柴胡汤是治疗抑郁症的良方.实用中医内科杂志.2008,(4)：74-75.
[45]谢振东.小柴胡汤治疗胆汁反流性胃炎的临床分析.光明中医.2008(4)：520.
[46]付继学,王著敏.小柴胡汤加味治疗梅尼埃病38例.中医研究.2008(9)：64-65。
[47]马兴友.小柴胡汤联合干扰素治疗慢性丙型病毒性肝炎疗效观察.辽宁中医药大学学报.2008(12),106-107.
[48]远山,冯琳,段海楠,等.金郁小柴胡汤治疗慢性胆囊炎45例.陕西中医.2008(4)：462-463.
[49]张刚柱.中西医结合治疗急性胆道感染60例.河南中医院学报.2008(2)：69.
[50]蒋建春,林伟,张刚,等.加味大柴胡汤治疗妊娠合并轻型急性胰腺炎疗效观察.华西医学.2008(2)：932-933.
[51]曹灵永.柴胡桂枝汤治疗纤维肌痛综合征的探讨.浙江中医杂志.2010(3)：216.
[52]王宏伟.从肝论治难治性癫痫34例临床观察.新中医.1999(4)：17-18.
[53]张春,肖方旗.柴胡桂枝汤治疗更年期综合征56例.国医论坛.2003(6)：10.
[54]王顺民.柴胡桂枝干姜汤治疗肝炎后综合征56例.实用中医内科杂志.2005(6)：556.
[55]武志平,闫桂玲.炙甘草汤合柴胡桂枝干姜汤治疗心律失常32例.新中医.2002(8)：56.
[56]庞宗然,刘宝山.柴胡桂枝干姜汤加减治疗腹泻型肠易激综合征86例疗效观察.河北中医.2002(2)：126-127.
[57]范海涛.柴胡桂枝干姜汤治疗乳腺增生症30例体会.中华医学与健康.2006(1)：63.
[58]杨明.四逆散配合针灸治疗胆汁反流性胃炎疗效观察.中国中医药信息杂志.2008(6)：74-75.
[59]黄宏敏.地黄饮子合四逆散治疗中风后抑郁症38例.辽宁中医杂志.2008(6)：890-891.
[60]鲍淑娟,冯晶.丹栀逍遥散加减治疗心脏神经官能症32例.长春中医药大学学报.2009(6)：862.
[61]丁泳,毛水全.脾胃逍遥散治疗便秘型肠易激综合征64例疗效观察.中国中医药科技.2010(1)：73-74.
[62]麦庆春,陈大宇,余伟吉,等.复元活血治疗腰椎间盘突出症气滞血瘀型50例疗效观察.黑龙江医药科学.2008(1)：66.
[63]符斌华,陈雄林.普济消毒饮治疗流行性腮腺炎60例疗效观察.九江医学.2009(4)：28.
[64]张少聪,陈晓峰,郑进福.补中益气汤治疗月经病研究进展.中国医药导报.2009(1)：149-151.
[65]鲁文涛,韩丽华.补中益气汤加味治疗急性心肌梗死后非感染性发热48例.新中医.2008(9)：85.
[66]唐清珠,顾成义.STARR术加补中益气汤治疗盆底松弛综合征所致顽固性便秘34例.中医药导报.2009(8)：45-46.
[67]王占云.补中益气汤治疗慢性结肠炎120例疗效观察.当代医学.2010(12)：153.
[68]陆毓庆.补中益气汤治疗梅尼埃病48例疗效观察.中国医药卫生.2007(9)：84-85.
[69]曹建恒.补中益气汤加味治疗腰椎间盘突出症52例.陕西中医.2005(4)：328-329.
[70]Kim SH, Lee SE, Oh H, et al.The radioprotective effects of bu-zhong-yi-qi-tang:a prescription of traditional Chinese medicine. Am J Chin Med.2002,30(1):127-37.
[71]Fuwa T, Tani T. Crude drugs for curing internal injury (NeiShang) caused by improper diet or fatigue in "NeiWaiShangBianHuoLun" and "PiWeiLun" Yakushigaku Zasshi.2006,41(1):1-8.
[72]冯卫,邱启霞.柴胡疏肝散加减治疗慢性消化不良89例.河南中医.2008(4)：64-65.
[73]冯志成.柴胡疏肝散联合盐酸曲唑酮治疗肝郁型阳痿26例疗效观察.广东医学.2008(4)：675-676.
[74]陈志宏.正柴胡饮颗粒治疗外感发热的疗效观察.上海中医药杂志.2006(4)：22-23.
[75]张玉英.柴葛解肌汤加减治疗小儿急性上感发热疗效观察.甘肃中医学院学报.2008(3)：39-40.
[76]李开梅,庄晓婵.中西医结合治疗流行性出血热2例.河南中医.2007(7)：74-75.
[77]林深怀,蔡熙.柴葛解肌汤合黄芪桂枝五物汤治疗颈椎病36例.内蒙古中医药.2010(3)：35.
[78]李元玉.血府逐瘀汤在外伤科临床应用.中国中医骨伤科杂志.2008(4)：49.
[79]韩雪华.血府逐瘀汤对80例心肌缺血患者心电图的影响.中国医学创新.2010(10)：177-178.
[79]朱鸿义.血府逐瘀汤加减治疗血管神经性头痛.中国中医急症.2010(2)：319-320.
[80]韩辉,杨文明,韩明向.加减血府逐瘀汤治疗脑卒中后抑郁症的随机对照临床研究.中医新药与临床药理.2010(1)86-88.
[81]吴菁,王晶.血府逐瘀汤联合西药治疗老年性便秘28例.实用中医药杂志.2008(11)：711.
[82]金晶.血府逐瘀汤临床治验举隅.浙江中医杂志.2010(1)：66-67.
[83]郑新安.柴胡达原饮治疗温病发热82例.河南中医学院学报.2007(4)：57.
[84]田利鲜.柴胡的药理作用和临床运用.湖北中医杂志,2008(1)：59.
[85]Chen E, Chen J, Cao SL, et al. Preparation of nasal temperature-sensitive in situ gel of Radix Bupleuri and evaluation of the febrile response mechanism. Drug Dev Ind Pharm.2010,4,36(4):490-6.)
[86]Abe H, Sakaguchi M, Arichi S. Pharmacological studies on a prescription containing Bupleuri Radix (Ⅳ). Effects of saikosaponin on the anti-inflammatory action of glucocorticoid. Nippon Yakurigaku Zasshi.1982 8,80(2):155-61.
[87]Kwon S, Lee B, Kim M, et al.Antidepressant-like effect of the methanolic extract from Bupleurum falcatum in the tail suspension test. Prog Neuropsychopharmacol Biol Psychiatry.2010,3,17,34(2):265-70.
[88]Willimott S, Barker J, Jones LA, et al. An in vitro based investigation of the cytotoxic effect of water extracts of the Chinese herbal remedy LD on cancer cells.2009,9,28,3:12.)
[89]Kang SJ, Lee YJ, Kim BM, Kim YJ, Woo HD, Jeon HK, Chung HW. Effect of Bupleuri Radix extracts on the toxicity of 5-fluorouracil in HepG2 hepatoma cells and normal human lymphocytes.Basic Clin Pharmacol Toxicol.2008,10,103(4):305-13.
[90]Yamakage M, Hattori J, Satoh J, Namiki A.. Effects of the Chinese herbal medicines Bupleuri radix, Ginseng radix, and Zingiberis rhizoma on lymphatic vessel activity in rats. Am J Chin Med.2006,34(6):1063-8
[91]Testai L, Silvio C, Ammar B, Luisa P, Vincenzo C, Martinotti EVasorelaxant effects of the chloroformic crude extract of Bupleurum fruticosum L. (Umbelliferae) roots on rat thoracic aorta. J Ethnopharmacol.2005,1, 4,96(1-2):93-7.
[92]Moga MM.. Alternative treatment of gallbladder disease. Med Hypotheses. 2003,1; 60(1):143-7.
[93]Wang Z, Li H, Xu H, et al. Beneficial effect of Bupleurum polysaccharides on autoimmune disease induced by Campylobacter jejuni in BALB/c mice. J Ethnopharmacol.2009,6,30,124(3):481-7.
[94]郭继贤,潘胜利.中国柴胡属19种植物挥发油化学成分的研究[J].上海医科大学学报,1990,17(4)：278.
[95]Matsumoto T, Sun XB, Hanawa T, Kodaira H, Ishii K, Yamada H. Effect of the antiulcer polysaccharide fraction from Bupleurum falcatum L. on the healing of gastric ulcer induced by acetic acid in rats. Phytother Res.2002,2,16(1):91-3.
[96]阴健,郭力弓.现代中药研究与临床应用[M].北京：学苑出版社.1993：542.
[97]谢东浩,蔡宝昌,安益强,等.柴胡皂苷类化学成分及药理作用研究进展.南京中医药大学学报2007,1(1)：63-65.
[98]Dobashi I, Tozawa F, Horiba N, et al. Central administrationof saikosaponin-d increases corticotropin-releasing factor mRNA levels in the rat hypothalamus[J]. Neuresci Lett,1995,197(3):235.
[99]周秋丽,张志强.柴胡皂苷和甘草甜素抑制Na+-K+-ATP酶活性的构效关系[J].药学学报,1996,31(7)：496.
[100]Kita T [Kampo medicine for the pain and the psychosomatic disorder--diagnosis and treatment] Masui.2007,11,56 Suppl:S179-84.)
[101]唐伟军,卢新华,周大现,等.柴胡镇痛效应的研究.湖南中医杂志,2003,7：52：
[102]杨雄志,曹岚,黄璐明.中药材纯度必须引起高度重视和严格监管.中国中医药信息杂志.2005,12(8)：85-87.
[103]费哲通.西乐葆,痛定思痛的选择：消炎止痛药心血管事件风波始末[N／0L].人民网,2005,04(26)：4[2010-04-19].http://health, people.com. cn/GB/26466/46586/46588/3350325. html
[104]吴红卫,刘冬生,王建军.中药治疗腰椎间盘突出症的用药分析.光明中医.2008,1(1)：94
[105]王殿俊.微循环与中医中药研究.微循环学杂志,1999(2)：1-2.
[106]Villemure and Bushnell, J Neurosci,2009,29:705-715.
[107]汤宏.自拟活血利湿汤为主治疗腰椎间盘突出症78例.安徽中医学院学报.2003,12(6)：23-24.
[108]吴红卫,刘冬生,王建军.中药治疗腰椎间盘突出症的用药分析.光明中医.2008,1(1)：94.