五运六气理论结合地域特性分析遵义地区“疫疠”发病特点

Investigation on the pathogenic characteristics of“epidemic disease”by combination of Five Evolutive Phases and Six Climatic Factors theory with in Zunyi regional characteristics

目的分析贵州遵义特定地理环境及特定时间下遵义医科大学附属医院就诊的部分新冠患者染疫的疾病特点。方法按纳排标准收集2022年12月10日至2023年2月10日于遵义医科大学附属医院住院并经中医会诊的患者,收集病人主要症状,舌、苔变化,辅助检查资料。分析证候及证型特点、分析辅查数据等,导出病因病机。结果119例患者,住院患者肺部CT均提示肺炎存在,炎性检验指标升高;中医证候表现前5位:咳嗽(91.59%)、咳痰(77.31%)、胸闷气促(54.62%)、发热(38.65%)、乏力(37.81%);舌象表现:红舌最多(31.09%),其次是正常的淡红舌(26.89%),第3位乃淡白舌(17.64%);腻苔者为多(81.51%);证型表现:湿毒郁肺型49例最多,湿热藴肺型45例次之,寒湿阻肺型则为11例,其中各证型兼夹风证型总计91例,夹燥型计20例。结论119例新冠病毒感染中医证候特点以咳嗽、咳痰、胸闷气促、发热、乏力为主要症状,舌淡或舌淡红,厚苔、腻苔为多。主要证型是湿毒郁肺型、湿热藴肺型和寒湿阻肺型。主要病因病机为2022年末至2023年初阶段各主客运、主客气,及各不同纪月各主客运、主客气不同,风、寒、湿、火、燥波动剧烈,伤肺卫,损脾土,兼遵义高寒亚热带地理环境,使寒、湿更剧平燥更甚,致寒湿疫疠兼夹风夹燥。

Objective To analyze the disease characteristics of some patients with COVID-19 infection who visited Affiliated Hospital of Zunyi Medical University in Zunyi,Guizhou,under the specific geographical environment and special time context.Methods The inpatients who consulted with traditional Chinese medicine(TCM)in the Affiliated Hospital of Zunyi Medical University in Zunyi from December 10,2022 to February 10,2023 were collected according to the inclusion and exclusion criteria.Data were collected on patient’s main symptoms,tongue,mossy changes and some auxiliary inspection materials.The etiology and pathogenesis was deduced by analyzing the characteristics of syndromes,syndrome types and auxiliary examination data.Results A total of 119 patients were included.CT scans of their lungs showed the presence of pneumonia and elevated indexes of inflammatory tests;The most common five TCM syndromes are:cough(91.59%),sputum(77.31%),chest tightness and shortness of breath(54.62%),fever(38.65%),and fatigue(37.81%);The tongue manifestations are:red tongue is the most common(31.09%),followed by normal reddish tongue(26.89%)and light white tongue(17.64%).The most common tongue moss is greasy moss(81.51%);The syndrome types are:49 cases have lung damp-toxic stagnation,45 cases have lung damp-heat stagnation,and 11 cases have lung cold-dampness stagnation,among which 91 cases were combined with wind syndrome and 20 cases with dryness type.Conclusion For the 119 cases infected with COVID-19,the main TCM symptoms are cough,expectoration,chest tightness,shortness of breath,fever and fatigue.The tongue is light or reddish,and thick or greasy moss is common.The main syndrome types are dampness toxin stagnating lung type,dampness heat accumulating lung type,and cold dampness stagnating lung type.The main differences for the etiologies and pathogenesis happen in the primary and secondary Yunqi in different stages and months between the end of 2022 and the beginning of 2023.The violent fluctuations of wind,cold,dampness,fire,and dryness can damage the function of lung and spleen.Moreover,the subtropical geographical environment of Zunyi makes the cold,dampness,and dryness more severe,leading to the cold,dampness and epidemics combine with wind and dryness.