慢性阻塞性肺疾病中医证候及证素分布规律与特征的文献分析研究

Literature analysis on the distribution and characteristics of TCM syndromes and syndrome elements in chronic obstructive pulmonary disease

目的:探讨慢性阻塞性肺疾病(COPD)中医证候、证素分布规律及特征,为相关证候标准规范及临床诊疗研究提供依据。方法:检索筛选符合标准的COPD文献并提取证候类型,将复合证型分解成基本的证候要素,统计各证候分布比例及证素出现频次、频率。结果:COPD病例数分布较高的中医证候为痰热壅肺、肺气虚、痰浊阻肺、肺肾气虚、肺脾两虚,稳定期证候出现频率较高的为肺肾两虚、肺气虚、肺肾气虚、肺脾气虚、肺脾两虚、肺脾肾虚,急性期证候出现频率较高的为痰热壅肺、痰瘀阻肺、痰热瘀肺、痰浊阻肺、肺脾肾虚。本病病位类证素为肺、肾、脾、心、肝,病性类证素按频次由多至少依次为气虚、痰、阳虚等。结论:慢性阻塞性肺疾病的中医证候以本虚标实为主要特征,肺脾肾虚贯穿于疾病始终,肺肾气虚可能成为COPD的基础证候。

Objective:To discuss the characteristic and distribution rule of TCM syndrome and syndrome elements of chronic obstructive pulmonary disease(COPD),and provide basis for the establishment of diagnosis criteria on essential syndromes.Methods:Satisfactory modern documents were reorganized and analyzed,and syndrome elements were extracted.All syndromes were classified to deficiency syndrome,excess syndrome,and deficiency complicated with excess syndrome.The distribution ratio of each syndrome and the frequency of occurrence of syndrome elements were statistically analyzed.Results:The TCM syndromes of COPD with higher distribution of cases are blockage of the lung by phlegm-heat,deficiency of lung-Qi,phlegm turbidity obstructing lung,deficiency of lung and kidney-Qi,deficiency of both the lung and spleen.TCM syndromes of COPD in stable phase with higher frequency are deficiency of both the lung and kidney,deficiency of lung-Qi,deficiency of lung and kidney-Qi,deficiency of lung and spleen-Qi,deficiency of both the lung and spleen,deficiency of lung and spleen and kidney.The TCM Syndromes of COPD in acute phase with higher frequency are blockage of the lung by phlegm-heat,retention of phlegm and blood stasis in the lung,retention of phlegm-heat and blood stasis in the lung,phlegm turbidity obstructing lung,deficiency of lung and spleen and kidney;Syndrome elements on disease location of COPD are lung,kidney,spleen,heart and liver.Elements on natures of this disease sorted from more to less are Qi deficiency,phlegm,Yang deficiency,Yin deficiency,heat,blood stasis,water retained,cold,wind,stagnation of the circulation of vital energy,retained fluid,dryness,Yang exhaustion.Conclusion:The principal characteristic of TCM syndromes of COPD is deficiency in origin and excess in superficiality.Deficiency of lung and spleen and kidney has always been in the whole course of disease.Deficiency of lung and kidney-Qi may be the basic syndrome type of COPD.