72例慢性乙型重型肝炎症状与舌脉象聚类分析

Cluster analysis of symptoms and tongue and pulse presentations of 72 patients with chronic severe hepatitis B

目的探讨慢性乙型重型肝炎(乙型慢重肝)的证候特点,确定其主要和次要证候,以指导临床应用。方法观察72例乙型慢重肝的症状表现,对症状进行频次、聚类分析。结果乙型慢重肝的症状和舌脉象经高频次分析后,提取出26个关键症状及31个舌脉象进行聚类分析。聚为5类为:第1类,滑脉、舌苔厚、舌苔腻、舌体嫩、舌苔干、舌尖红;第2类,肢体困重、纳差、乏力、少气懒言、头重、腹胀、呕吐、恶心、小便不利、头晕、大便干结、呃逆、矢气、厌食油腻、口渴喜饮、吞酸嗳腐、口苦、口干、便下不爽、口渴少饮、口粘腻、沉脉、两目干涩、弦脉、嘈杂、舌苔白、口淡、舌下脉络迂曲、舌下脉络青紫、舌苔黄、数脉、舌苔薄、舌体瘦;第3类,舌苔焦;第4类,灰黑苔、无苔;第5类,迟脉、疾脉、弱脉、实脉、微脉、呕酸水、尿黄、细脉、舌有齿痕、舌体胖、舌苔润、涩脉、舌质瘀点、舌质暗、舌质红。结论乙型慢重肝病因主要为湿邪,其病理关键是湿阻中焦,气机阻滞,升降失司。早期治疗上应以疏肝和胃、温阳祛湿为主。

Objective To investigate the characteristics of traditional Chinese medicine （TCM） differentiating syndromes of chronic severe hepatitis B, and differentiate primary and secondary symptoms in order to guide clinical practice. Methods The clinical symptoms of 72 patients with chronic severe hepatitis B were observed and cluster analysis was made according to the fre- quency of the symptoms. Results Twenty-six key symptoms and 31 tongue and pulse presentations were chosen to be included in cluster analysis according to their high frequency. Five clusters were yielded. The first cluster included slippery pulse, thick and greasy tongue fur, tender tongue body, dry tongue fur and red tip of tongue; the second cluster included heaviness and weakness of limbs, anorexia, fatigue, deficient breath and laziness to speak, heaviness of head, abdominal distension, vomiting, nausea, difficult urination, dizziness, dry stool, hiccup, flatus, dislike of greasy food, thirst with desire to drink, acid regurgitation and fetid eructation, bitter taste of month, dry mouth, difficult defecation, thirst with small fluid intake, sticky and greasy taste in mouth, sunken pulse, eye dryness, wiry pulse, gastric discomfort with acid regurgitation, white tongue fur, dysgeusia, curl and blue suhlingual collaterals, yel- low tongue fur, frequent pulse, thin tongue fur and thin tongue body; the third cluster included black tongue fur; the fourth cluster in- cluded grey and black tongue fur and no tongue fur; the fifth cluster included retarded pulse, rapid pulse, weak pulse, replete pulse, indistinct pulse, vomiting acid, yellow urine, small pulse, teeth-printed tongue, corpulent tongue, moist tongue fur, unsmooth pulse, pctechial tongue, dark red and reddish tongue proper. Conchlsions Chronic severe hepatitis B mainly results from damp pathogen, and its key pathogenesis involves damp blockage of middle energizer, obstruction of Qi, and ascending and descending disorder. Early treatment should focus on ＂soothing liver and regulating stomach＂ and ＂warming Yang and dissolving dampness＂.