【作者】 甘慧娟；

【导师】 朱文锋；

【作者基本信息】 湖南中医药大学 ， 中医诊断学， 2007， 博士

【摘要】 目的:探讨咳嗽证素分布、组合及证素的本质。方法:1.文献研究:系统复习整理古今文献,并对近十年咳嗽的相关文献进行统计学分析,了解咳嗽名称、病因病机、病位、证型分布特点与研究进展。2.临床流行病学调研:采用临床调研与中医计量诊断、多元统计分析结合的方法,对福州市区1095例咳嗽患者常见证素进行研究,探讨其证素分布、组合规律及对诊断有统计意义的重要症状。3.实验研究:通过对血常规、血脂、血糖等临床常用检测指标的分析,探讨其与痰、热证素之间的关系。结果:1.文献研究:系统复习整理古今文献,了解古今对咳嗽含义,咳嗽名义叙述含糊、分类说法不一,咳嗽是作为症状,亦或为病存在较多的分歧,辨证分型多样,且多建立在临床报道和个人经验基础上,或从西医“病”的角度开展研究,根据疾病的病理特点而采用固定的证候分型,忽略了中医的整体辨证思维,亦不能满足临床实际需要,证素辨证符合系统论整体原理,能较近似的反映咳嗽的特点。2.临床调研:通过临床调研,运用中医计量诊断的方法,对咳嗽证素的分布及组合规律进行了初步的探讨。结果显示:(1)症状、体征分布:咳嗽主要以痰、热症状体征分布最多。(2)变量聚类分析显示:咳嗽常见证素有:外风、气虚、寒、阳虚、痰、阴虚、火热、肺、表、脾、肾、心。并对外风、气虚、寒、阳虚、痰、火热、表证素进一步作主成分分析,找出每个证素的主症、次症。(3)证素分布规律:病性证素痰和病位证素肺贯穿各个阶段,各个病程中火热多见;气虚在病程较长时出现的频率最高;病程较短时病位证素以表多见,病程较长时多影响致脾、肾、心。年龄越小,证素分布多以火热等实证证素多见,小儿常兼夹食积、动风,病位影响至胃、小肠、肝。年龄越大,以虚实夹杂证素多见,主要表现为气虚、阳虚夹痰、热、寒、饮,病位以肺脾肾为主,最终影响到心。(4)结合证素在咳嗽各阶段的分布与组合特点:认为痰与肺是咳嗽发病的病理基础;外邪侵袭是主要诱因,热占主导地位;肾是咳嗽影响到心的中心环节。3.临床实验研究:结果表明:咳嗽痰、热证素患者均存在着血常规异常;脂质代谢及糖代谢的异常;但两组间无显著差异。结论:1.咳嗽是肺系病变的一个极常见症状,并常常是其主症,临床不宜直接以咳嗽作为病名。但可以咳嗽这一主症作为轴心来归类肺系病变,称为“咳嗽病类”。2.根据聚类分析,咳嗽的常见证素有:痰、火热、气虚、外风、阳虚、寒、肺、表。3.咳嗽证素分布组合复杂,多证素组合为主,肺、痰贯穿咳嗽的各阶段。不同病程,不同年龄组的病位、病性侧重不同。4.指标可作为辅助检查手段,但不能作为痰或热证素的特征指标,因此临床不能仅仅根据这些客观指标简单套中医的某个证。多因素信息处理是证实质研究的新方法。更多还原

【Abstract】 Objective: To explore the distribution, combination and the essence of syndrome’s elements of coughMethods:1. Literature research: To systems review literature existed in the past and recent years and statistically analyze the cough-related documents in the past decade,to recognize the denotation ,etiological factors, pathogenesis ,syndromes distributions and research progression of cough . 2.Clinical and experimental research: Use the methods of the clinical investigation combining with diagnosis measurement of Traditional Chinese medicine (TCM) and multiple statistical analysis to research the common syndrome’s elements of 1095 cough patients in FUZHOU. To approach the rules of its distribution and combination ,and the important symptoms which contribute to diagnosis statistically as well. 3.Empirical study :To approach the relationship between the detection indexes such as haemocyte, blood-fat, blood glucose ,which commonly used in clinics, and phlegm and heat syndrome’s elements by analyze these indexes.Results: 1. Literature research: By completely reviewing all the past literatures ,to know the descriptions of the significance and denotation of cough in the past and recent years are ambiguous, and the classifying methods aren’t identical. There exist many dissensions of whether cough has to be regarded as a symptom or a disease, and in the differentiation of symptoms and signs for classification of syndrome, which mostly based on clinical reports and individual experience. Or to research cough by the point of view of the "disease" in modern medicine, and classify syndromes stably according to the pathology characteristic of the disease, these methods neglect the integer thinking of differentiation of syndromes of TCM, and also couldn’t meet the clinical need. Differentiation of syndrome’s elements accords with the Gestalt Principle of System Theory, and could reflect proximately the characters of cough.2. Clinical research: Through clinical research, using the method of counting-diagnosis of TCM, to research the distribution, combination of the syndrome’s elements of cough. The result:(1) Symptoms and physical signs: the most symptoms and physical signs of cough is phlegm and heat.(2) Variable clustering analysis: the common elements of syndrome of cough : exogenous wind-evil ,deficiency of Qi, cold, deficiency of Yang, insufficiency of yang, phlegm , heat and exterior. To do the principal component analysis to every elements of syndrome, find out the cardinal symptoms, subcardinal ones.(3) Distribution regular of syndrome’s elements : the characteristic syndrome’s element phlegm and the position syndrome’s element Lung appear in every phase of the disease, heat appears mostly in all course of the disease; when the course is long the frequency of the appearance of deficiency of Qi is the highest, and the spleen , the kidney and the heart are effected. When it is short the position syndrome’s element exterior appears mostly. The patient is younger, the excess syndrome’s elements such as heat appear more frequently. Concerning child the food retention and interior stirring-up of wind usually appear , whose stomach, small intestine, and liver are effected. The patient is older ,the syndrome’s elements of simultaneous deficiency and excess appear more frequently, such as deficiency of Qi or Yang combining with phlegm, heat, cold, or retention of fluid ,whose lung, spleen and kidney are effected ,and the heart would be effected at last.(4) Combination regular of elements of syndrome: Phlegm and lung is the pathology basement of cough, the exterior evil is the main motivation, and heat is in the primary place.3.Clinical experiment research: the result shows: There exists haemocyte , lipid metabolism and glycometabolic abnormity in the patients of phlegm and heat cough, but there’s no significant deviation between these two groups.Conclusions: 1.Cough is the common even the primary symptom of lung diseases, so it’s not suitable to regard "cough" as a name of a disease. But it could be called as "cough species" according to using the primary symptom cough as a core to classify lung diseases. 2. according to variable clustering analysis, the common syndrome’s elements of cough are : exogenous wind-evil ,deficiency of Qi, cold, deficiency of Yang, insufficiency of yang, phlegm , heat and exterior. 3. The distribution and combination of syndrome’s elements are very complicated, the combination of several syndrome’s elements is major, lung and phlegm are present in every phase of cough. The disease position and characteristic is different between the groups of different courses and different ages. 4. The indexes could be used as auxiliary examination methods, without being regarded as the characteristic indexes of the syndrome’s elements of phlegm and heat. So it can’t be used alone to diagnose a syndrome in the clinic, several-factors treating is the new method for the research of syndrome’s elements.更多还原