缺血性中风恢复期常见证候和证候要素的现代文献研究
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摘要
目的:通过现代文献研究和专家问卷调研,探讨缺血性中风恢复期中医证候的分布规律,并在此基础上提取证候要素,进一步揭示中医证候要素的内涵,为进一步提高缺血性中风恢复期的辨证准确率、提高临床治疗效果奠定基础。方法:(1)对符合要求的缺血性中风恢复期的证候和证候要素进行规范,运用SPSS13.0进行频数统计。(2)通过专家问卷调查,挖掘专家经验,按照“平均序数”方法将各证候要素的诊断指标进行排序,建立了基于专家经验的缺血性中风恢复期证候诊断量表。结果:(1)文献研究发现缺血性中风恢复期最常见的4种证候依次是气虚血瘀证、肾虚痰瘀互阻证、肝肾阴虚,痰瘀互阻证、气阴两虚,痰瘀互阻证,可覆盖大多数病例。证候要素中病位在脑、肾、肝、脾;(2)通过专家问卷确定以下15种证候要素:实性证候要素:血瘀、痰浊、气滞、寒凝、腑实、肝阳上亢、风痰、湿;虚性证候要素:气虚、阳虚、阴虚、肝阴虚、肾阴虚、肾阳虚、脾虚。其中,实性证候要素以血瘀、痰浊、气滞、腑实、寒凝为主;虚性证候要素以气虚、阴虚、阳虚、肝阴虚、肾阴虚、脾虚为主要证候要素。结论:文献研究表明,缺血性中风恢复期的证候要素是有限的。缺血性中风恢复期的证候要素组合中,单因素证血瘀最多,其次为气虚;双因素证以气虚+血瘀最多,其次为血瘀+痰浊;三因素证以气虚+血瘀+痰浊最多,其次为肾虚+血瘀+痰浊。证候要素间的组合形式反映了证候要素之间存在关联。专家问卷调查结果和文献调研的结果基本一致。
Objective:To explore and study the law of syndrome elements of convalescence stage ,and futher deepen syndrome standardization , then laid the groundwork for improving the accuracy rate of categorical identification and the clinical treatment effect of convalescence stage,the reseach was carried out on the basis of the contemporary literature investigation and study along with the expert consulation.
Metheods:To Standardize the syndrome and syndrome elements which fit certain requirements of Convalescence stage by using SPSS13.0 to give frequency statistics .(2) The diagnosis measuring scale of syndrome elements was established after the diadynamic index was sorted according to average ordinal number by.
Results:(1)Four syndrome elements were withdrew from the literature investigation.They are qi deficiency and blood stasis,deficiency of Kidney qi, phlegm-turbidity and blood stasis in Channel; deficiency of yin of both Liver and Kidney , phlegm-turbidity and blood stasis in Channel ;deficiency of kidney -blood stasis ; deficiency of qi and yin -blood stasis; deficiency of yin of both Liver and Kidney.(2)Fifthteen elements were established by experts consulation:solid elements: qi deficiency, phlegm-turbidity, qi stagnancy, congealing cold, viscera solid, endogenous damp, yang hyperaactivity, anemogenous phlegm;deficiency of elements: yin deficiency, yang dificiency, qi deficiency, yin deficiency of liver, yin deficiency of kidney, dificiency of spleen.Conclusion: The literature research indicated that the syndrome elements of coronary disease angina pectoris are definite.Results shows that the syndrome elements combinat with regularity. In the syndromes, blood stasis is the most among the tetro-element ones,next is qi deficiency ; qi deficiency + blood stasis is the most among the double-element ,next is blood stasis+phlegm-turbidity; qi deficiency + blood stasis+phlegm-turbidity is the most among triple-element syndrome, next is kidney deficiency+ blood stasis+ phlegm-turbidity. The research indicated that the syndrome elements of coronary disease angina pectoris are definite.The results of literature reseach and expert consulation are homologied.
Objective:To explore and study the law of syndrome elements of convalescence stage ,and futher deepen syndrome standardization , then laid the groundwork for improving the accuracy rate of categorical identification and the clinical treatment effect of convalescence stage,the reseach was carried out on the basis of the contemporary literature investigation and study along with the expert consulation.
Metheods:To Standardize the syndrome and syndrome elements which fit certain requirements of Convalescence stage by using SPSS13.0 to give frequency statistics .(2) The diagnosis measuring scale of syndrome elements was established after the diadynamic index was sorted according to average ordinal number by.
Results:(1)Four syndrome elements were withdrew from the literature investigation.They are qi deficiency and blood stasis,deficiency of Kidney qi, phlegm-turbidity and blood stasis in Channel; deficiency of yin of both Liver and Kidney , phlegm-turbidity and blood stasis in Channel ;deficiency of kidney -blood stasis ; deficiency of qi and yin -blood stasis; deficiency of yin of both Liver and Kidney.(2)Fifthteen elements were established by experts consulation:solid elements: qi deficiency, phlegm-turbidity, qi stagnancy, congealing cold, viscera solid, endogenous damp, yang hyperaactivity, anemogenous phlegm;deficiency of elements: yin deficiency, yang dificiency, qi deficiency, yin deficiency of liver, yin deficiency of kidney, dificiency of spleen.Conclusion: The literature research indicated that the syndrome elements of coronary disease angina pectoris are definite.Results shows that the syndrome elements combinat with regularity. In the syndromes, blood stasis is the most among the tetro-element ones,next is qi deficiency ; qi deficiency + blood stasis is the most among the double-element ,next is blood stasis+phlegm-turbidity; qi deficiency + blood stasis+phlegm-turbidity is the most among triple-element syndrome, next is kidney deficiency+ blood stasis+ phlegm-turbidity. The research indicated that the syndrome elements of coronary disease angina pectoris are definite.The results of literature reseach and expert consulation are homologied.
引文
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[5]姚乃礼.中医证候鉴别诊断学.2版.北京:人民卫生出版社,2002.
[6]王永炎,张启明,张志斌.证候要素及其靶位的提取.山东中医药大学报,2006.30(1):6.
[7]姚乃礼.中医症状鉴别诊断学.2版.北京:人民卫生出版社,2000.
[8]张志斌,王永炎.辨证方法新体系的建立.北京中医药大学学报,2005.28(1):
[9]贾满仓,朱薇.气虚血瘀与中风相关性探讨,河南中医学院学报[J]:2005,20(117):41-42.
[10]唐茂成.中风病从肝脾论治[J].福建中医药,2000,31(2):43-44.
[11]石青,邱仕君.中医脾肾相关理论在缺血性中风中的临床应用研究
[12]张树泉,王白玲,苗香辅.治疗脑梗塞的经验[J].中医杂志,1998,28(1):24.
[13]邱幸凡.从“正虚络痹”治疗中风偏瘫的体会[J].湖北中医杂志,1997,19(5):3.
[14]段丽梅,殷亚林.“治风先治血,血行风自灭”在中风病中的运用(J].河南中医,1998.18(4):229.
[15]王运满,李长生,杨晓妮.化瘀克塞汤预处理对局灶性脑缺血大鼠HSP70表达的影响:山东大学学报(医学版)[J].2008,46(1)34.
[16]司国民.中医治疗中风病恢复期165例体会;四川中医[M].2005,23(3):50.
[17]段才萍.活血化瘀治疗脑出血临床观察[J].四川中医,2003,21(4):44-45.
[18]焦久存,吕士君,周贵福.等320例脑梗塞恢复期证候规律的临床观察,中华中医药学刊[M],2008,26(8):1766-1767.
[19]任凤梧.通心络胶囊治疗气虚血瘀型中风55例[J].辽宁中医学院学报,1999(3): 181.
[20]胡庆全.脑梗塞中医证型与微循环关系研究[J].中国微循环,2001,5(4):306-307.
[21]余勃,许鹏.缺血性中风从痰瘀致毒论治.陕西中医[J],2006:27(2):193-194.
[22]雷燕,王永炎,黄启福.络病理论探微.北京中医药大学学报[J],1998:21(2):18.
[23]宋剑南.从生物化学角度看痰及痰瘀相关.中国中医基础医学杂志,2000:6(3):40-43.
[24]李继军.平肝祛痰通络法配合康复疗法治疗中风恢复期[J].湖北中医杂志,1999,21(增刊):24-25.
[25]方永奇.痰证研究思路探讨.中国中医基础医学杂志,1996:2(6):20.
[26]宋剑南,刘东远,牛晓红,金红,李爱华.高脂血症与中医痰浊关系的实验研究.中国中医基础医学杂志,1995:1(1):49-51.
[27]静文英,刘采英.321例心脑血管伴高脂血症患者血液流变学变化与中医辨证的关系.内蒙古中医药1993:12(2):1-3.
[28]周建伟,等.缺血性中风与血液“高凝状态”关系的研究.中国中医急症,1994:3(3):112-113.
[29]王礼文,葛亚东,顾洪璋.血液流变学及血脂相关指标在中风诊断中的应用.中国微循环,2002:6(6):35-36.
[30]徐木林.中风之古与今[J].辽宁中医杂志,1996,23(6):253.
[31]张树泉,王白玲,苗香辅.治疗脑梗塞的经验[J].中医杂志,1998,28(1):24.
[32]邱幸凡.从“正虚络痹”治疗中风偏瘫的体会[J].湖北中医杂志,1997,19(5):3.
[33]段丽梅,殷亚林.“治风先治血,血行风自灭”在中风病中的运用[J].河南中医,1998.18(4):229.
[34]冷建国.化痰法治疗中风急性期98倒临床观察[J].四川中医,1996,14(8):21.
[35]张德山自拟偏瘫复正汤治疗急性脑梗塞103倒[J].中医研究,1997.10(4):30.
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