支气管镜下望诊肺痨局部辨证规律探讨

目的 :通过电子支气管镜镜下观察,探索肺痨局部病变的规律,提出肺痨新的中医局部辨证分型。方法 :确诊的肺、支气管结核(肺痨)患者93例,按照常规辨证为肺阴亏虚、阴虚火旺、气阴耗伤、阴阳两虚型。用电子支气管镜进行气道内局部观察,把得出的结果与整体诊断不同证型结合舌苔、脉象进行比较分析。结果:镜下肉眼表现望诊归纳为三类。具有黏膜黄斑、浅表溃疡、浅表血管曲张等化脓性病变者占74.19%;具有腔内肉芽肿、分嵴部增宽、眨眼征等形态改变表现者占3.22%;具有黏膜苍白、软骨环间肌肉瘦削、苍白色瘢痕组织等营养不良表现者占22.58%。不同辨证分型、舌苔、脉象分析,差异有统计学意义(P0.05),不同舌质分析差异无统计学意义(P0.05)。结论:中医临床辨证方法均以"阴虚"为中心,突出"正气不足"贯穿始终,治疗上强调扶正养阴。今利用电子支气管镜镜下观察,结合舌苔、脉象,局部辨证分为痨热毒郁肺血败肉腐型、气滞血瘀痰凝湿阻型和气血不足气阴亏虚型,为诊治肺痨开创新思路。

Discussion on Differentiation Rules of Micro Inspection Diagnosis of Local Findings of Lung Tuberculosis under Bronchoscopy

Objective:Through the bronchoscopic findings to explore the local morphological changes of tuberculosis(TB) and to put forward a new local differentiation method of Traditional Chinese Medicine(TCM).Methods:Total of 93 patients diagnosed as pulmonary TB were differentiated into 4 types according to TCM four diagnostic methods:lung yin deficiency,yin deficiency and fire excess,consumption of qi and yin,impairment of both qi and yin. The experimenters observed the airway by electronic bronchoscope,and com pared the findings(including the tonguecoating and pulse) in different syndrome types by holistic diagnosis.Results:The manifestation under bronchofiberscopy could be generalized as follows:yellow spot of mucosa,superficial ulceration,mucosal vascular varicose and other purulent lesions accounted for 74.19%;intra-luminal granuloma,widened carina,owl wink and other morphological changes accounted for 3.22%;pale mucosa,weak inter-cartilage ring muscle,cicatricial tissue and other malnutrition manifestation accounted for 22.58%. Syn drome differentiation,tongue coating and pulse were of statistical difference(P<0.05),but tongue quality was of no statistical difference(P> 0.05). Conclusions :TCM clinical syndrome differentiation for TB focuses on"yin deficiency" and emphasizes "deficiency of healthy qi". TCM treatment for TB should be nourishing yin and strengthening healthy qi. Based on the electronic bronchoscopic findings,in combination with the tongue coating and pulse,by local syndrome differentiation TB could be divided into types of accumulated toxic heat in the lungs with purulent blood rotten flesh,of qi stagnation,blood stasis,coagulation of phlegm and dampness block,of deficiency of qi,blood and yin,which could provide a new approach for diagnosis and treatment for TB.