抗痨药干预过程的肺结核分期辨证模式的探讨  

Investigation of syndrome differentiation in the stage of chemotherapy intervention for pulmonary tuberculosis

作　　者：李静[1] 聂广[2] 余卫业[2] 吴妹英[1] 肖玉梅[1] 王霞芳[1] 刘智[2] 柯学[2] 

机构地区：[1]江苏省苏州市第五人民医院结核病科,215000 [2]广东省深圳市第三人民医院中西医结合科

出　　处：《环球中医药》2011年第3期174-177,共4页Global Traditional Chinese Medicine

基　　金：国家"十一五"科技重大专项(2008ZX10005-010)

摘　　要：目的通过对证候、证素、病因病机等统计分析,试图建立以证素为核心的分期辨证的辨证模式。方法将肺结核60余项症状体征归为阴虚、火热、气虚、阳虚、血瘀、肺、脾、肾八个证素。把不同证素对应的症状、体征制成调查问卷的形式,收集化疗前、化疗中、化疗后各100例患者资料,分别统计其临床症状、体征、证素,进而确定肺结核各个阶段的主要病机和兼夹病机,主要证候和兼夹证候。结果 (1)化疗前肺结核患者的主要临床表现有消瘦(80%)、咳嗽(71%)、咳痰(58%)、潮热(56%)、失眠(51%),相对高频的证素是肺、火(热),主要证候为火热灼肺,阴津受损;(2)化疗中的主要症候是尿黄(70%)、消瘦(68%)、咳嗽(60%)、口干(57%)、胸痛(54%)、咽痒(47%)、口渴(44%),相对高频的证素有肺、阴虚,基本证候为肺阴虚证;(3)化疗后患者的主要症候是咳嗽(59%)、胸部隐痛(55%)、咳痰(44%)、口渴(32%)、口干(23%),相对高频的证素为肺、血瘀、阴虚,基本证候为阴虚血瘀证。结论分期辨证能体现疾病的发展过程,符合传统的传染病的辨证思维;通过抗痨药干预的三个阶段的研究,与西医的诊疗现实相接轨;能反映病性与病位,即疾病的本质。Objective To set up a new syndrome differentiation system using the key syndrom elements in the stage of chemotherapy intervention for pulmonary tuberculosis by statistical analysis of symptoms,elements of syndrome,etiology and pathogenesis.Methods 60 items of symptoms and signs of pulmonary tuberculosis are classified as eight different syndrome elements,such as deficiency,fire-heat,qi deficiency,yang deficiency,pulmonary,spleen and kidney.The corresponding symptoms and signs of every syndrome elements were make into survey questionnaire to collect materials of 300 patients,100 before chemical therapy,100 during chemical therapy,100 after chemical therapy.The main and minor pathogenesis,the main and minor patterns of syndrome in the course of pulmonary tuberculosis were confirmed by analyzing the clinical symptoms,signs and elements of syndrome.Results（1）The main symptoms of patients before chemical therapy are emaciation（80%）,cough（71%）,expectoration（58%）,hectic fever（56%）,insomnia（51%）.The main elements of syndrome are pulmonary,fire-heat,while the main patterns of syndrome is the lung＇s burning by fire heat and the impaired yin essence.（2）The main symptoms of patients during chemical therapy are yellow urine（70%）,emaciation（68%）,cough（60%）,dry mouth（57%）,chest pain（54%）,throat itching（47%）,thirst（44%）.The main elements of syndrome are pulmonary and yin deficiency,while the main patterns of syndrome is deficiency of lung-yin.（3）The main symptoms of patients after chemical therapy are cough（59%）,chest pain（55%）,expectoration（44%）,dry mouth（23%）,thirst（32%）.The main elements of syndrome are pulmonary,blood stasis and yin deficiency,while the main patterns of syndrome is deficiency of yin and blood stasis.Conclusion The medical differential mode of syndrome differentiation in stage accords with the traditional syndrome differentiation thinking of infectious diseases,which can embody the evolution process of the disease.Our study was

关 键 词：肺结核 证素 病机 证候 分期辨证 

分 类 号：R241[医药卫生—中医诊断学]