临床治愈198例慢性荨麻疹的中医证候、用方体会及远期疗效分析

TCM Syndrome,Prescription and Long-term Efficacy of 198 Cured Cases of Chronic Urticaria

目的通过总结慢性荨麻疹的中医证候分型、用方经验及复发情况,探讨中医辨证治疗慢性荨麻疹的优势。方法通过对568例慢性荨麻疹患者的电话回访,分析其中临床治愈的198例慢性荨麻疹患者的中医辨证分型,归纳为风寒、风热、肺卫不固等12个证型,记录每个证型患病例数;统计病例中临床常用方剂的应用次数,总结临床治疗慢性荨麻疹的有效方剂;对临床治愈病例停用中药6个月后进行回访,记录复发例数,计算复发率。结果 198例患者中医证候以风热、风寒、肺卫不固、血虚、脾肾阳虚、上热下寒6型最多见,分别为42例、25例、18例、19例、22例、18例;应用方剂荆防方42次,麻黄方22次,玉屏风散42次,四物消风饮20次,真武汤23次,半夏泻心汤12次,乌梅丸6次等。198例患者中停药6个月后有30例复发,复发率约为15.15%。结论慢性荨麻疹中医证候复杂,需辨证分型论治,多证合并需多方合用治疗,治疗过程中需要及时调方换药;中医辨证治疗慢性荨麻疹复发率低,有其独特优势。

Objective In order to investigate the advantage of treating chronic urticaria based on syndrome differentiation by summarizing its TCM syndromes, prescriptions and chance of recurrence. Methods A total of 568 patients with chronic urticaria were interviewed by telephone to collect feedbacks. One hundred and ninety-eight patients receiving complete resolution were analyzed retrospectively. They were classified into 12 TCM syndromes, including wind-cold, wind-heat and defencive Qi instability, etc. Numbers of cases were recorded for each group. Numbers of effective formulas that were commonly used were calculated to identify potential cure for the disease. Patients who were completed cured were followed up6 months after withdrawal from medication. Numbers of recurrence were recorded and recurrence ratio was calculated. Results Among 198 cases, wind-cold（n=42）, wind-heat（n=24）, defencive Qi instability（n=18）, blood-insufficiency（n=19）, spleenkidney yang deficiency（n=22）, upper heat and lower cold（n=19） were common syndromes. Thirty cases relapsed 6 months after drug withdrawal; recurrence ratio was 15.15%. Conclusion TCM syndromes of chronic urticaria are complicated and should be treated based on syndrome differentiation. Multiple prescriptions should be combined when syndromes are complicated. Formulas need to be adjusted in time during the treatment. TCM treatment to chronic urticaria contribute to lower recurrence ratio,and therefore have an unique advantage.