478例流感样病例的证候特点分析

Analysis on syndrome characteristics in 478 influenza-like cases

目的分析流感样病例的证候分布特点。方法对流感样病例进行中医证候的问卷调查,采用六经、卫气营血与三焦辨证三法合用进行证候分析。结果流感样病例共478例,对465例进行了证候分析(其余13例进行症候特点描述),其病邪以风热为主,98.9%为温热病邪。①证候分布:88%有太阳证(伤寒证74.6%,太阳病证17.6%),56.6%出现少阳证(太少合病16.8%,少阳病证2.4%),63.2%出现阳明证(太明合病21.5%,三阳合病32%,阳少合病5.4%,阳明病证4.3%);90.5%有卫分证(单卫分证33.1%),66.8%出现气分证(57.4%为卫气合病,9.5%为单气分证);热郁胆腑(16.6%)、肺热壅盛证(11.8%)较少见,偶见肺热腑实(2.6%)、阳明腑证(0.2%)、湿热中阻证(1.1%);②证候分布与发病季节:在不同发病季节,太阳证、太阳病证、阳明证、阳明病证、卫分证、单纯卫分证、气分证、单纯气分证、卫气合病、热郁胆腑、肺热壅盛证之出现比例具有显著差异(P<0.05);③证候分布与病程:病程越长,单卫分证之出现比例越低,而气分证、卫气合病证、阳明证、三阳合病、肺热壅盛、热郁胆腑之出现比例越高。结论北京地区流感样病例大多为温热病、合病证,以三阳合病、太明合病、太少合病较为常见;发病季节、病程不同时,部分证候之分布有显著差异。

Objective To analyse the characteristics of syndrome distribution in influenza-like cases.Methods The influenza-like cases were investigated by questionnaire of TCM syndromes.The syndrome analysis was conducted by using six-meridian syndrome differentiation,defense-qi-nutrient-blood syndrome differentiation and triple-energizer syndrome differentiation together.Results Among 478 influenza-like cases,465 were given syndrome analysis（other 13 were given the description of syndrome characteristics）.The pathogenic factors are mainly wind-heat,and warm-heat accounted for 98.9%.① The distribution of syndromes showed as follows： The cases with Taiyang syndrome accounted for 88%（syndrome of cold damage for 74.6% and Taiyang diseases accounted for 17.6%）,Shaoyang syndrome,56.6%（disease involving both Taiyang and Shaoyang,16.8%,Shaoyang diseases,2.4%）,Yangming syndrome,63.2% [disease involving both Taiyang and Yangming,21.5%,disease involving Taiyang,Shaoyang and Yangming（three Yang） 32%,disease involving both Yangming and Shaoyang,5.4%,Yangming diseases,4.3%].The cases with defense aspect syndrome accounted for 90.5%（single defense aspect syndrome accounted for 33.1%）,qi aspect syndrome,66.8%（disease involving both defense and qi aspects,57.4%,single qi aspect syndrome,9.5%）.There were a few cases with the syndrome of heat blockage in gallbladder（16.6%） and syndrome of heat obstruction in lung（11.8%）.The syndromes of lung-heat and bowel-excess（2.6%）,Yangming bowel syndrome（0.2%） and dampness-heat obstructing in the middle（1.1%） were uncommon.②Relationship between syndrome distribution and seasons showed that the occurrence ratio of Taiyang syndrome,Yaiyang disease,Yangming syndrome,Yangming disease,defense aspect syndrome,single defense aspect syndrome,qi aspect syndrome,single qi aspect syndrome,disease involving both defense and qi aspects,syndrome of heat blockage in gallbladder and syndrome of heat obstruction in lung had significant difference（P0.05） in different seasons.③Relationship between syndrome distribution and disease course showed that the longer the disease course,the lower the occurrence ratio of single qi aspect syndrome,and the higher the occurrence ratio of qi aspect syndrome,disease involving both defense and qi aspects,Yangming syndrome,disease involving three Yang,syndrome of heat obstruction in lung and syndrome of heat blockage in gallbladder.Conclusion The influenza-like cases in Beijing area are mostly warm-heat disease and complicated diseases,among which disease involving three Yang,disease involving both Taiyang and Yangming and disease involving both Taiyang and Shaoyang are common.When the seasons and disease course are different,the distribution of some syndromes had significant difference.