儿童咳嗽变异性哮喘中医证素分布规律研究

Etiological analyze of the syndrome elements' distribution of Chinese medicine in pediatric cough variant asthma

关键词:  咳嗽变异性哮喘  证素  病位  病性  儿童

Key words:  cough variant asthma  syndrome elements  disease position  disease character  children

摘要:

[目的] 通过问卷调查的形式结合证素辨证方法学探讨儿童咳嗽变异性哮喘的中医病位、病性证素特点及其组合规律，为提高儿童咳嗽变异性哮喘临床辨证论治水平以及制定防治方案提供依据。 [方法] 以广东省中医院儿科门诊部符合诊断标准的91例患者为研究对象，进行问卷调查，收集四诊资料，根据“证候辨证素”量表找到每一症状对各证素的权值，最后计算各症状对各证素权值之和，超过阈值100分的证素则判断成立，分析病位证素、病性证素以及病位与病性证素组合规律。[结果] 咳嗽变异性哮喘中，病位证素共7个，肺为核心病位，其出现的频率（97.80%）明显高于其他病位证素，病位证素表（95.60%）相对常见，其他病位证素依次为脾（57.14%）、胃（29.67%）、肾（3.30%）、心（3.30%）、肝（1.10%）.病位肺、表、脾、胃等4个证素平均积分超过150分。病位证素组合以二病位、三病位、四病位为主，单一病位出现频率较低。病性证素方面，实性病性有9个，虚性病性4个。实性病性中，病性痰（53.85%）出现频率最高，病性外风（45.05%）、寒（40.66%）、湿（27.47%）等相对常见，病性饮（10.99%）、气滞（8.79%）、热（4.40%）、燥（4.40%）、食积（3.30%）等出现频数较低。虚性病性证素依次为气虚、阳虚、血虚、阴虚，出现频率分别为：87.91%、69.23%、50.55%、26.37%，虚性病性气虚、阳虚平均积分超过150，提示为重度病变；病性证素组合中，二病性组合最常见，频数、频率为61例（67.76%），其次为单一病性证素，频数与频率为19例（21.11%）.病位与病性组合形式中，二病位与单一病性组合“肺+表+气虚”出现频数与频率为76例（83.52%），三病位与单一病性证素组合“肺+表+脾+气虚”出现频率为51例（56.04%）. [结论] 咳嗽变异性哮喘核心病位在肺，与表、脾相关；其发病虚实互见，气虚、阳虚在本病发生、发展中具有重要意义；痰、风等为主要实性病性，其中痰为主要病理产物，亦是主要病因。

Abstract:

[Objective] This study used the form of questionnaire combined with syndrome differentiation method to investigate the children cough variant asthma in traditional Chinese medicine (TCM) disease position elements, disease character elements and combination rule, in order to improve the children's cough variant asthma clinical syndrome differentiation level and provide the basis for the prevention and control programs.[Methods] Ninety one cases in the outpatient department of pediatrics in our hospital tally with the diagnosis standard of disease patients were as the research object. Questionnaire survey was done and the diagnostic data was collected. According to the syndrome differentiation elements scale, weight of every symptom to the syndrome elements were found and calculated. Syndrome elements threshold more than 100 points were judged to be true. Disease position syndrome elements, disease character syndrome elements and the rule of combination of disease position and disease character syndrome elements were analyzed. [Results] There were seven disease position syndrome elements in pediatric cough variant asthma. Lung was the core disease position, and the frequency of occurrence (97.80%) was significantly higher than other syndrome elements and relatively commonly seen in the syndrome elements of disease position table (95.60%). Other syndrome elements of disease position were the spleen (57.14%), stomach (29.67%), kidney (3.30%), heart (3.30%) and liver (1.10%). The average score of four syndrome elements of lung, superficial, spleen and stomach were more than 150. The combination of syndrome elements of disease position mainly was two disease positions, three diseases positions, four disease positions; the occurrence frequency of single disease position is low. In the aspect of syndrome elements of disease character, there are nine sthenic disease characters and four deficiency disease characters. In sthenic disease characters, frequency of phlegm character (53.85%) was the highest, exogenous wind-evil (45.05%), cold (40.66%) and wet (27.47%) were relatively commonly seen. The frequency of excessive fluid (10.99%), qi stagnation (8.79%), heat (4.40%), dry (4.40%), dyspepsia (3.30%) was relatively lower. Deficiency disease character elements were qi deficiency, yang deficiency, blood deficiency and yin deficiency in turn. The frequency was 87.91%, 69.23%, 50.55% and 26.37% respectively. The average score of qi deficiency and yang deficiency was more than 150. It suggested the disease was severe. The combination of syndrome elements of disease character, two disease characters was the most common. The frequency was 61 cases (67.76%), followed by single disease character syndrome element; the frequency was 19 cases (21.11%). In the form of combination of disease positions and characters, occurrence frequency of the combination of two disease positions and single disease character “lung+ superficial+ qi deficiency” was 76 (83.52%), occurrence frequency of the combination of three disease positions and single disease character syndrome elements “lung + superficial + spleen+ qi deficiency” was 51 (56.04%). [Conclusion] core position of pediatric cough variant asthma is lung, and related to superficial and spleen. The development of the disease was deficient and excessive syndromes appearing together, and qi deficiency and yang deficiency played an important role in the disease occurrence and development. Phlegm and wind were the main sthenic disease characters. Of the total, phlegm was the main pathological product and causation of disease.