261例多发性硬化患者临床特点和中医证候分布

目的总结多发性硬化(multiple sclerosis,MS)患者的临床特点、中医证候分布,探讨MS的发病机制。方法用临床病例分析统计方法,对261例MS患者的临床特点、舌苔脉象和中医证型进行归纳、分析。结果本组病例女性与男性患者之比为1.8:1,患者发病年龄在20～40岁之间的151例(58%),80.2%的患者无明显的诱因,以急性起病、复发-缓解多见,平均复发2.1次,大多数患者以感觉、视觉和运动障碍为首发和就诊即时症状,中医辨证有肝肾阴虚、脾肾阳虚、阴阳两虚、脾气不足、痰热瘀阻等,主要涉及肾、肝、脾3种脏器。结论本组病例证候要素以肝肾阴虚、脾肾阳虚、痰、血瘀、湿、热为最多。因此,MS本虚以肝肾阴虚、脾肾阳虚为主,邪实以痰、血瘀、湿、热合而为病为主。其中肝肾阴虚和痰瘀内阻的病理机制在多发性硬化患者中具有普遍性和代表性,这一特点从患者的舌象和脉象上也可以得到佐证。

Clinical features and traditional Chinese medicine syndrome types presentation of multiple sclerosis:an analysis of 261 cases

Objective To summarize the features of multiple sclerosis (MS) in China, analyze their traditional Chinese medicine (TCM) syndrome and pathogenesis, standardize the method of TCM syndrome differentiation and treatment. Methods The clinical features/tongue and pulse/differentiation of TCM syndrome of 261 MS patients were comprehensively analyzed using clinical statistical method. Results Female to male ratio of patients was 1.8:1, 58 percent of patients were from 20 to 40 years old at the onset, 80.2 percent of patients had no cause, most of them had acute onset and remitting relapsing type, their average relapsing times was 2.2, symptoms and signs of both first attack and registering time were mainly dysfunction of sensation, vision, and motor, the type of TCM syndrome differentiation were as follows, deficiency of both liver and kidney yin, deficiency of both spleen and kidney yang, deficiency of both yin and yang, deficiency of spleen qi, phlegm-heat and blood stasis in the body, and so on. In TCM, kidney, liver and spleen were corresponding zang. Conclusion This group of patients had the same clinical features as those reported by Chinese and overseas experts, deficiency of liver and kidney yin and deficiency of both spleen and kidney yang as well as phlegm/blood stasis /humidity/heat in the body are main pathogenesis and clinical TCM type, In summary, deficiency of both liver and kidney yin, phlegm-blood stasis in the body are main pathogenesis and clinical TCM type, both their tongue and pulse expression also support this conclusion.