345例登革热中医证候学特征及病因病机分析

TCM Syndrome Characteristics and Mechanism Analysis of 345 Cases with Dengue Fever

目的初步探讨登革热的中医证候学特点及病因病机。方法运用回顾性分析方法对345例住院登革热病例临床资料进行流行病学、中医证候学、证候演变规律进行整理和分析。结果 345例登革热患者发病时间集中于9月中旬至10月上旬,平均发病后第(5.58±1.55)天入院,绝大部分患者出现高热、斑疹、斑丘疹及皮下出血点,伴有纳差、恶心、呕吐、腹泻、腹痛等脾胃症状,舌色以红或暗红为主,舌苔以黄腻或白腻苔为主,脉象以弦为主;证型分布从多至少依次为瘀毒交结,卫气同病,余邪未净,暑湿伤阳、气不摄血。约5%患者发展为重症。结论登革热具有明显的流行性和季节性,其中医证候演变有其独特的规律,本病的始动因素为温热疫毒,核心病机为邪毒致瘀、毒瘀交结;热、瘀、毒、虚、兼夹湿邪是重要的病理改变。

Objective： To explore TCM Syndrome characteristics and pathological mechanism of Dengue fever. Methods： Clinical data of 345 hospitalized cases with Dengue fever were collected and characteristics of TCM syndrome differentiation and disease evolution laws were analyzed. Results： The onset time of 343 cases of Dengue fever was concentrated from mid-September to early October. The average hospitalization time was （5.58± 1.55 ） days. Most patients had hyperpyrexia,macula eruption,popular eruption and subcutaneous bleeding,accompanied with the symptoms of anorexia, nausea, vomiting, diarrhea, abdominal pain and other symptoms caused by stomach-spleen disorders. Red tongue or dark red tongue ,yellow-slimy fur or white-slimy fur was common. String-like pulse was most common. The most common pattern was binding of toxin and blood stasis pattern. The other two common patterns were both defense-qi aspects disease pattern and residual toxin pattern. The conditions were aggressive in some patients whose temperature had dropped down to normal. About 5% patients were deteriorated to severe Dengue cases. Conclusions： Dengue fever has its own unique TCM syndrome evolution with obvious seasonal and epidemic characteristics, DF has its own unique ruler in its developing. Initial factor of this disease is warm and epidemic pathogen. The core pathogenesis is stasis induced by epidemic pathogen and binding of toxin and blood stasis. Heat, stasis, toxin, deficiency and water-dampness are the vital pathological changes.