原发性失眠肝郁类证候分布及其诊断要素

Syndrome Distribution and Diagnostic Essentials of Liver Stagnation Type in Primary Insomnia

目的探讨原发性失眠肝郁类证候中医证型分布情况及其诊断性症状、体征。方法选取原发性失眠肝郁类证病例851例,采集患者的失眠特点、精神症状、头面躯体不适症状、心血管系统症状、呼吸系统症状、消化系统症状、泌尿系统、全身皮肤黏膜情况、二便情况、舌象、脉象。参考辨证标准进行辨证,统计各证型出现频率高的症状、体征(频率>10%),将该证型的常见症状、体征通过二元Logistic回归分析的方法,筛选出对证候具有判断意义的症状和体征。结果失眠肝郁证的主要中医证型为肝郁脾虚证142例(32.7%)、肝郁阴虚证115例(26.4%)、肝郁化火证94例(21.6%)。肝郁脾虚证的初步诊断性症状、体征为:心烦易怒,情绪低落,时睡时醒,舌淡,胃脘不适,便溏,饮食乏味、纳少,腹胀,咽中异物感。肝郁阴虚证的初步诊断性症状、体征为:心烦易怒,情绪低落,潮热,胸闷,五心烦热,脉细数。肝郁化火证的初步诊断性症状、体征为:心烦易怒,情绪低落,口苦,面赤,舌红,脉弦数。结论原发性失眠肝郁证的主要中医证型为肝郁脾虚证、肝郁阴虚证、肝郁化火证,其共有症状为:不寐伴情绪低落,心烦易怒。

Objective To explore the syndrome distribution and related diagnostic symptoms and signs of liver stagnation syndrome in primary insomnia. Methods We selected 851 cases of primary insomnia of liver stagnation type, and collected their insomnia characteristics, mental symptoms, facial and somatic symptoms, cardiovascular system symptoms, respiratory symptoms, digestive symptoms, urinary symptoms, body skin and mucosa condition, stool and urine condition, tongue condition and pulse condition. Then we differentiate their syndromes referring to the syndrome differentiation standards, and counted the symptoms and signs in high frequency of each syndrome （ 〉 10% ）. The frequent symptoms and signs were analyzed through binary logistic regression to figure out diagnostic essentials. Results The main syndromes in primary insomnia of liver stagnation are syndrome of liver stagnation and spleen deficiency （ 142 cases, 32.7% ） , syndrome of liver stagnation and yin deficiency （ 115 cases, 26.4% ） and syndrome of liver stagnation transforming into fire （94 cases, 21.6% ）. The initial diagnostic symptoms and signs of syndrome of liver stagnation and spleen deficiency are upset and irritability, being down in spirits, broken sleep, pale tongue, epigastric discomfort, loose stool, poor and decreased appetite, abdominal distension and the sensation of foreign body in pharynx. The initial diagnostic symptoms and signs of syndrome of liver stagnation and yin deficiency are upset and irritability, being down in spirits, hot flash, chest distress, dysphoria with feverish sensation in chest, palms and soles and thready rapid pulse. The initial diagnostic symptoms and signs of syndrome of liver stagnation transforming into fire are upset and irritability, low in spirits, bitter taste, flushed complexion, red tongue and stringy rapid pulse. Conclusion The main syndromes of primary insomnia of liver stagnation type are syndrome of liver stagnation and spleen deficiency, syndrome of liver stagnation of yin deficiency and syndrome of liver stagnation transforming into fire. Their common symptoms are insomnia with being down in spirits as well as upset and irritability.