基于临床流行病学调查的原发性骨质疏松症中医基本证候研究

Study on the TCM general syndrome of Osteoporosis based on the clinical epidemiological investigation

目的:探讨原发性骨质疏松症的证候因素和证候特征。方法:根据临床流行病学调查和调查问卷的方法,采用描述性统计、聚类分析和决策树等数据挖掘技术,对横断面调查数据进行分析。结果:(1)原发性骨质疏松症除骨痛、驼背、身高变矮、骨折外,中医主要症状为腰膝酸软、视物模糊、发脱、腿沉、倦怠乏力和畏寒肢冷;次要症状为怕热、眼睛干涩、烦躁易怒、头晕、齿摇、耳鸣、气短、便秘和盗汗。(2)原发性骨质疏松症的主要证候为肾阳虚证、肾精不足证、肾气虚证、肾阴阳两虚证、脾肾阳虚证、肾阴虚证和肝肾阴虚证,主要证候因素为阴虚、阳虚、气虚、气滞、湿浊和血瘀;(3)阴虚决策树诊断模型以五心烦热、盗汗和便秘三个变量为主,阳虚决策树诊断模型以畏寒肢冷、大便稀溏、腰膝酸软、头晕和气短五个变量为主。结论:(1)原发性骨质疏松症中医6个主要症状和9个次要症状,主要证候因素为阴虚、阳虚、气虚、气滞、湿浊和血瘀,常见证候为肾阳虚证、肾精不足证、肾气虚证、肾阴阳两虚证、脾肾阳虚证、肾阴虚证和肝肾阴虚证。(2)原发性骨质疏松症是以肾、肝、脾三脏虚损为本,气滞、湿浊、血瘀为标的本虚标实之证。

The purpose of this study is to investigate and discuss the syndrome and syndrome factors of osteoporosis. Questionnaire based survey, and clinical and epidemiological surveys were employed to collect needed information and data. The data was analyzed using descriptive statistics, decision - making tree and cluster analysis. The investigation has produced the following results：1） in addition to typical symptoms of osteoporosis, such as bone aching, shortened stature, humpback, and fractures, the TCM theory lists the following as the main symptoms： soreness in the lumbar region and knee joints, blurred vision, loss of hairs, heavy leg, lassitude and weakness, aversion to cold, and cold limbs. In the meantime, a range of other symptoms, including aversion to heat, ocular dryness, dysphoria, irritability, dizziness, luxated tooth, tinnitus, short breath, constipation, and night sweat, are listed as the secondary; 2） the main osteoporosis syndromes are kidney Yang vacuity, kidney essence vacuity, kidney Qi vacuity, dual vacuity of kidney Yin and Yang, kidney and spleen Yang vacuity, kidney Yin vacuity, and kidney/hepatic Yin vacuity. The following are the main syndrome factors： Qi vacuity, Yin vacuity, Yang vacuity, wet muddy stagnation of Qi, and blood stasis; 3） decision - making tree： the diagnosis model of Yin vacuity is determined by dysphoria with feverish sensation in the chest, palms and soles, night sweat, and constipation, while Yang vacuity is determined by aversion to cold, cold limbs, watery stool, soreness in the lumbar region and knee joints, dizziness, and short breath. The investigation has come up with the following resuhs：1） six primary and nine secondary symptoms of osteoporosis have been sorted out. The primary syndrome factors are Qi vacuity, Yin vacuity, Yang vacuity, stagnation of Qi and blood stasis, with familiar syndromes being as kidney Yang vacuity, kidney essence vacuity, kidney Qi vacuity, dual vacuity of kidney Yin and Yang, kidney and spleen Yang vacuity, kidney Yin vacuity, and kidney and hepatic Yin vacuity; 2） the syndrome of osteoporosis is asthenia in origin, and sthenia in superficiality, which originates from kidney, liver, and spleen vacuity. The superficiality finds expression in stagnation of Qi and blood stasis.