吕仁和辨治糖尿病医案症状、证候和治则解析

Symptoms,syndrome types and therapeutic principles in medical records of diabetes differentiated and treated by Professor LV Ren-he

目的通过对吕仁和治疗糖尿病医案中医辨证要素的统计分析,总结吕仁和教授分期辨治糖尿病的学术思想。方法 128例经吕仁和教授诊治的糖尿病医案,经过"解析和标引"预处理,借助"中医医案数据库"的统计分析功能,将医案分成脾瘅期、消渴期、消瘅期三期,分别统计分析其症状体征、证候和治则。结果脾瘅期症状以倦怠乏力、口干最突出,气阴两虚证可能在脾瘅期较为常见。消渴期黄苔出现几率最高,瘀血阻络证居证候统计的第2位,提示热证与血瘀证均是消渴期常见的重要标实证候,肝肾阴虚和气阴亏虚是消渴期常见的本虚证型,吕仁和教授既往总结的脾肾阳虚证相对少见。消瘅期症状以倦怠乏力、腰酸痛、目昏较常见,提示肝肾两虚在此期尤为明显,湿热、痰饮、瘀血在消瘅期普遍存在,彼此胶结,共同酿成"浊毒";证候统计显示瘀血阻络证居首位,与前两期的证候统计结果相比,表明随着病程进展,瘀血阻络证出现频次明显增加,符合吕仁和教授的"微型癥瘕"病理假说;治则的统计结果与吕仁和教授认识的此期"气血阴阳俱虚、浊毒内停"的证候特点相吻合。结论糖尿病三期医案的症状、证候和治则分析内在吻合度良好,且与吕仁和教授糖尿病分期理论相符合。

Objective To sum up the academic thought of Professor LV Ren-he＇s in differentiation and treatment of diabetes at stages through the statistical analysis on the factors of TCM syndrome differentiation of diabetes in cases treated by Professor LV Ren-he.Methods The diabetic cases treated by Professor LV Ren-he（n=128） were classified into Pidan stage,Xiaoke stage and Xiaodan stage based on the statistical function of TCM Medical Record Database after the pretreatment with resolution and indexing.The symptoms,signs,syndromes and therapeutic principles were analysed respectively.Results The syndrome of dual deficiency of qi and yin might be common in Pidan stage,and occurrence rate of yellow tongue fur was the highest in Xiaoke stage.The syndrome of blood-stasis obstructing collaterals took second in the statistics of syndrome types,which showed that heat syndrome and blood-stasis syndrome were common and important excess syndrome of the tip in Xiaoke stage.Liver-kidney yin deficiency syndrome and qi-yin deficiency syndrome were common deficient syndrome of the root in Xiaoke stage.Spleen-kidney yang deficiency syndrome summarized by Professor LV Ren-he was relatively rare in the past.The statistics of symptoms and signs in Xiaodan stage showed that syndrome of dual deficiency of liver and kidney was obvious in this stage.Dampness-heat,phlegm-fluid and blood stasis were common in Xiaodan stage and they cemented together to lead to turbidity-toxin.The statistics of syndromes showed that the syndrome of blood-stasis obstructing collaterals came first in Xiaodan stage.It indicated that the frequency of the syndrome of blood-stasis obstructing collaterals increased significantly with the development of disease course compared with the statistic results of other two stages,which corresponded with Professor LV Ren-he＇s hypothesis of microscopic aggregation-accumulation.The statistic results of therapeutic principles were consistent with the syndrome features in this stage recognized by Professor LV Ren-he,i.e.deficiency of qi,blood,yin and yang and internal retention of turbidity-toxin.Conclusion The analysis of symptoms,signs,syndromes and therapeutic principles in three stages of diabetes had a higher internal goodness of fit,and accorded with Professor LV Ren-he＇s theory of differentiation and treatment of diabetes at stages.