甲型流感中医证候特点分析

Pattern characteristics of type A influenza in Traditional Chinese Medicine

目的探讨北京地区甲型流感病例的中医证候特点。方法对在北京中医药大学东方医院发热门诊就诊的甲型流感确诊病例共151例,进行中医四诊资料的临床问卷调查,采用卫气营血辨证进行证候分析。结果 149例(占98.7%)为外感风热病邪,即属于风热证,其中风热夹湿者37例(占24.5%),仅2例(占1.3%)为外感风寒病邪;出现卫分证136例(占90.1%)、气分证91例(占60.3%)、卫气合病证78例(占51.7%)、单一卫分证59例(占39.1%)、单一气分证14例(占9.3%);在气分证中,热盛阳明证52例(占34.4%)、热郁少阳证40例(占26.5%)、肺热壅盛证30例(占19.9%)、湿热中阻证28例(占18.5%)、热扰胸膈证10例(占6.6%);病程不同的甲型流感病例的气分证(X2=9.73,P=0.02)、单一卫分证(X2=8.78,P=0.03)之构成比具有显著差异,病程越长,气分证出现比例越高,而单一卫分证比例越低;季节、年龄、既往慢性病史对流感证候分布的差异性比较无统计学意义(P>0.05)。结论病程是甲型流感证候的重要影响因素;在北京地区,甲型流感绝大多数为风热病邪,部分为风热夹湿;以卫气合病证最常见,其次为单一卫分证,单一的气分证十分少见。

Objective To analyze the pattern characteristics of the type A Influenza in Beijing area. Methods Patients who were diagnosed with Type A Influenza and received treatment in Dongfang hospital, Beijing University of Chinese medicine were included into our research.First, all the included patients answered a TCM questionnaire to gather their basic data and symptoms.Then, patterns of all participants were differentiated according to ying, wei, qi and blood diagnostic principles.Results Of 151 cases with confirmed type A Influenza, 149 cases （98.7%） were identified as exogenous wind-heat patterns while only 2 cases （1.3%） were of exogenous wind-cold patterns.Of the wind-heat patterns, 37 cases （24.5%） were further differentiated as wind-heat with dampness pattern.Wei level pattern was found in 136 cases （90.1%）. Qi level pattern was present in 91 cases （60.3%）.Wei-Qi level pattern occurred in 78 cases （51.7%）. Single Wei level pattern occurred in 59 cases （ 39.1%） .Single Qi level pattern occurred in 14 cases （9.3%）.Among the Qi level pattern, 52 cases were yangming heat pattern （34.4%）, 40 cases （26.5%） were the shaoyang pattern , 30 cases （19.9%） were the excessive lung-heat pattern, 28 cases （18.5%）were the dampness-heat obstructing middle energizer pattern, and 10 cases （6.6%） were the pattern of heat in the chest and diaphragm.There were significant differences between the constituent ratios of the Qi level patterns （X2=9.73,P=0.02）, and single Wei level pattern, of different durations （X2=8.78,P=0.03）.The longer the duration was, the higher the proportion of the Qi pattern was accounted for, and the lower the proportion of single Wei level pattern, the lower its occurrence was.However, no significant differences were observed among the distribution of patterns between season, age or its past disease history （ P ＆gt;0.05 ）. Conclusion Duration of disease is an important factor which could affect the pattern distribution of type A influenza.In Beijing, the patterns of type A influenza are mostly externally contracted wind-heat pathogens, second by wind-heat with dampness.The most common pattern is the Wei-Qi pattern, followed by the single Wei level pattern, while the single Qi level pattern is very rare.