阴证咽喉肿痛的四诊信息及其对应辛温方药应用特点研究  

Study on four diagnostic information and the application characteristics of corresponding pungentwarm medicinal formulas in sore throat with Yin syndrome

作　　者：管桦桦[1] 蔡佑青 胡碧霞[3] 何嘉慧[3] 张晓轩[1] 老膺荣[1] 杨志敏[3] 

机构地区：[1]广东省中医院扶阳流派工作室,广东广州510120 [2]广东省中医院芳村医院肾内科,广东广州510000 [3]广州中医药大学第二临床医学院,广东广州510405

出　　处：《上海中医药杂志》2016年第9期23-27,51,共6页Shanghai Journal of Traditional Chinese Medicine

基　　金：广东省科技厅科研项目(2013B021800246);广东省中医院扶阳流派传承工作室项目(2013KT1517);广东省中医院颜德馨膏方工作室项目[中医二院(2014)89号-6];广东省中医院岭南中医学术流派临床研究专项(YN2014LN03);广州中医药大学第二临床医学院"学生跟师中医学术流派学习活动"项目[中医临二(2015)3号]

摘　　要：目的整理与分析辛温方药治疗阴证咽痛的四诊信息特点。方法收集并选择符合条件的医案69则,经规范化处理后,以结构化的形式录入Excel数据表中,采用Fisher确切概率检验与关联规则Apriori算法分析数据并形成结果报告。结果 1麻黄附子细辛汤、附子干姜汤、半夏散及汤、四逆汤为治疗阴证咽痛的常用方剂。2阴证咽痛在望诊中常可见舌色淡、苔白、质润有津液的舌象;充血、扁桃体肿大的咽喉局部特点;精神萎靡的整体状态。切诊常呈现或沉或细或弱的脉象与手足寒。闻诊常可知患者声音嘶哑。同时,咽喉部梗塞、恶风寒、咽干、咳嗽等是常见的伴随症状。3阴证咽痛患者常具有感受风寒、应用清热解毒方药无效、抗生素或养阴清热药物无效或加重的病史特点。4诱因感受风寒与对常规治疗方案反应不佳的病史特征与本病典型舌象、脉象的形成有一定的相关性。5四诊信息"面红热、小便多、舌体胖、舌边有齿痕及舌苔白"对于姜附与麻桂类方的选择具有统计学意义(P<0.05)。而"咽痛日轻夜重、咽充血、不欲饮与喜热饮"对于区分两者不具有统计学意义(P>0.05)。结论阴证咽痛的诱因、病史特征,以体质为纽带,与本病常见症状及舌象、脉象的形成确有一定的相关性。四诊信息"面红热、小便多、舌体胖边有齿痕"有助于姜附类方的选用;"舌苔白"则有助于麻桂类方的选用。Objective To summarize and analyze the characteristics of four diagnostic information about pungent-warm medicinal formulas in the treatment of sore throat with Yin syndrome. Methods 69 cases that met the inclusion criteria were collected. After standardized processing,related information were exported into EXCEL in the form of structured data. These data was analyzed by the Fisher exact probability test and association rules Apriori algorithm analysis and formed the result reports. Results①Mahuang Fuzi Xixin decoction, Fuzi Ganjiang decoction,pinellia powder or decoction, Sini decoction were used as common prescription for sore throat with Yin syndrome.②In the inspection of tongue picture, pale and moist tongue with saliva and white fur were often observed, which showed the local characteristics of threat as hyperemia and antiadoncus and whole state of mental sluggishness. In the pulse feeling and palpation, deep or thready or weak pulse and cold of hands and feet were often presented. In the anscuitation and olfaction ,the hoarse voice of patients could be found ,with common accompanied symptoms of throat infarction, aversion to cold, dry throat and cough at the same time, ③In the medical history, patients often suffered wind-cold and poorly responsed to the prescription of clearing-heat and detoxifying,antibiotics and drugs of nourishing yin and clearing-heat,or even got worse.④There were certain correlation among the cause of suffering cold-wind,the history characteristic of poor response to conventional treatment and the formation of typical tongue and pulse. ⑤For the four diagnostic information of＂ red complexion , frequent urination, enlarged and teeth-marked tongue with white coating＂, types of prescription with aconite and dried ginger,as well as ephedra vulgaris and cassia twig, could be applicated with statistical significance （P 〈 0. 05 ）. For the distinction between the two types prescription, the information of ＂angina light in day and heavy in night , pharynx hyperemia, dislik

关 键 词：咽喉肿痛 阴证 喉痹 乳蛾 辛温方药 四诊信息 姜附类方 麻桂类方 

分 类 号：R276.1[医药卫生—中医五官科学]