46例新型冠状病毒病中医证候学分析

Analysis of Traditional Chinese Medicine Syndromes of 46 Cases of COVID-19

目的:应用聚类分析方法对46例新型冠状病毒病(COVID-19)患者进行中医证候学分析。方法:对46例COVID-19患者中医症状、体征、舌象、脉象四诊信息,进行频数分析及聚类分析,结合临床专业知识归类总结COVID-19患者的中医证型,并结合证候采集中位天数分析其演变规律。结果:46例COVID-19患者主要症状和体征:发热(频次39,占比84.8%),纳差(频次44,占比95.7%),乏力(频次42,占比91.3%),喘息憋气(频次35,占比76.1%),口干渴(频次21,占比45.7%),胸闷气短(频次20,占比43.5%),大便溏(频次6,占比13%),舌红(频次30,占比65.2%),苔黄腻(频次27,占比58.7%),脉滑(频次30,占比62.5%)。中医证型分为湿热并重证(13例),湿毒闭肺证(10例),热郁胆经证(7例),湿重于热证(5例),阴伤气耗证(5例),寒湿内侵证(4例),湿毒血瘀证(2例)。按其发病时间依次为寒湿内侵证(中位天数6.5 d),湿重于热证(10 d),湿热并重证(10 d),湿毒闭肺证(11.5 d),热郁肝胆证(13 d),湿毒血瘀证(15 d),阴伤气耗证(16 d)。结论:46例COVID-19患者中,湿热证最为常见,其后为热郁肝胆证、阴伤气耗证,寒湿内侵证,湿毒血瘀证。病机演变为湿邪向热、毒进展,后期出现耗伤气阴表现。

Objective:To analyze the traditional Chinese medicine(TCM)syndromes of 46 patients with coronavirus disease-2019(COVID-19)by cluster analysis method.Method:The 46 COVID-19 patients with TCM symptoms,signs,tongue and pulse were analyzed by frequency analysis and clustering analysis,and the TCM syndrome types of COVID-19 patients were classified and summarized by combining clinical expertise,and the evolution law was analyzed by combining the median days of the syndrome collection.Result:The major signs and symptoms of the 46 patients with COVID-19:fever(frequency of 39,accounted for 84.8%),poor appetite(frequency of 44,95.7%),fatigue(frequency of 42,91.3%),wheezing breath(frequency of 35,76.1%),dry mouth(frequency of 21,45.7%),lung condition short(frequency of 20,43.5%),defecate pond(frequency of 15,32.6%),red tongue(frequency 30,accounting for 65.2%),yellowish moss(frequency 27,accounting for 58.7%),and slimy pulse(frequency 30,accounting for62.5%).TCM syndromes were divided into seven types,i.e.dampness and heat syndrome(13 cases),dampness and toxin syndrome(10 cases),heat stasis syndrome(7 cases),dampness and heat syndrome(5 cases),cold dampness internal invasion syndrome(4 cases),dampness poison blood stasis syndrome(2 cases).According to the time of onset,there were cold and dampness syndrome(median days 6.5 days),dampness was heavier than heat syndrome(10 days),dampness and heat syndrome(10 days),dampness and heat syndrome(11.5 days),heat stagnation of liver and gallbladder syndrome(13 days),dampness and blood stasis syndrome(15 days),and Yin injury syndrome(16 days).Conclusion:Among the 46 cases of COVID-19,damp-heat syndrome was the most common,followed by heat stagnation of liver and gallbladder syndrome,Yin injury and gas consumption syndrome,cold and damp internal invasion syndrome,and dampness and blood stasis syndrome.The pathogenesis of the disease evolved into heat and poison,and later appeared to consume Qi Yin performance.