海洛因依赖者中医证型研究

目的:探讨海洛因依赖者不同戒断期的中医证型。方法:将363例符合DSM—Ⅳ海洛因依赖诊断标准者分为依赖期、急性戒断期、稽延性戒断早期、稽延性戒断后期,并根据中医四诊进行辨证分型。结果:(1)依赖期分为心阴不足型、脾虚胃热型、气虚瘀痰内阻型。(2)急性戒断期分为气血虚类感型、肾胃阳虚类感型、肝肾两虚型。(3)稽延性戒断早期分为心脾两虚、神不守舍型,气血两虚、筋脉失养型,肝肾两亏、毒邪内伤型,肝郁不舒、热毒内扰型。(4)稽延性戒断后期分为气阴两虚、心神失养型,肾阴亏乏、神志不宁型,气滞血瘀、热邪上扰型,脾虚湿困、痰邪上扰型。(5)相关分析:吸毒时间与虚脉呈正相关(r=0.137,P<0.01),戒断时间与虚寒类舌苔呈正相关,与实热类舌苔呈负相关(r=-0.163,P<0.01),戒断评分与虚象舌质呈正相关(r=0.152,P<0.01),与虚实夹杂类合象呈负相关(r=-0.169,P<0.01)。结论:海洛因依赖可分为4期14个证型,为中医脱毒治疗提供参考依据。

Study on TCM Syndrome Types in Patients of Heroin Dependence

Purpose: To explore TCM syndrome types of heroin dependence at different abstinence phases. 363 cases who conformed with the criteria for diagnosis of heroin dependence (DSM - IV) were divided into dependence phase, acute abstinence phase, early protracted abstinence phase, protracted abstinence anaphase. and they were classified syndrome types according to TCM four diagnostic methods. (1) The dependence phase was divided into insufficiency of heart - Yin. deficiency of the spleen and heat of the stomach, and accumulation of phlegm due to Qi -deficiency; (2) The acute abstinence phase was divided into deficiency of Qi and blood . Yang-deficiency of the kidney and stomach, and deficiency of both the liver and kidney. (3) The early protracted abstinence early phase was divided into deficiency of both the heart and spleen, mental derangement, deficiency of both Qi and blood, failure in nourishment of muscles and tendons, insufficiency of the liver and kidney, internal invasion of pathogenic factor, stagnation of the liver -Qi. and internal invasion of toxic heat; (4) The protracted abstinence anaphase was divided into deficiency of both Qi and Yin. failure in nourishment of mentality, insufficiency of kidney - Yin. unsteadiness of mentality, stagnation of Qi and blood stasis, up -invasion of pathogenic heat, water retention due to hypofunction of the spleen, up-invasion of pathogenic phlegm. (5) Correlation analysis: At taking narcotic, positive correlation with pulse of deficiency type (r = 0. 137. P<0. 01), and at abstinence, positive correlation with tongue coat of deficiency and cold type, and negative correlation with the tongue coat of excess heat type (r = 0. 163, P<0. 01) were showed, and score of abstinence was correlated positively with tongue proper of deficiency type(r = 0.152, F<0. 01) and negatively with tongue picture of coexistence of deficiency and excess (r= 0. 169. P< 0. 01). Conclusion: Heroin dependence can be divided into 4 stages and 14 syndrome types, which provide reference for TCM abstinence treatment.