急性髓劳中医分期诊断证候要素研究

Study on Syndrome Factors of Chinese Medicine Staging Diagnosis of Acute Myeloid Fatigue

目的:观察急性髓劳的中医分期诊断证候要素,明确其证型演变规律。方法:录入急性髓劳病例92例,采集患者治疗前、治疗后3个月及治疗后6个月的临床证候,同时按照"三期四型"理论进行中医辨证施治。并用SPSS17.0统计软件ROC分析法对数据进行处理、分析。结果:初期有43例患者的临床证候特征符合热毒壅盛型,有49例患者的临床证候特征符合阴虚火旺型;中期92例患者的临床证候特征均符合气阴两虚型;后期92例患者的临床证候特征均符合阴阳两虚型。热毒壅盛型主要证候为壮热,颜面潮红,出血,头晕,小便色黄,舌红,苔薄黄;次要证候为体倦乏力,便干,口渴,少寐多梦。阴虚火旺型主要证候为面白颧红,口干舌燥,出血,头晕,体倦乏力,耳鸣,舌红绛,少苔;次要证候为盗汗,心悸易惊,手足心热,小便色黄。气阴两虚型主要证候为面色少华,神情倦怠,胸闷,心悸易惊,自汗,手足心热,舌淡胖,少苔;次要证候为盗汗,纳呆,气促,畏寒恶风。阴阳两虚型主要证候为面色苍白,时冷时热,少寐多梦,自汗,腰膝酸软,舌淡胖,苔薄白;次要证候为盗汗,形寒肢冷,便溏。结论:急性髓劳的证型演变规律为热毒壅盛型/阴虚火旺型到气阴两虚型再到阴阳两虚型,初步形成了急性髓劳中医分型诊断标准雏形。

Objective:To observe the syndrome factors of Chinese medicine staging diagnosis of acute myeloid fatigue,and to clarify its evolution law of syndrome types.Methods:A total of 92 cases with acute myeloid fatigue were recorded,and the clinical syndromes of them were collected before treatment,three months after treatment and six months after treatment.At the same time,Chinese medicine syndrome differentiation was performed according to the theory of"three stages and four types".ROC analysis was carried out via SPSS17.0 statistical software to process and analyze the data.Results:At the initial stage,43 patients had clinical syndrome characteristics consistent with the type of excessive heat and toxin accumulation,and 49 patients had clinical syndrome characteristics consistent with the type of yin deficiency and excessive fire;the clinical syndrome characteristics of 92 patients in the middle stage were consistent with the type of both qi and yin deficiency,and the late stage of 92 cases of clinical syndrome characteristics were consistent with the type of yin and yang deficiency.The main syndromes of the type of excessive heat and toxin obstruction include strong heat,flushed face,bleeding,dizziness,yellow urine,red tongue,and thin yellow coating;secondary syndromes are fatigue and weakness,dry stools,thirst,little sleep and many dreams.The main syndromes of the type of yin deficiency and excessive fire include pale face,red zygomatic,dry mouth and tongue,bleeding,dizziness,fatigue and weakness,tinnitus,red and purple tongue,and few coating;secondary syndromes are night sweat,palpitations,tendency to worry,hot middle parts of hands and feet,and yellow urine.The main syndromes of the type of both qi and yin deficiency include pale face,tired appearance,chest distress,palpitations,tendency to worry,spontaneous sweat,and hot middle parts of hands and feet;secondary syndromes are night sweat,poor appetite,short breath,aversion to chills and winds.The main syndromes of the type of yin and yang deficiency include pale face,from-time-to-time cold and hot feelings,little sleep and many dreams,spontaneous sweat,sore and weak waists and knees,pale and enlarged tongue,and thin and white coating;secondary syndromes are night sweat,cold body and limbs,loose stools.Conclusion:The evolution law of syndrome types is from the type of excessive heat and toxin accumulation or the type of yin deficiency and excessive fire,to the type of both qi and yin deficiency or the type of yin and yang deficiency.The criteria of Chinese medicine staging diagnosis of acute myeloid fatigue has been preliminarily formed.