围绝经期失眠症中医证候分布及其特点

TCM Pattern Distribution and Characteristics of Menopause Insomnia

目的探索围绝经期失眠症(MI)中医证型的分布及中医证候特点。方法采用临床流行病学调查方法对487例MI患者症状、体征、舌脉象四诊资料进行调查,并运用聚类分析等方法对调查结果进行数理统计分析。结果 MI患者症状、体征和舌脉象主要有84个,症状、体征出现的频率前5项为精神不振(75.6%)、入睡困难(72.3%)、晨起思睡(62.8)、神疲乏力(62.8%)、早醒(58.5%)等。舌脉象以舌质红(43.5%)、苔黄(47.0%),脉细(51.7%)、脉弦(44.4%)多见。487例患者中肾虚肝郁证296例、肝郁脾虚证117例、脾肾阳虚证21例、肾阴阳两虚证21例、心胆气虚证18例和心脾两虚证14例。月经紊乱患者以肝郁脾虚证、心脾两虚证和肾虚肝郁证为主,绝经患者以脾肾阳虚证和肾阴阳两虚证多见。主要失眠症状构成中肝郁脾虚证和肾虚肝郁证以入睡困难为主;脾肾阳虚证和肾阴阳两虚证以多梦、时睡时醒、早醒为多;心胆气虚证多见恶梦惊醒、多梦、时睡时醒、早醒,而心脾两虚证以多梦、时睡时醒为多。结论 MI患者的基本中医证型为肝郁脾虚证、脾肾阳虚证、肾虚肝郁证、肾阴阳两虚证、心胆气虚证和心脾两虚证,各中医证型在月经和主要失眠症状构成情况上有其自身特点。

Objective To study the TCM pattern distribution and characteristics of menopause insomnia （MI）. Methods The symptoms, signs, tongue and pulse manifestations in 487 MI patients were investigated with methods of clinical epidemiological study. A mathematical statistical analysis of survey results was conducted by cluster analysis. Results There were 84 symptoms, signs, tongue and pulse manifestations in MI patients. The top 5 symptoms and signs were lack of energy （75.6%）, difficulty in falling asleep （72. 3%）, morning somnolence （62. 8%）, lassitude （62. 8%） and early awakening （58.5%）. The common tongue and pulse manifestations were red tongue （43.5%）, yellow tongue fur （47.0%）, fine pulse （51.7 % ） and string-like pulse （44.4 % ）. There were 296 patients with kidney-deficiency liver-depression pattern, 117 patients with liver-depression spleen-deficiency pattern, 21 patients with spleen-kidney yang deficiency pattern, 21 patients with kidney yin-yang deficiency pattern, 18 patients with heart-gallbladder qi deficiency pattern, and 14 patients with heart-spleen deficiency pattern in 487 patients. The common patterns in patients with menstrual disorders were liver-depression spleen-deficiency pattern, heart-spleen deficiency pattern and kidney-deficiency liver-depression pattern. The common patterns in menopausal patients were spleen-kidney yang deficiency pattern and kidney yin-yang deficiency pattern. The main symptom in patients with liver-depression spleen-deficiency pattern and kidney-deficiency liver-depression pattern was difficulty in falling asleep. The common symptoms in patients with spleen-kidney yang deficiency pattern and kidney yin-yang deficiency pattern were dreams, easy to wake up and early awaking. The common symptoms in patients with heart-gallbladder qi deficiency pattern were nightmares, dreams, easy to wake up and early awaking. The common symptoms in patients with heart-spleen deficiency pattern were dreams and easy to wake up. Conclusion The basic TCM patterns of MI are liver-depression spleen-deficiency pattern, spleen-kidney yang deficiency pattern, kidney-deficiency liver-depression pattern, kidney yin-yang deficiency pattern, heart-gallbladder qi deficiency pattern and heart-spleen deficiency pattern. Each TCM pattern has its own characteristics in the symptoms of insomnia and menstruation.