目的 探究临床中药热熨治疗膝骨关节炎（knee osteoarthritis，KOA）的用药规律及其毒性中药应用情况，为临床应用和组建新热熨方提供参考。方法 检索中国知网、万方、维普、中国生物医学文献数据库和PubMed数据库，按照纳入与排除标准，筛选中药热熨治疗KOA的处方，运用Microsoft Excel 2019软件统计分析药物的使用频次、功效类别、性味归经、毒性中药用量，采用IBM SPSS Modeler 18.0、Cytoscape 3.8.2和SPSS Statistics 25.0软件进行关联规则分析，并对关联强度较高的中药用量进行聚类分析。结果 经筛选后共纳入处方241首，共计219味中药，包含毒性中药37味。使用频次较高的中药为红花、透骨草、伸筋草、独活、牛膝等，药物功效以祛风湿药、活血化瘀药、补虚药为主，药物归经以肝经、脾经、肾经为主，四气以温为主，五味以辛、苦为主。毒性中药使用频数较高的为透骨草、川乌、草乌等，药物功效以祛风湿药、化痰止咳药、活血化瘀药为主，药物归经以肝经、脾经、肾经为主，四气以温为主，五味以辛、苦为主，其中大毒中药6味、小毒中药12味、有毒中药19味，大毒、小毒、有毒的中药使用频次最多的依次为川乌、透骨草、制川乌。关联规则分析得到药对4条，3味药组20条，4味药组17条，5味药组1条。聚类分析可见中药热熨治疗KOA潜在新处方4首。结论 中药热熨治疗KOA的处方以祛风湿药和活血化瘀药为主，兼补虚药等，具有祛邪为先，补虚为辅的用药特点。“乳香-没药”“透骨草-没药-乳香-伸筋草-红花”等配伍最常见。毒性中药在热熨治疗KOA时使用较多，用量较大，虽可增强疗效，但需严控用量，防止中毒现象的发生。

Objective To explore the medication rules and toxic traditional Chinese medicine (TCM) application of TCM in the treatment of knee osteoarthritis (KOA) by hot ironing, so as to provide reference for clinical application and establishment of new hot ironing prescriptions. Methods The databases of CNKI, Wanfang, VIP, China Biomedical Literature Database and PubMed were searched. According to the inclusion and exclusion criteria, the prescriptions of TCM in treatment of knee osteoarthritis by hot ironing were screened. Microsoft Excel 2019 software was used to statistically analyze the frequency of drug use, efficacy categories, sexual taste, flavor and meridian tropism and toxic TCM dosage. IBM SPSS Modeler 18.0, Cytoscape 3.8.2 and SPSS Statistics 25.0 software were used for association rule analysis, and cluster analysis was conducted for the consumption of TCM with high association strength. Results A total of 241 prescriptions were included after screening, with a total of 219 TCMs, including 37 toxic TCMs. All the TCMs with high frequency of use were Honghua (Carthami Flos), Tougucao (Trberculate Speranskia Herba), Shenjincao (Lycopodii Herba), Duhuo (Angelicae Pubescentis Radix), Niuxi (Achyranthis Bidentatae Radix), etc. The drug efficacy was given priority to with dispelling wind and dampness drugs, promoting blood circulation and removing blood stasis drugs, tonifying deficiency drugs, etc. The drug meridian was given priority to with liver meridian, spleen meridian and kidney meridian, the four qi was given priority to with warm nature, and the five flavors were given priority to with pungent and bitter. The high frequency use of toxic TCM were Trberculate Speranskia Herba, Chuanwu (Aconiti Radix), Caowu (Aconiti Kusnezoffii Radix) and so on. The drug efficacy was given priority to with dispelling wind and dampness drugs, promoting blood circulation and removing blood stasis drugs, dispelling phlegm and relieving cough drugs, etc. The drug meridian was given priority to with liver meridian, spleen meridian and kidney meridian. The four qi was given priority to with warm nature, and the five flavors were given priority to with pungent and bitter. The toxicity classification showed that there were six kinds of big toxic TCMs, 12 kinds of small toxic TCMs and 19 kinds of toxic TCMs. The most frequently in order of big toxic TCMs, small toxic TCMs and toxic TCMs were Trberculate Speranskia Herba, Aconiti Radix and Zhichuanwu (Aconiti Radix Cocta). Association rules analysis showed that there were four drug pairs, 20 pairs of three drug groups, 17 pairs of four drug groups and one pair of five drug groups. Cluster analysis found four potential new prescriptions of TCM in the treatment of KOA by hot ironing. Conclusion The prescriptions of TCM medicine in the treatment of KOA by hot ironing are mainly dispelling wind and dampness drugs and promoting blood circulation and removing blood stasis drugs, as well as tonifying deficiency drugs, which have the characteristics of dispelling pathogenic factors first and tonifying deficiency second. Ruxiang (Olibanum)-Moyao (Myrrha), Trberculate Speranskia Herba-Myrrha-Olibanum-Lycopodii Herba-Carthami Flos and other compatibility are the most common. Toxic TCM is widely used in the treatment of KOA by hot ironing, with large dosage. Although it can enhance the curative effect, it is necessary to strictly control the dosage to prevent the occurrence of poisoning.

R285.6

国家自然科学基金项目（81774402）；山东省中医药高层次人员培训项目专项经费资助（鲁卫中医药科教字[2021]6号）；齐鲁卫生与健康领军人才培育工程专项经费资助（鲁卫人才字[2020]3号）