从257例病例中探讨登革热的中医临床辨治

Exploration of Traditional Chinese Medical Syndrome Differentiation and Treatment for Dengue Fever: An Analysis of 257 Cases

【目的】探讨登革热的中医病因病机及辨证治疗规律。【方法】采用回顾性病例调查研究设计,对2013年收治的257例登革热病例的发病特征、中医证候、治疗方案等情况进行收集、整理与分析。【结果】病例中有6种常见的证型,包括卫气同病、气分热盛、暑湿中阻(袭表)、气血两燔、邪伏膜原、瘀毒交结,相对应的常见的选方有银翘散、柴葛解肌汤、新加香薷饮、清瘟败毒饮、达原饮、犀角地黄汤等。【结论】广州地区登革热病例的中医卫气营血辨证多为气分热盛,兼有营血分证,且大多夹湿,治则上宜用寒凉之品以清解气分热毒,兼以凉血透气和祛湿。

Objective To explore the etiology, pathogenesis, syndrome differentiation and treatment for dengue fever according to the theory of traditional Chinese medicine （ TCM） . Methods A retrospective case analysis was carried out in 257 dengue fever patients admitted in 2013 by Guangdong Provincial Hospital of Traditional Chinese Medicine. The clinical data of pathogenic features, TCM symptoms and signs, and therapeutic regimen were collected and analyzed. Results Six commonly-seen TCM syndrome patterns for dengue fever were classified into disease involving both defensive system and Qi system, excessive heat in defensive system, summer-heat and dampness stagnating the middle-jiao or attacking the exterior, excessive heat in both Qi system and blood system, pathogenic factors lodging between diaphragm and pleura, and mixture of blood stasis and toxicity, and the corresponding prescriptions were Yinqiao Powder, Chaige Jieji Decoction, Xinjia Xiangru Decoction, Qingwen Baidu Decoction, Dayuan Decoction, Xijiao Dihuang Decoction, respectively. Conclusion The TCM syndrome patterns of dengue fever in Guangzhou area are characterized as excessive heat in Qi system, complicated with nutrient and blood system syndrome, and mostly are blended with dampness. Correspondingly, the therapeutic principles should be clearing heat and removing toxicity in Qi system with cold-cool herbs, and assisting with cooling blood to clear heat in Qi system and removing dampness.