台湾地区经前期综合征中医证候（实证）分布及人格特质分析
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摘要
经前期综合征(Premenstrual Syndrome, PMS)是指育龄妇女在月经前7～14天(即在月经周期的黄体期)反复出现的精神、行为及体质等方面的综合症状,月经来潮或结束后症状消失。
目的
研究了解经前期综合征患者的中医证候中实证的分布规律,并评估病患的人格特点与经前期综合征的关系。为中医药防治PMS的临床研究建立规范的评估系统和提供严谨的科研资料。
方法
通过流行病学研究方法,采用多学科同步观察分析,调查项目分为中医临床症状问卷调查和艾森克个性问卷调查两大部分。本文参照新世纪教材《中医妇科学》、《中医病症诊疗标准》及第六版《妇产科学》等有关文献标准制定中西医诊断标准,共纳入了502例经前期综合征实证患者。其中中医证候学调查收录了女性经前症状及中医四诊共计43项内容,包括：乳房胀痛、胸闷、烦躁易怒、头痛、失眠、小腹胀痛、食欲差、头晕、胁痛、抑郁、善太息、精力不集中、月经后期、口干咽燥、疲乏、情绪低落、大便秘结、心烦、腰膝酸软、水肿、两目干涩、潮热、嗳气、手足心热、便溏、因情志而泄泻、胃胀、全身不适、月经先期、食欲亢进、尿黄、口腔溃疡、口苦、面红、目赤、盗汗、肠鸣矢气、耳鸣、面部烘热、恐惧、衄血、舌象、脉象。人格特征调查使用我国已有艾森克个性问卷(Eysenck Personality Questionaire,简称EPQ)的成人式修订本,共88项内容。对被调查人群的中医症状分布采用描述性统计分析,观察其频数分布情况,探讨经前期综合征的主要中医症状及舌象、脉象。采用聚类分析方法将被调查人群进行分类,了解观察人群的中医证候分布情况,并将聚类分析的结果与临床诊断的中医证候分类结果进行一致性分析。根据临床经验和文献研究所设,将乳房胀痛、胸闷、小腹胀痛、头痛、烦躁易怒、头晕、失眠、食欲差、善太息、抑郁、胁痛、水肿的严重程度做为经前综合征的评分项目。每一症状分为“无,轻微,中度可以忍受,重度难以忍受”四个等级,分别以0～3分计算,总评分为0～36分。采用多元回归分析计算经前综合征的总评分与艾森克个性问卷的P、E、N、L各维度的回归系数,并得出回归方程,探讨经前期综合征与个性的定量关系,由此来导入此型患者是属于何种中医五行人(木、火、土、金、水)。使用EpiData软件进行数据的编码、数据库文件的生成、数据的录入校对,并利用其转出功能转化为SPSS数据库文件,用SPSS16.0进行频数分析、聚类分析及多元回归分析。
结果
此次调查的女性经前症状及中医四诊体征共计43项内容,结果显示：被调查者常见症状比例居前十位的是乳房胀痛、胸闷、脉弦、烦躁易怒、头痛、失眠、小腹胀痛、食欲差、头晕、胁痛。
聚类分析后将被调查者分为5类,分别占到全部调查者的27.09%、25.70%、19.32%、16.93%、10.96%,根据专业知识可分别将其辨证为肝气上逆证、肝郁气滞证、阴虚肝旺证、肝气乘脾证、肝火上炎证。
经聚类分析后肝气上逆证与临床诊断的一致性为86.76%；经聚类分析后肝郁气滞证证与临床诊断的一致性为92.25%；经聚类分析后阴虚肝旺证与临床诊断的一致性为92.78%；经聚类分析后肝气乘脾证与临床诊断的一致性为95.29%；经聚类分析后肝火上炎证与临床诊断的一致性为65.45%。
经前期综台征发生率高但症状轻(9.28±3.16分),中度以下患者共466人,占92.8%。经前期综旨征与个性有关,与艾森克个性问卷维度中精神质P、内外向E、掩饰L呈负相关,与神经质N呈正相关。
结论
1.对符合中医实证的PMS症状进行聚类分析,分成5类中医证候群,分别为肝气逆证、肝郁气滞证、阴虚肝旺证、肝气乘脾证、肝火上炎证。
2.PMS中医实证的常见症状,前10位的是乳房胀痛(95.22%)、胸闷(89.44%)、脉弦(76.89%)、烦躁易怒(70.72%)、头痛(68.13%)、失眠(59.36%)、小腹胀痛(54.98%)、食欲差(53.39%)、头晕(50.60%)、胁痛(41.83%)。调查结果与经前期综合征的国内外文献研究中的症状基本一致。
3.根据PMS与艾森克量表各维度方程,提示P、E、L维度与PMS呈负相关,N维度与其呈正相关。即趋向保守、安静、孤僻、说谎、缺乏同情心、仇视、情绪过分、易激动者,其PMS症状较严重。通过艾森克人格问卷的P、E、N、L,可估计女性经前期综合征的程度。
Premenstrual Syndrome (abbreviation for PMS) is the syndrome of repeatedly appearance of spirit、behavior and somaplasm abnormality, which happens among reproductive women seven to fourteen days before menstruation and disappears after menstrual onset or run-out.
Objective
In this study, we try to gain the message of Chinese Medicine Syndrome distribution rule of the PMS patients with excess syndrome, and evaluate the relationship between patients'personality characteristics and premenstrual syndrome, hoping to establish standard evaluation system of clinical research for prevention and therapy for PMS of Chinese Medicine and provide with strict scientific information
Methods
The study used the research methods of epidemiology, adapted synchronization observation and analysis of multi-subjects and the investigation projects includes two parts, namely Chinese Medicine symptom questionnaire and Eysenck Personality Inventory. Our criteria standardization used diagnosis standardization of integrated medicine of Chinese medicine and Western medicine, referring to new century textbook of gynecology in Chinese Medicine、diagnosis and treatment standardization of diseases and symptoms in Chinese Medicine, and the sixth edition obstetrics and gynecology, etc. In the research, we recruited 502 cases with PMS deficient syndrome. Survey of Chinese Medicine syndrome includes symptoms before menstruation and symptoms collected by Chinese four diagnositic methods, totally forty-three items. There is spargosis、chest distress、restlessness and easy tantrum headache、insomnia、distending pain of lower abdomen bad appetite、dizziness、hypochondriac pain、depression、easy sighing、absence of mind、delayed menorrhea, dryness of mouth and pharynx、fatigue、low emotion、constipation、upset、softness and weakness of waist and knee、edema, dryness of eyes、tidal fever、ructation、feverish sensation over the palm and sole、loose stool、diarrhea caused by emotion、gastric distention、general malaise、proceeded menorrhea、bullimia,yellow urine、dental ulcer、bitter taste of mouth、flushing、red eye、night sweat、rugitus and flatus、tinitus、facial drying and heating、fear、non-traumatic hemorrhage、tongue manifestation、pulse manifestation. Adult revised edition of Eysenck Personality Questionnaire (abbreviation for EPQ) used in China, which include totally 88 items, was applied to investigate cases'Personality characteristic. Distribution of Chinese Medicine symptoms was analyzed by descriptive statistics. Through observing their frequency, we tried to explore the distribution information of major Chinese Medicine symptoms、tongue manifestation and pulse of PMS. Cluster analysis was used to classify the investigation crowd in order to observe the distribution of Chinese Medicine syndrome information, and make concordance analysis between results of cluster analysis and classify results of Chinese Medicine syndrome diagnosed clinically. Based on clinical experience and literature research, we used the severity of spargosis、chest distress、distending pain of lower abdomen、headache、restlessness and easy tantrum, dizziness、insomnia, bad appetite、easy sighing、depression, hypochondriac pain and edema as evaluation items for PMS. Multiple regression analysis was used to work out the coefficient of regression of total score of PMS and each dimension of P, E、N and L in the Eysenck Personality Inventory. Then regression equation was obtained to explore the quantitative relationship between PMS and personality. Thus patients of each type was divided into one type of the Chinese Medicine's five elements people (wood、fire、earth、metal、water). EpiData software was used to deal with coding data、generating data files、correcting record of data, and transform the database into SPSS database files by its function of shifting out. Then SPSS16.0 was applied to make frequency analysis、cluster analysis and multiple regression analysis.
Results
There are forty-three items in total on symptoms of female premenstrual and symptoms and signs collected by Chinese four diagnositic methods in the survey. The results showed:common symptoms of our cases occupied the forward ten were spargosis.chest distress.string pulse、restlessness and easy tantrum、headache、insomnia、distending pain of lower abdomen、bad appetite、dizziness and hypochondriac pain. After cluster analysis, cases were classified into five kinds, accounting for about 27.09%.25.70%、19.32%、16.93%.10.96% relatively among all patients investigated, and based on the expertise, their syndrome differentiation was syndrome of upward invasion of liver Qi、syndrome of stagnation of liver-Qi. syndrome of hyperactivity of fire due to yin deficiency、syndrome of liver Qi invading spleen and syndrome of liver fire flaring up. After cluster analysis, concordance between syndrome of upward invasion of liver Qi and clinical diagnosis was 86.76%; concordance between syndrome of stagnation of liver-Qi and clinical diagnosis was 92.25%; concordance between syndrome of hyperactivity of fire due to yin deficiency and clinical diagnosis was 92.78%; concordance between syndrome of liver Qi invading spleen and clinical diagnosis was 95.29%; concordance between syndrome of liver fire flaring up and clinical diagnosis was 65.45%. Incidence of PMS was high, but its symptoms were slight (9.28±3.16分). There were 466 patients under moderate severity, occupying 92.8%. PME was corrective to personality, was negative correlative to Eysenck Personality Questionnaire's dimensions such as psychoticism as P. exterior and inerior E. wrap L, and was positive correlative to neurotic trait as N. Conclusions
From investigation results of clinical symptoms in Chinese Medicine, though Chinese symptoms of premenstrual syndrome is very complicate, yet pathological changes of liver are main, dealing with heart、spleen、lung and kidney. Concordance between results of cluster analysis and clinical diagnosis was quite high. Additionally, dimension P. dimension E and dimension L in Eysenck Personality Questionnaire had negative correlation to PMS, while dimension N was positive correlative to PMS, which means the more conservation、quiet、unsociable、lying、lack of sympathy、hatred、excessive emotion and irritable the patients were, the more serious their clinical symptoms were. Scores of P. E and N might have some correlation to Chinese Medicine's five elements people.
目的
研究了解经前期综合征患者的中医证候中实证的分布规律,并评估病患的人格特点与经前期综合征的关系。为中医药防治PMS的临床研究建立规范的评估系统和提供严谨的科研资料。
方法
通过流行病学研究方法,采用多学科同步观察分析,调查项目分为中医临床症状问卷调查和艾森克个性问卷调查两大部分。本文参照新世纪教材《中医妇科学》、《中医病症诊疗标准》及第六版《妇产科学》等有关文献标准制定中西医诊断标准,共纳入了502例经前期综合征实证患者。其中中医证候学调查收录了女性经前症状及中医四诊共计43项内容,包括：乳房胀痛、胸闷、烦躁易怒、头痛、失眠、小腹胀痛、食欲差、头晕、胁痛、抑郁、善太息、精力不集中、月经后期、口干咽燥、疲乏、情绪低落、大便秘结、心烦、腰膝酸软、水肿、两目干涩、潮热、嗳气、手足心热、便溏、因情志而泄泻、胃胀、全身不适、月经先期、食欲亢进、尿黄、口腔溃疡、口苦、面红、目赤、盗汗、肠鸣矢气、耳鸣、面部烘热、恐惧、衄血、舌象、脉象。人格特征调查使用我国已有艾森克个性问卷(Eysenck Personality Questionaire,简称EPQ)的成人式修订本,共88项内容。对被调查人群的中医症状分布采用描述性统计分析,观察其频数分布情况,探讨经前期综合征的主要中医症状及舌象、脉象。采用聚类分析方法将被调查人群进行分类,了解观察人群的中医证候分布情况,并将聚类分析的结果与临床诊断的中医证候分类结果进行一致性分析。根据临床经验和文献研究所设,将乳房胀痛、胸闷、小腹胀痛、头痛、烦躁易怒、头晕、失眠、食欲差、善太息、抑郁、胁痛、水肿的严重程度做为经前综合征的评分项目。每一症状分为“无,轻微,中度可以忍受,重度难以忍受”四个等级,分别以0～3分计算,总评分为0～36分。采用多元回归分析计算经前综合征的总评分与艾森克个性问卷的P、E、N、L各维度的回归系数,并得出回归方程,探讨经前期综合征与个性的定量关系,由此来导入此型患者是属于何种中医五行人(木、火、土、金、水)。使用EpiData软件进行数据的编码、数据库文件的生成、数据的录入校对,并利用其转出功能转化为SPSS数据库文件,用SPSS16.0进行频数分析、聚类分析及多元回归分析。
结果
此次调查的女性经前症状及中医四诊体征共计43项内容,结果显示：被调查者常见症状比例居前十位的是乳房胀痛、胸闷、脉弦、烦躁易怒、头痛、失眠、小腹胀痛、食欲差、头晕、胁痛。
聚类分析后将被调查者分为5类,分别占到全部调查者的27.09%、25.70%、19.32%、16.93%、10.96%,根据专业知识可分别将其辨证为肝气上逆证、肝郁气滞证、阴虚肝旺证、肝气乘脾证、肝火上炎证。
经聚类分析后肝气上逆证与临床诊断的一致性为86.76%；经聚类分析后肝郁气滞证证与临床诊断的一致性为92.25%；经聚类分析后阴虚肝旺证与临床诊断的一致性为92.78%；经聚类分析后肝气乘脾证与临床诊断的一致性为95.29%；经聚类分析后肝火上炎证与临床诊断的一致性为65.45%。
经前期综台征发生率高但症状轻(9.28±3.16分),中度以下患者共466人,占92.8%。经前期综旨征与个性有关,与艾森克个性问卷维度中精神质P、内外向E、掩饰L呈负相关,与神经质N呈正相关。
结论
1.对符合中医实证的PMS症状进行聚类分析,分成5类中医证候群,分别为肝气逆证、肝郁气滞证、阴虚肝旺证、肝气乘脾证、肝火上炎证。
2.PMS中医实证的常见症状,前10位的是乳房胀痛(95.22%)、胸闷(89.44%)、脉弦(76.89%)、烦躁易怒(70.72%)、头痛(68.13%)、失眠(59.36%)、小腹胀痛(54.98%)、食欲差(53.39%)、头晕(50.60%)、胁痛(41.83%)。调查结果与经前期综合征的国内外文献研究中的症状基本一致。
3.根据PMS与艾森克量表各维度方程,提示P、E、L维度与PMS呈负相关,N维度与其呈正相关。即趋向保守、安静、孤僻、说谎、缺乏同情心、仇视、情绪过分、易激动者,其PMS症状较严重。通过艾森克人格问卷的P、E、N、L,可估计女性经前期综合征的程度。
Premenstrual Syndrome (abbreviation for PMS) is the syndrome of repeatedly appearance of spirit、behavior and somaplasm abnormality, which happens among reproductive women seven to fourteen days before menstruation and disappears after menstrual onset or run-out.
Objective
In this study, we try to gain the message of Chinese Medicine Syndrome distribution rule of the PMS patients with excess syndrome, and evaluate the relationship between patients'personality characteristics and premenstrual syndrome, hoping to establish standard evaluation system of clinical research for prevention and therapy for PMS of Chinese Medicine and provide with strict scientific information
Methods
The study used the research methods of epidemiology, adapted synchronization observation and analysis of multi-subjects and the investigation projects includes two parts, namely Chinese Medicine symptom questionnaire and Eysenck Personality Inventory. Our criteria standardization used diagnosis standardization of integrated medicine of Chinese medicine and Western medicine, referring to new century textbook of gynecology in Chinese Medicine、diagnosis and treatment standardization of diseases and symptoms in Chinese Medicine, and the sixth edition obstetrics and gynecology, etc. In the research, we recruited 502 cases with PMS deficient syndrome. Survey of Chinese Medicine syndrome includes symptoms before menstruation and symptoms collected by Chinese four diagnositic methods, totally forty-three items. There is spargosis、chest distress、restlessness and easy tantrum headache、insomnia、distending pain of lower abdomen bad appetite、dizziness、hypochondriac pain、depression、easy sighing、absence of mind、delayed menorrhea, dryness of mouth and pharynx、fatigue、low emotion、constipation、upset、softness and weakness of waist and knee、edema, dryness of eyes、tidal fever、ructation、feverish sensation over the palm and sole、loose stool、diarrhea caused by emotion、gastric distention、general malaise、proceeded menorrhea、bullimia,yellow urine、dental ulcer、bitter taste of mouth、flushing、red eye、night sweat、rugitus and flatus、tinitus、facial drying and heating、fear、non-traumatic hemorrhage、tongue manifestation、pulse manifestation. Adult revised edition of Eysenck Personality Questionnaire (abbreviation for EPQ) used in China, which include totally 88 items, was applied to investigate cases'Personality characteristic. Distribution of Chinese Medicine symptoms was analyzed by descriptive statistics. Through observing their frequency, we tried to explore the distribution information of major Chinese Medicine symptoms、tongue manifestation and pulse of PMS. Cluster analysis was used to classify the investigation crowd in order to observe the distribution of Chinese Medicine syndrome information, and make concordance analysis between results of cluster analysis and classify results of Chinese Medicine syndrome diagnosed clinically. Based on clinical experience and literature research, we used the severity of spargosis、chest distress、distending pain of lower abdomen、headache、restlessness and easy tantrum, dizziness、insomnia, bad appetite、easy sighing、depression, hypochondriac pain and edema as evaluation items for PMS. Multiple regression analysis was used to work out the coefficient of regression of total score of PMS and each dimension of P, E、N and L in the Eysenck Personality Inventory. Then regression equation was obtained to explore the quantitative relationship between PMS and personality. Thus patients of each type was divided into one type of the Chinese Medicine's five elements people (wood、fire、earth、metal、water). EpiData software was used to deal with coding data、generating data files、correcting record of data, and transform the database into SPSS database files by its function of shifting out. Then SPSS16.0 was applied to make frequency analysis、cluster analysis and multiple regression analysis.
Results
There are forty-three items in total on symptoms of female premenstrual and symptoms and signs collected by Chinese four diagnositic methods in the survey. The results showed:common symptoms of our cases occupied the forward ten were spargosis.chest distress.string pulse、restlessness and easy tantrum、headache、insomnia、distending pain of lower abdomen、bad appetite、dizziness and hypochondriac pain. After cluster analysis, cases were classified into five kinds, accounting for about 27.09%.25.70%、19.32%、16.93%.10.96% relatively among all patients investigated, and based on the expertise, their syndrome differentiation was syndrome of upward invasion of liver Qi、syndrome of stagnation of liver-Qi. syndrome of hyperactivity of fire due to yin deficiency、syndrome of liver Qi invading spleen and syndrome of liver fire flaring up. After cluster analysis, concordance between syndrome of upward invasion of liver Qi and clinical diagnosis was 86.76%; concordance between syndrome of stagnation of liver-Qi and clinical diagnosis was 92.25%; concordance between syndrome of hyperactivity of fire due to yin deficiency and clinical diagnosis was 92.78%; concordance between syndrome of liver Qi invading spleen and clinical diagnosis was 95.29%; concordance between syndrome of liver fire flaring up and clinical diagnosis was 65.45%. Incidence of PMS was high, but its symptoms were slight (9.28±3.16分). There were 466 patients under moderate severity, occupying 92.8%. PME was corrective to personality, was negative correlative to Eysenck Personality Questionnaire's dimensions such as psychoticism as P. exterior and inerior E. wrap L, and was positive correlative to neurotic trait as N. Conclusions
From investigation results of clinical symptoms in Chinese Medicine, though Chinese symptoms of premenstrual syndrome is very complicate, yet pathological changes of liver are main, dealing with heart、spleen、lung and kidney. Concordance between results of cluster analysis and clinical diagnosis was quite high. Additionally, dimension P. dimension E and dimension L in Eysenck Personality Questionnaire had negative correlation to PMS, while dimension N was positive correlative to PMS, which means the more conservation、quiet、unsociable、lying、lack of sympathy、hatred、excessive emotion and irritable the patients were, the more serious their clinical symptoms were. Scores of P. E and N might have some correlation to Chinese Medicine's five elements people.
引文
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