煤工尘肺208例中医证候初步研究

目的探讨煤工尘肺的中医证型及证候学特点,丰富中医药治疗煤工尘肺的理论,为辨证论治提供指导依据。方法对收集的208例煤工尘肺患者中医证候进行调查研究和统计分析。结果煤工尘肺病性类证候要素主要有:气虚、热(火)、风(外)、痰、血瘀、寒(外)、阴虚、湿(内)。病位主要集中在肺、脾、肾。临床辨证有10种证候:肺气虚证、风热犯肺证、血瘀证、痰热蕴肺证、脾气虚证、风寒犯肺证、痰湿阻肺证、肺阴虚证、肾阴虚证、表寒肺热证。对四诊信息进行聚类分析,可聚为7类:肺气虚证、痰热蕴肺证、痰湿阻肺证、风热犯肺证、血瘀证、肾阴虚证、脾气虚证。辨证以肺气虚证、痰湿阻肺证、血瘀证、肾阴虚证、脾气虚证为主;合并急性感染时,常合并痰热蕴肺证、风热犯肺证的兼证。结论本病多为本虚标实,本虚以肺气虚为主。患者常因本虚,易感受风热、风寒之外邪。利用聚类分析的方法在一定程度上揭示了煤工尘肺中医证候学的主要特点。

Investigation of TCM syndromes of coal workers’pneumoconiosis:a 208-case study

Objective To discuss the characteristics of TCM patterns and syndromes of coal workers’pneumoconiosis so as to enrich TCM theory for the treatment of this disease and provide the evidence for syndrome differentiation and treatment.Methods TCM syndromes of 208 patients with CWP were collected,investigated and statistically analyzed.Results The syndrome factors of workers'pneumoconiosis included qi deficiency,heat(fire),exogenous wind,phlegm,blood stagnation,exogenous cold,deficiency of Yin,and endogenous damp.The locations of the illness are the lung,spleen and kidney.After differentiation of the patterns,TCM syndrome identified ten patterns:deficiency of lung qi,attack of lung by wind and heat,stagnation of blood,blockage of lung by phlegm heat,deficiency of spleen qi,attack of lung by wind and cold,blockage of lung by phlegm damp,deficiency of lung Yin,deficiency of Yin of kidney,and exterior cold and lung heat.Using cluster analysis of symptoms,seven kinds of patterns were identified:deficiency syndrome of lung qi,accumulation of phlegm heat in the lung,obstruction of lung by phlegm damp,attack of lung by wind and heat,stagnation of blood,deficiency of kidney Yin,and deficiency of spleen qi.When acute infection is complicated,the accompanied TCM syndrome types include blockage of the lung by phlegm heat,and blockage of the lung by wind and heat.Conclusion CWP is manifested by deficiency in the root and excess in the secondary condition.Deficiency of lung qi is the main root.Patients with CWP are liable to be infected by exogenous wind and cold.By means of cluster analysis,the main characteristics of TCM syndromes of CWP can be revealed to some extent.