基于六经病欲解时理论运用经方治疗亚急性咳嗽临床研究

Clinical Study on Applying Classical Formulas to Treat Subacute Cough Based on Theory of “Periods of Symptom Alleviation of Six-Channel Diseases”

目的:对基于“六经病欲解时”理论运用经方治疗亚急性咳嗽患者的临床资料进行回顾性分析,评价其临床疗效。方法:根据纳入标准与排除标准,收集2021年9月—2022年3月在浙江省立同德医院呼吸与危重症医学科门诊诊断为亚急性咳嗽患者的临床资料,采取前后自身对照设计,比较治疗前后咳嗽视觉模拟评分法(VAS)、简易咳嗽程度评分表(CET)评分变化情况,并参照《中药新药临床研究指导原则(试行)》评定其临床疗效。结果:共纳入研究病例43例。以“六经病欲解时”及“提纲证”为六经病判断依据,则单经病17例,多经合病26例。在单经病中最多见阳明病6例(35%),其次太阴病4例(24%)、厥阴病4例(24%);多经合病中最多见阳明太阴合病8例(31%),太阴厥阴合病5例(19%),阳明少阳合病4例(15%),少阳太阴合病3例(12%)。使用频率前5位的经方依次为苓甘五味姜辛汤>乌梅丸>小柴胡汤>白虎汤>旋覆代赭汤。咳嗽VAS积分治疗前[7 (6,7)]分,治疗后[2 (2,3)]分,差异有统计学意义(P<0.05)。CET积分治疗前[15 (13,16)]分,治疗后[7 (6,9)]分,差异有统计学意义(P<0.05)。经中医干预治疗后总有效率79.1%。结论:基于“六经病欲解时”理论指导下运用经方对定时发作的亚急性咳嗽具有较好临床疗效。

Objective:To conduct a retrospective analysis on the clinical data of treating patients with subacute cough by applying classical formulas based on the theory of“periods of symptom alleviation of six-channel diseases”,and evaluate its clinical effect.Methods:According to the inclusion and exclusion criteria,the clinical data of patients diagnosed as subacute cough at the outpatient of Respiratory and Critical Care Medicine Clinic of Tongde Hospital of Zhejiang Province from September 2021 to March 2022 were collected.The pre-treatment and post-treatment self-control designs were used to compare the changes in scores of Visual Analogue Scale(VAS)of cough,and Cough Evaluation Test(CET)before and after treatment.The clinical effects were evaluated according to the“Guiding Principles for Clinical Research of New Chinese Medicine(Trial)”.Results:A total of 43 cases were included.With the criteria of“periods of symptom alleviation of six-channel diseases”and“principle syndrome”serving as the basis for judging six-channel diseases,there were 17 cases of single-channel diseases and 26 cases of multiple-channel diseases.Among single-channel diseases,yangming disease was most commonly seen with 6 cases(35%),followed by taiyin disease with 4 cases(24%)and jueyin disease with 4 cases(24%).Among multiple-channel diseases,the most common cases were yangming and taiyin disease with 8 cases(31%),taiyin and jueyin disease with 5 cases(19%),yangming and shaoyang disease with 4 cases(15%),and shaoyang and taiyin disease with 3 cases(12%).The top five most frequently used formulas in descending order are Linggan Wuwei Jiangxin Decoction,Wumei Pills,Xiaochaihu Decoction,Baihu Decoction,Xuanfu Daizhe Decoction successively.The VAS score of cough was[7(6,7)]before treatment and[2(2,3)]after treatment,the difference being significant(P<0.05).The CET score was[15(13,16)]before treatment and[7(6,9)]after treatment,the difference being significant(P<0.05).After intervention and treatment of Chinese medicine,the total effective rate was 79.1%.Conclusion:Guided by the theory of“periods of symptom alleviation of six-channel diseases”,the use of classical formulas has good clinical effects in treating subacute cough with timed onset.