从脑梗死急性期中医证候要素分析谈体质学说在脑梗死一级预防中的应用

目的:通过研究脑梗死急性期的中医证候演变规律,为建立脑梗死的中医一级预防体系提供依据。方法:对1972—2012年中国期刊全文数据库(CNKI)及维普资讯中文科技期刊数据库(VIP)发表的脑梗死中医证候要素相关文献进行全面检索,对其中脑梗死中医证候要素分布及不同时期变化规律进行统计分析。结果:纳入文献103篇,总病例数860例。近40年,在脑梗死急性期,中医证候要素出现的频率由高到低依次为:风>痰>火>血瘀>阴虚>气虚。然而近10年来,脑梗死急性期中医证候要素所占比例已经发生了变化,其中,瘀证的比例逐渐上升,略超过了痰证所占的比例。结论:风、火、痰、瘀是脑梗死急性期的主要证候要素,其中,风、火是脑梗死急性期的主要临床表现证候,而非致病证候;痰、瘀既是脑梗死急性期的主要表现证候,亦是致病证候。痰湿质、气虚质、瘀血质、阴虚质是脑梗死的高危体质,在脑梗死一级预防阶段应予以重视;湿热质与脑梗死发生率的相关性需要进一步研究与验证,可列为脑梗死的警惕体质。

Discussion on Application of Physique Theory in Primary Prevention of Cerebral Infarction Through Analysing Elements of TCM Syndrome in Acute Stage of Cerebral Infarction

Objective：Through studying evolution law of TCM syndrome in acute stage of cerebral infarction,it was to provide basis for establishing the TCM system of primary prevention of cerebral infarction. Methods ： The related literatures about elements of TCM syndrome of cerebral infarction were comprehensively searched from China Journal Full - text Database（CNKI） and journal VIP Chinese database（VIP） in 1972 -2012 ,statistically analyzing the distribution and change law in different periods about TCM syndrome of cerebral infarction. Results ：103 literatures were brought into analysis, including 860 cases. Nearly 40 years, in acute stage of cerebral infarction, the frequency of elements of TCM syndrome from high to low was： wind, phlegm,fire, blood sta- sis,yin deficiency and qi deficiency. However,the proportion changed in recent 10 years, that is, the proportion of stasis has increased gradually, and slightly more than which of phlegm. Conclusion：The mail elements of syndrome in acute stage of cerebral infarction were wind, fire, phlegm and stasis, and among them,wind and fire are the main clinical manifestations of syndromes, but non-pathogenic syndrome. However,pblgem and stasis are both manifestation and pathogenic syndromes. The high risk constitution of cerebral infarction include phlegm - dampness, Qi - deficiency, blood stasis and Yin-deficiency constitution, which should be paid more attentions in primary prevention of cerebral infarction. Meanwhile the relativity between damp-heat constitution and incidence of cerebral infarction needs the further research and verification, which can be classified as vigilance constitution.