名老中医医案小儿遗尿证候特点分析

Syndrome Characteristics of Infantile Enuresis Based on Medical Records of Prestigious Doctor of Traditional Chinese Medicine

目的探究小儿遗尿证型的中医证候特点,为临床辨证提供指导。方法采用线上数据库检索和线下图书馆人工检索相结合的方式,以“遗尿”or“遗溺”and“名老中医”or“名中医”and“医案”or“经验”为关键词,收集1949—2022年名老中医治疗小儿遗尿医案,构建名老中医诊治小儿遗尿医案数据库。运用频数分析、主要成分因子分析与聚类分析,归纳常见证型的证候特征,研究医案中遗尿患儿的中医证候分布特点。结果共纳入350例医案,将频次≥15的四诊信息进行因子分析,得到12个公因子。将公因子进行聚类分析,结合中医专业知识,最终确定6种常见证候特点。结论小儿遗尿主要病位证素为肾、脾、肝,病性证素为阳虚、气虚、血虚、阴虚。从肝论治小儿遗尿以热证及郁证多见。因此临床治疗应以温补脾肾为主,配合泻肝清热利湿或疏肝之法。

Objective To explore the TCM syndrome characteristics of infantile enuresis syndrome types and provide guidance for clinical syndrome differentiation.Methods By combining online database retrieval with offline library manual retrieval,taking“enuresis”or“uracratia”and“prestigious doctor of traditional Chinese medicine”or“famous doctor of traditional Chinese medicine”and“medical record”or“experience”as keywords,the medical records of prestigious doctor of traditional Chinese medicine in treating infantile enuresis was collected,and the database of medical records of prestigious doctor of traditional Chinese medicine in treating infantile enuresis was construct.Frequency analysis,principal component factor analysis and cluster analysis were used to summarize the syndrome characteristics of common syndromes and study the distribution characteristics of TCM syndromes of enuresis patients in medical records.Results A total of 350 medical records were included,and 12 common factors were obtained by factor analysis of four diagnoses with frequency more than 15.By clustering analysis of common factors,combined with the professional knowledge of traditional Chinese medicine,the characteristics of 6 common syndromes were finally determined.Conclusion The main pathogenic syndromes of infantile enuresis are kidney,spleen and liver,and the pathogenic syndromes are yang deficiency,qi deficiency,blood deficiency and yin deficiency.Heat syndrome and depression syndrome are common in treating infantile enuresis from liver.Therefore,clinical treatment should be based on warming the spleen and kidney,combined with purging the liver,clearing heat and diuresis or soothing the liver.