慢性乙型重型肝炎不同分期的中医证候规律研究

Syndrome complex of different stages of chronic severe hepatitis B

目的探讨慢性乙型重型肝炎不同分期之间的中医证型分布及其演变规律。方法将2009年3月—2010年2月我院收治的慢性乙型重型肝炎患者按其不同分期进行临床体征和症状、舌脉象及中医证候学调查,并辨证为湿热发黄证、瘀热发黄证、气虚瘀黄证、阴虚瘀黄证和阳虚瘀黄证5个中医证型。结果慢性乙型重型肝炎早期的主要体征和症状为面目黄如桔皮、尿黄、口苦、口干、口渴喜饮、厌食油腻、面色晦暗、朱砂掌、红痣或蟹纹等;舌象为舌红、舌老、苔黄、苔厚、苔腻;脉象为弦、沉、数、实、滑。中晚期主要症状和体征为面目黄如烟熏、面色晦暗、朱砂掌、红痣或蟹纹、肌衄、口渴少饮、鼻齿衄、乏力、腹胀、纳差、尿黄及手足心热;舌象为舌红、舌暗红、舌老、苔薄;脉象为细、数、沉、涩、弦。湿热发黄证、瘀热发黄证、气虚瘀黄证和阴虚瘀黄证4个证型为慢性乙型重型肝炎的主要证型,而阳虚瘀黄证型较少;慢性乙型重型肝炎早期的主要证型为湿热发黄证和瘀热发黄证,而中晚期的主要证型为阴虚瘀黄证和气虚瘀黄证。结论湿热发黄和瘀热发黄为慢性乙型重型肝炎早期的主要病因病机;湿热未尽、瘀血内停及气阴亏虚为慢性乙型重型肝炎中晚期的主要病因病机;慢性乙型重型肝炎早期病性多实,中晚期病性多虚。

Objective To investigate the distribution of differentiating syndromes in different stages of chronic severe hepatitis B and the law of their evolution. Methods A study of signs and symptoms, tongue and pulse presentations and traditional Chinese medicine （TCM） symptom complex was conducted on the patients with different stages of chronic severe hepatitis B, who were treated in our hospital from Mar. 2009 to Feb. 2010. TCM syndromes were classified into 5 types, namely hygropyretic jaundice, blood stasis-heat jaundice, Qi-deficiency jaundice, Yin-deficiency jaundice and Yang-deficiency jaundice. Results In the patients with the early stage of chronic severe hepatitis B, the main signs and symptoms included yellowish face and eyes, like the color of orange peel, yellow urine, bitter taste of mouth, dry mouth, thirst with desire to drink, dislike of greasy food, dull complexion, cinnabar palm, and red nevus or crab patterns, etc.; tongue presentations were red tongue proper, old tongue and yellowish, thick and greasy tongue fur; pulse presentations were wiry, sunken, frequent, replete and slippery pulse. In the patients with the middle and advanced stage of chronic severe hepatitis B, the main signs and symptoms included yellowish face and eyes, dull complexion, cinnabar palm, red nevus or crab patterns, muscular bleeding, thirst with small fluid intake, nose or gum bleeding, fatigue, abdominal distension, anorexia, yellow urine, and heat in the palms and soles; tongue presentations were red and dull red tongue proper, old tongue and thin tongue fur; pulse presentations were small, frequent, sunken, unsmooth and wiry pulse. The main TCM syndromes of chronic severe hepatitis B were hygropyretic jaundice, blood stasis-heat jaundice, Qi-deficiency jaundice and Yin- deficiency jaundice. Yang-deficiency jaundice was seldomly found. The main TCM syndromes of the early stage of chronic severe hepatitis B were hygropyretic jaundice and blood stasis-heat jaundice, and those of the middle and advanced stage of chronic severe hepatitis B were Yin-deficiency jaundice and Qi-deficiency jaundice. Conclusions Dampness-heat and blood stasis are con- sidered as the main etiology and pathogenesis of the early stage of chronic severe hepatitis B, and the retention of dampness-heat, blood stasis and deficiency of Qi and Yin as those of the middle and advanced stage of chronic severe hepatitis B. Excess syndroms are prevalent in the patients with the early stage of chronic severe hepatitis B, and deficiency syndroms in the patients with the middle and advanced stage of chronic severe hepatitis B.