198例混合痔舌象特征及辨证分型临床研究

Clinical study of 198 cases on tongue characteristic and syndrome differentiation of mixed hemorrhoid

目的:对混合痔临床分期Ⅱ-Ⅳ期及各证型的舌象特点进行客观化分析,以期为混合痔辨证分型提供客观依据。方法:住院择期手术混合痔患者198例,按不同主要症状分为A组(Ⅱ期长期便血)、B组(Ⅱ期便血伴痔核脱出)、C组(Ⅲ期)、D组(Ⅳ期);按证型分为湿热下注型、气滞血瘀型、脾虚气陷型。运用ZBOX-Ⅰ舌脉象仪采集舌象图片,通过分析软件获得舌象特征指数,应用方差分析比较各期及各证型舌象特征指数的差异。结果:①D组胖瘦指数最高(P<0.05),C组较D组患者齿痕指数大(P<0.05);混合痔Ⅱ-Ⅳ期中以湿热下注型最多见,占全部病例的44.95%,其次为脾虚气陷型,占31.82%;气滞血瘀型中D组所占比例最高,占30.43%。②湿热下注型老嫩指数、腐腻指数、润燥指数均高于气滞血瘀型和脾虚气陷型(P<0.05)。结论:混合痔临床各期有部分的舌象特征差异,舌体形态特征指数可以为混合痔辨证分型提供部分客观依据。

Objective： To observe the tongue characteristic of mixed hemorrhoid in the clinical stage Ⅱ-Ⅳ, and provide the objective basis for the dif erentiation of mixed hemorrhoids. Methods： According to dif erent clinical syndromes and syndrome dif erentiations, 198 inpatients with mixed hemorrhoid were divided into four groups： group A（Ⅱ phase, hemafecia long time）, group B（Ⅱ phase, hemafecia with haemorrhoids emerge）, group C（Ⅲ phase）, group D（Ⅳ phase）. Patients were divided into three types of syndromes according to syndromes dif erentiation： downward l ow of damp-heat（DFDH）, blood stasis due to stagnation of qi（BSSQ） and sinking of qi due to deficiency of the spleen（SQDS）. Tongue images and characteristic index were collected by ZBOX-Ⅰ digital analysis instrument on tongue and pulse in TCM. Tongue parameters in each group and type were analyzed by ANOVA. Results： ①The tongue parameters including the indexes of plumpness and thinness in group D were higher than other groups（P〈0.05）. The indexes of teeth-printed tongue in group C were higher than group D（P〈0.05）. In Ⅱ-Ⅳ phase, type of downward l ow of damp-heat was the most common, accounted for 44.95% of all cases, followed by type of sinking of qi due to deficiency of the spleen, accounted for 31.82% of all cases. In Ⅳ phase, type of blood stasis due to stagnation of qi accounted for the highest proportion（30.43%）. ②The indexes of toughness and tenderness, greasy fur, moistness and dryness in type of DFDH were higher than in the other two types（P〈0.05）. Conclusion： There are some dif erences in tongue characteristics in Ⅱ-Ⅳ clinical stages of mixed hemorrhoids, and the indexes of tongue parameters could provide some objective basis for syndrome dif erentiation of mixed hemorrhoid.