770例甲型H1N1流感证候统计分析及其与内伤病证关系研究
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摘要
1研究目的：
通过统计和比较分析无内伤基础病、五类不同内伤基础病、特殊人群等3大类型甲型H1N1流感的临床中医证候特点,分析其不同的病因病机及其相互关系,以期对甲型H1N1流感的临床治疗思路和方法有所启发和提高。
2研究方法：
将770例甲型H1N1流感确诊病例分为无内伤基础病组、内伤基础病组、特殊人群组,根据病情程度,选取不同数目的病程节点,统计各组内不同时间节点的症状和体征频次,总结其症状和体征频次演变特点,进行组间比较分析。其中,内伤基础病组分肺系内伤组、心系内伤组、肾与膀胱内伤组、消渴内伤组、肝胆内伤组；特殊人群组包含在无内伤基础病组内,又分为孕妇组与肥胖组。以上每一组内又进一步分为轻症组、重症组、危重症组三个亚组。用频数分析描述各组39项症状和9项体征的出现频次,将出现频次大于或等于50%的症状列为主症作主要分析,次症仅作参考。
3研究结果：
3.1无内伤基础病组：
轻症组病程为10天左右,主症除肺部症状、体表症状外,头面部口、鼻咽等清窍症状亦较明显。重症组病程为11天左右,咳痰、脉数变为主症,较重者可见痰中带血,甚至咳吐粉红色泡沫痰。危重症组病程为18天左右,主症中出现了湿啰音、喘息气促；痰中带血和咳吐粉红色泡沫痰出现频率上升部分病例也可见到烦躁、神昏谵语、紫癜、出血点等表现。
3.2内伤基础病组
3.2.1肺系内伤：
本组无轻症病例。重症病程为17天左右,湿啰音、倦怠乏力、纳差、咽部充血、干啰音成为主症。危重症病程为16天左右,咳痰、湿啰音、干啰音的出现率上升明显,脉数的出现率也有所上升,且增加了胸闷憋气、气短、倦怠乏力、腹胀等症状。
3.2.2心系内伤：
轻症病程为9天左右,发热出现频率下降,鼻塞流涕、头痛、汗出、咽痛、咽干舌燥消失,咽部充血成为主症。重症病程为10天左右,湿啰音、咽痛、咽部充血成为了主症,脉数不再是主症。危重症病程为12天左右,胸闷憋气倦怠乏力成为主症,且胸闷憋气较喘息气促出现频率更高。
3.2.3肾与膀胱内伤：
本组无轻症病例。重症病程为8天左右,脉数出现率明显上升,咽部充血湿啰音成为主症。危重症病程为7天左右,胸闷憋气、湿啰音、痰中带血出现率明显上升,倦怠乏力、纳差、心悸、气短、水肿也成为主症
3.2.4消渴内伤：
轻症病程为5天左右,症状种类简而少。重症病程为15天左右,病程较长,主症增加了湿啰音,且脉数出现率下降。危重症组病程为18天左右,咳嗽、喘息气促明显,发热不突出,同时有胸闷憋气、咽部充血、气短,脉数出现率下降。
3.2.5肝胆内伤：
轻症病程为14天左右,咳痰、肌肉酸痛、腹泻成为了主症。重症病程为18天左右,除没有脉数外,其他主症与无内伤基础病重症组相同。危重症病程为16天左右,与无内伤基础病危重症组相比,其主症并未出现喘息气促和脉数,而是增加了尿黄和倦怠乏力。
3.3特殊人群：
3.3.1孕妇组：
轻症组病程约为5天,主症中出现了恶风寒,而头痛、咽痛、咽干舌燥消失,同时,鼻塞流涕、汗出的频率明显上升；重症组病程约为7天,主症中出现了头痛、咽痛,同时脉数频率上升；危重症病程约为13天,主症中,喘息气促、脉数频率上升,而咳痰、湿啰音出现频率有所下降。
3.3.2肥胖组：
本组无轻症病例。重症组病程约为16天,主症中以咳痰、湿啰音、咽部充血、喘息气促较为突出；危重症病程约为19天,主症中纳差、咽痛、痰中带血、倦怠乏力较显著,而发热、脉数相对不突出。
4研究结论：
4.1无内伤基础病组
本组总体上遵循卫气营血传变规律,病位以肺为中心,传变快,层次清。
轻症组主要证候特点为风热毒邪侵袭肺卫；病情转折点在第3天左右；病邪主要由卫表而解。
重症组主要证候特点为气分热炽,生痰动血；病情转折点在第5天左右；邪气的变化主要在于从无形之热转为有形之痰湿,病邪主要由气分而解,少部分病例有邪气还表现象,但无入血趋势
危重症组证候特点为气分热炽,伤津动血,热、湿、毒、津血交迫,甚者肺闭气脱；病情转折点在第7天左右；邪气的变化主要在于有形痰热、湿毒的骤然增加和潜在的无形之气的耗伤,病邪主要由气分而解,部分病例津血外渗明显,病邪也可从血分而解,而无出表迹象。
危重症血证的形成关键不只在于血热,也与湿毒、津伤和气虚关系密切。
4.2内伤基础病组：
肺系内伤基础的甲流病情较重,病程较长,预后较差。肺气虚损,痰瘀内伏,复感风热毒邪是其基本病机。其中,重症组病情转折点在第5天左右,其证候特点偏于痰热阻肺,肺气虚弱,部分病例可见到脾胃不和及肺脾气虚；危重症病情转折点在第7天以后,其发热不显著,而主要表现为痰湿内盛、肺肾气虚、肾不纳气以及腑气不畅,有喘脱之险。
心系内伤基础的甲流病程较短,病情表现虽剧,但预后尚好。主要病机为心气不足,复感外邪,宗气运行不畅。轻症组咽部充血症状较为明显,病情转折点为第3天左右,邪气由表而解；重症组咽痛、咽部充血较突出,病情转折点为第5天,邪气由气分而解；危重症胸闷憋气、倦怠乏力等衰弱感觉较为显著,病情转折点为第7天,邪气主要由气分而解,少数病例可见邪气传变入血表现。
肾与膀胱内伤基础的甲流病程较短,但病情较重。其基本病机为肾气虚,风热毒邪外袭,水凌心肺。肺部湿啰音、胸闷憋气、痰中带血、倦怠乏力、心悸、脉数等是其突出表现。
消渴内伤基础的甲流病情较重,病程较长,病情演变较为缓慢,预后较差。气阴不足,外感风热毒邪,伤津耗气是本组基本病机。重症组以气分湿热表现为主,发热较其他主症并不显著,少数病例有表证或血证表现,病情转折点在第5天；危重症气阴两虚与痰湿内盛均较突出,其喘脱的危险性较大,病情转折点在第7天。
肝胆内伤基础的甲流病情较重,病程较长,预后较差。少阳气机郁滞不畅是其显著特点。轻症与重症既可见到卫表之肌肉酸痛、咽痛咽痒等表气不利的表现,也可见到恶心、呕吐、腹泻等腑气不和的表现；危重症咳嗽、咳痰并不突出,而主要表现为尿黄、倦怠乏力等三焦不畅,脾肾气虚的现象。
4.3特殊人群：
4.3.1孕妇组
本组病程中易见到营卫不和,气血不足的表现。
轻症组初起表现为邪在肺卫,恶风寒、汗出等卫气虚的现象较为突出,病情转折点在第3天,病邪可随汗出而从肺卫而解。重症组初起主要表现为痰热阻肺,易伴见咽痛、头痛、肌肉酸痛等营气不利的表现,病变主要在气分,可波及营血分,病情转折点在第3天,毒邪主要从气分而解。危重症突出表现为水湿内生,气阴大伤,尤其以前3天气阴两伤加重更为突出,伴有血证者前7天血分热势较炽,第7天为病情转折点,第7天到第14天仍需慎重调护,防止热势复张。
随着孕周的增加,出现危重症的几率增加。
4.3.2肥胖组：
与无内伤基础病组相比,肥胖组特点在于初起即表现为较明显的痰湿阻肺,肺卫之气郁闭。病情虽重,但预后尚好。重症组病情转折点在第3天,以邪实表现为主；危重症病情转折点在第5天,初起除咳痰、喘息气促、咽痛等痰湿内阻,肺卫郁闭的表现外,倦怠乏力、纳差、恶风寒等肺脾气虚的表现也较为明显,病机转变在于肺卫郁闭之气随痰湿的开化而得到舒展。
1Objec t i ve
To explore the different etiology, pathogenesis and their mutual relationship based on the results of statistics and analysis of TCM syndrome feature in H1N1influenza cases which were classified into three groups, no internal injury group, five different internal injury group and special group, and then to gain enlightenment from it for cures of H1N1influenza.
2Method
770cases of H1N1influenza were classified into no internal injury group, five different internal injury group and special group. We selected different point in Course according to different severity of patients'condition, and then calculated frequency distribution of symptoms and signs in different point in time in different groups, summarize their evolvement characteristics, and compare them among groups. The internal injury group was classified into lung system internal injury group, cardiac system internal injury group, kidney and bladder internal injury group, Xiaoke internal injury group, hepatobiliary system internal injury group. The special group, divided into pregnant women group and obesity group, was contained in no internal injury group. Each group above was classified into mild group, severe group and critically ill group. Frequency analysis was used to describe the frequency of39symptoms and9signs in each group. The symptoms of which frequencies were equal or greater than50%were regarded as primary symptoms and subsidiary symptoms for reference.
3Resul t
3.1no-internal injury group
The course of mild group was about10days. Beside pulmonary and body surface symptoms, the performances of mouth, nose, pharyngeal were obvious in primary symptoms. The course of severe group was about11days. Expectoration and rapid pulse became two primary symptoms. Blood-stained sputum and even pink bubble sputum can be seen in severe cases. The course of critically ill group was about18days. Moist rales and tachypnea appeared in primary symptoms, frequencies of blood-stained sputum and pink bubble sputum were increased, and the performances of dysthesia, coma and delirium, purpura and hemorrhagic spot can be seen in some cases.
3.2internal injury group
3.2. Hung system internal injury group
There was no mild case in this group. The course of severe group was about17days. Moist rales, languid, poor appetite, pharyngeal hyperemia and rhonchus became primary symptoms. The course of critically ill group was about16days. Frequencies of expectoration, moist rales and rhonchus and rapid pulse were significantly increased, and chest congestion, labored breathing, shortness of breath, languid, abdominal distension were newly appeared.
3.2.2cardiac system internal injury group
The course of mild group was about9days. Frequency of fever decreased, nasal congestion and running nose, headache, sweating, pharyngalgia, dry throat and tongue disappeared, and pharyngeal hyperemia became a primary symptom. The course of severe group was about10days. Moist rales, pharyngalgia and pharyngeal hyperemia became primary symptoms except rapid pulse. The course of critically ill group was about12days. Chest congestion, labored breathing, languid appeared in primary symptoms, and frequency of chest congestion, labored breathing was higher than tachypnea.
3.2.3kidney and bladder internal injury group
There was no mild case in this group too. The course of severe group was about8days. Pharyngeal hyperemia and moist rales became primary symptoms, and frequency of rapid pulse significantly increased. The course of critically ill group was about7days. Languid, poor appetite, palpitation, shortness of breath, edema became primary symptoms, and frequencies of chest congestion, labored breathing, moist rales, blood-stained sputum significantly increased.
3.2.4Xiaoke internal injury group
The course of mild group was about5days and only a few symptoms appeared. The longer course of severe group was about15days. Moist rales appeared and frequency of rapid pulse decreased. The course of critically ill group was about18days. There were obvious cough and tachypnea. fever was not prominent, and chest congestion, labored breathing, pharyngeal hyperemia, shortness of breath appeared. Frequency of rapid pulse decreased.
3.2.5hepatobiliary system internal injury group
The course of mild group was about14days. Expectoration, muscular soreness, diarrhea became primary symptoms. The course of severe group was about18days. The primary symptoms were the same as that in no internal injury group except rapid pulse. The course of critically ill group was about16days. Tachypnea and rapid pulse disappeared and yellow urine languid became primary symptoms comparing with that in no internal injury group.
3.3special groups
3.3.1pregnant women group
The course of mild group was about5days. Aversion to wind and cold appeared and frequencies of nasal congestion and running nose, sweating significantly increased. Headache, pharyngalgia, dry throat and tongue disappeared. The course of severe group was about7days. Headache, pharyngalgia became main symptoms and frequency of rapid pulse increased. The course of severe group was about13days. Frequencies of tachypnea and rapid pulse increased, while expectoration and moist rales decreased.
3.3.2obes i ty group
There was no mild case in this group. The course of severe group was about16days. Expectoration, moist, pharyngeal hyperemia, tachypnea were obvious. The course of severe group was about19days. Poor appetite, pharyngalgia, blood-stained sputum, tachypneawere prominent in primary symptoms while fever and rapid pulse not.
4conelusion
4. lno internal injury group
This group obey the law of defensive, energy, nutrients and blood transmission in general and lung is the focus location. It transmitted fast and the steps were clear.
The main syndrome characteristic of mild group was lung-defensive hit by wind-heat toxin evil. Turning point of the condition was in the third day and evil was relieved from defensive exterior.
The main syndrome characteristic of severe group was dominant heat in Qi system, producing phlegm and blood disturbance. Turning point of the condition was in the fifth day. The main change was the transmission from invisible Qi to visible phlegm. The evil was mainly relieved from Qi system, only a few from exterior, and no trend to blood system. The syndrome characteristic of severe group was dominant heat in Qi system, body fluid impairment and blood disturbance, heat, dampness, toxin, body fluid and blood mixing, and even obstruction of the lung and Qi exhaustion. Turning point of the condition was in the seventh day. The main pathogenesis change lay in suddenly increased visible phlegm, heat, dampness toxin and consumption of invisible Qi. The evil was mainly relieved from Qi system too, and in some cases with obvious exosmosis of body fluid and blood it was relieved from blood system, but no trend to exterior.
The key factor of blood trouble lay in not only blood-heat, but also dampness toxin, consumption of body fluid and qi deficiency.
4.2internal injury group
The cases in lung system internal injury group had serious condition and longer course, the prognosis is poor. The basic pathogenesis was being infected bywind-heat toxin evil on the basis of lung qi deficiency, latent phlegm and blood stasis. Turning point of severe group was in fifth day. The syndrome characteristic of this group lay in phlegm-heat obstructing lung, lung qi deficiency, lung-spleen qi deficiency and incoordination between the spleen and the stomach could be seen in some cases. Turning point of critically ill group was after the seventh day. Fever was not obvious and the main performance was exuberance of interior phlegm-dampness, lung-kidney qi deficiency, kidney dysfunction in qi holding and fu-qi impassable. They were in danger of stopping breathing due to tachypnea.
The course of cardiac system internal injury group was shorter and it had favourable prognosis in spite of intense condition. The main pathogenesis was pectoral qi obstruction due to infected based on heart-qi deficiency. Performance of pharyngeal hyperemia was obvious in mild groups and turning point was in the third day, evil was relieved from exterior. There were significant pharyngalgia and pharyngeal hyperemia in severe group. The turning point was in the fifth day and evil was relieved from qi system. The feeling of weakness, such as chest congestion, labored breathing, languid, obviously appeared in critically group. Turning point of the course was in the seventh day and the evil was relieved from qi system too, a few with trend to blood. The kidney and bladder internal injury group had a shorter course and serious condition. The basic pathogenesis was lung and heart invaded by water-qi due to infected by exogenous evil on basis of kidney qi deficiency. The significant performance was moist rales, chest congestion, labored breathing, blood-stained sputum, languid, palpitation and rapid pulse.
The condition of Xiaoke internal injury group was more serious and it had a poor prognosis. The progress was slow and longer. Body fluid impairment and consumption of qi was the basic pathogenesis due to being infected on the basis of deficiency of both qi and yin. The main syndrome of severe group was dampness-heat in qi system and fever was non-significant. The turning point was in the fifth day. Deficiency of both qi and yin was as obvious as exuberance of interior phlegm-dampness in critically ill group and the turning point was in the seventh day. It was in danger of stopping breathing due to tachypnea.
The course of hepatobiliary system internal injury group was longer, the condition was serious and it had a poor prognosis too. The significant characteristic was stagnation of shaoyang-qi activity. The performance of non-circulating exterior qi and stoppage of fu-qi could be seen not only in mild group but also in severe group. Cough and expectoration were not obvious in critically ill group and the significant performance was the stoppage of sanjiao and deficiency of spleen and kidney.
4.3special groups
4.3.1pregnant women group
The performance of disharmony between ying and wei, deficiency of qi and blood could be seen commonly in this group. Firstly, it performed evil in lung-defensive in mild group, and deficiency of weiqi was significant. The turning point was in the third day, and evil was relieved from lung-defensive along with sweating. The primary syndrome of severe group was phlegm-heat obstructing lung with some performance of non-circulating ying-qi, and the main location was in qisystem, only some in ying and blood system. The turning point was in the third day and evil was relieved from qi system. The significant performance of critically ill group was endogenetic water-dampness and particularly damaged qi and yin, especially in the first three days. Cases with blood syndrome performed dominant heat in blood system in the first seven days. The turning point was in the seventh day, and patients still need to be care to prevent recurrence during the second week. The chance of critically ill cases increased with the increasing of gestational weeks.
4.3.2obesity group
The significant performance of this group was phlegm-dampness obstructing lung and closing of lung-defensive qi at first. The condition was serious but the prognosis was well. The severe group performed mainly excess of evil and the turning point of it was in the third day. Turning point of critically ill group was in the fifth day. Deficiency of lung-spleen qi was as obvious as the performance of phlegm-dampness obstructing lung and closing of lung-defensive qi in this group at first. Change of pathogenesis lay in that the closed lung-defensive qi extended with reduction of phlegm-dampness.
通过统计和比较分析无内伤基础病、五类不同内伤基础病、特殊人群等3大类型甲型H1N1流感的临床中医证候特点,分析其不同的病因病机及其相互关系,以期对甲型H1N1流感的临床治疗思路和方法有所启发和提高。
2研究方法：
将770例甲型H1N1流感确诊病例分为无内伤基础病组、内伤基础病组、特殊人群组,根据病情程度,选取不同数目的病程节点,统计各组内不同时间节点的症状和体征频次,总结其症状和体征频次演变特点,进行组间比较分析。其中,内伤基础病组分肺系内伤组、心系内伤组、肾与膀胱内伤组、消渴内伤组、肝胆内伤组；特殊人群组包含在无内伤基础病组内,又分为孕妇组与肥胖组。以上每一组内又进一步分为轻症组、重症组、危重症组三个亚组。用频数分析描述各组39项症状和9项体征的出现频次,将出现频次大于或等于50%的症状列为主症作主要分析,次症仅作参考。
3研究结果：
3.1无内伤基础病组：
轻症组病程为10天左右,主症除肺部症状、体表症状外,头面部口、鼻咽等清窍症状亦较明显。重症组病程为11天左右,咳痰、脉数变为主症,较重者可见痰中带血,甚至咳吐粉红色泡沫痰。危重症组病程为18天左右,主症中出现了湿啰音、喘息气促；痰中带血和咳吐粉红色泡沫痰出现频率上升部分病例也可见到烦躁、神昏谵语、紫癜、出血点等表现。
3.2内伤基础病组
3.2.1肺系内伤：
本组无轻症病例。重症病程为17天左右,湿啰音、倦怠乏力、纳差、咽部充血、干啰音成为主症。危重症病程为16天左右,咳痰、湿啰音、干啰音的出现率上升明显,脉数的出现率也有所上升,且增加了胸闷憋气、气短、倦怠乏力、腹胀等症状。
3.2.2心系内伤：
轻症病程为9天左右,发热出现频率下降,鼻塞流涕、头痛、汗出、咽痛、咽干舌燥消失,咽部充血成为主症。重症病程为10天左右,湿啰音、咽痛、咽部充血成为了主症,脉数不再是主症。危重症病程为12天左右,胸闷憋气倦怠乏力成为主症,且胸闷憋气较喘息气促出现频率更高。
3.2.3肾与膀胱内伤：
本组无轻症病例。重症病程为8天左右,脉数出现率明显上升,咽部充血湿啰音成为主症。危重症病程为7天左右,胸闷憋气、湿啰音、痰中带血出现率明显上升,倦怠乏力、纳差、心悸、气短、水肿也成为主症
3.2.4消渴内伤：
轻症病程为5天左右,症状种类简而少。重症病程为15天左右,病程较长,主症增加了湿啰音,且脉数出现率下降。危重症组病程为18天左右,咳嗽、喘息气促明显,发热不突出,同时有胸闷憋气、咽部充血、气短,脉数出现率下降。
3.2.5肝胆内伤：
轻症病程为14天左右,咳痰、肌肉酸痛、腹泻成为了主症。重症病程为18天左右,除没有脉数外,其他主症与无内伤基础病重症组相同。危重症病程为16天左右,与无内伤基础病危重症组相比,其主症并未出现喘息气促和脉数,而是增加了尿黄和倦怠乏力。
3.3特殊人群：
3.3.1孕妇组：
轻症组病程约为5天,主症中出现了恶风寒,而头痛、咽痛、咽干舌燥消失,同时,鼻塞流涕、汗出的频率明显上升；重症组病程约为7天,主症中出现了头痛、咽痛,同时脉数频率上升；危重症病程约为13天,主症中,喘息气促、脉数频率上升,而咳痰、湿啰音出现频率有所下降。
3.3.2肥胖组：
本组无轻症病例。重症组病程约为16天,主症中以咳痰、湿啰音、咽部充血、喘息气促较为突出；危重症病程约为19天,主症中纳差、咽痛、痰中带血、倦怠乏力较显著,而发热、脉数相对不突出。
4研究结论：
4.1无内伤基础病组
本组总体上遵循卫气营血传变规律,病位以肺为中心,传变快,层次清。
轻症组主要证候特点为风热毒邪侵袭肺卫；病情转折点在第3天左右；病邪主要由卫表而解。
重症组主要证候特点为气分热炽,生痰动血；病情转折点在第5天左右；邪气的变化主要在于从无形之热转为有形之痰湿,病邪主要由气分而解,少部分病例有邪气还表现象,但无入血趋势
危重症组证候特点为气分热炽,伤津动血,热、湿、毒、津血交迫,甚者肺闭气脱；病情转折点在第7天左右；邪气的变化主要在于有形痰热、湿毒的骤然增加和潜在的无形之气的耗伤,病邪主要由气分而解,部分病例津血外渗明显,病邪也可从血分而解,而无出表迹象。
危重症血证的形成关键不只在于血热,也与湿毒、津伤和气虚关系密切。
4.2内伤基础病组：
肺系内伤基础的甲流病情较重,病程较长,预后较差。肺气虚损,痰瘀内伏,复感风热毒邪是其基本病机。其中,重症组病情转折点在第5天左右,其证候特点偏于痰热阻肺,肺气虚弱,部分病例可见到脾胃不和及肺脾气虚；危重症病情转折点在第7天以后,其发热不显著,而主要表现为痰湿内盛、肺肾气虚、肾不纳气以及腑气不畅,有喘脱之险。
心系内伤基础的甲流病程较短,病情表现虽剧,但预后尚好。主要病机为心气不足,复感外邪,宗气运行不畅。轻症组咽部充血症状较为明显,病情转折点为第3天左右,邪气由表而解；重症组咽痛、咽部充血较突出,病情转折点为第5天,邪气由气分而解；危重症胸闷憋气、倦怠乏力等衰弱感觉较为显著,病情转折点为第7天,邪气主要由气分而解,少数病例可见邪气传变入血表现。
肾与膀胱内伤基础的甲流病程较短,但病情较重。其基本病机为肾气虚,风热毒邪外袭,水凌心肺。肺部湿啰音、胸闷憋气、痰中带血、倦怠乏力、心悸、脉数等是其突出表现。
消渴内伤基础的甲流病情较重,病程较长,病情演变较为缓慢,预后较差。气阴不足,外感风热毒邪,伤津耗气是本组基本病机。重症组以气分湿热表现为主,发热较其他主症并不显著,少数病例有表证或血证表现,病情转折点在第5天；危重症气阴两虚与痰湿内盛均较突出,其喘脱的危险性较大,病情转折点在第7天。
肝胆内伤基础的甲流病情较重,病程较长,预后较差。少阳气机郁滞不畅是其显著特点。轻症与重症既可见到卫表之肌肉酸痛、咽痛咽痒等表气不利的表现,也可见到恶心、呕吐、腹泻等腑气不和的表现；危重症咳嗽、咳痰并不突出,而主要表现为尿黄、倦怠乏力等三焦不畅,脾肾气虚的现象。
4.3特殊人群：
4.3.1孕妇组
本组病程中易见到营卫不和,气血不足的表现。
轻症组初起表现为邪在肺卫,恶风寒、汗出等卫气虚的现象较为突出,病情转折点在第3天,病邪可随汗出而从肺卫而解。重症组初起主要表现为痰热阻肺,易伴见咽痛、头痛、肌肉酸痛等营气不利的表现,病变主要在气分,可波及营血分,病情转折点在第3天,毒邪主要从气分而解。危重症突出表现为水湿内生,气阴大伤,尤其以前3天气阴两伤加重更为突出,伴有血证者前7天血分热势较炽,第7天为病情转折点,第7天到第14天仍需慎重调护,防止热势复张。
随着孕周的增加,出现危重症的几率增加。
4.3.2肥胖组：
与无内伤基础病组相比,肥胖组特点在于初起即表现为较明显的痰湿阻肺,肺卫之气郁闭。病情虽重,但预后尚好。重症组病情转折点在第3天,以邪实表现为主；危重症病情转折点在第5天,初起除咳痰、喘息气促、咽痛等痰湿内阻,肺卫郁闭的表现外,倦怠乏力、纳差、恶风寒等肺脾气虚的表现也较为明显,病机转变在于肺卫郁闭之气随痰湿的开化而得到舒展。
1Objec t i ve
To explore the different etiology, pathogenesis and their mutual relationship based on the results of statistics and analysis of TCM syndrome feature in H1N1influenza cases which were classified into three groups, no internal injury group, five different internal injury group and special group, and then to gain enlightenment from it for cures of H1N1influenza.
2Method
770cases of H1N1influenza were classified into no internal injury group, five different internal injury group and special group. We selected different point in Course according to different severity of patients'condition, and then calculated frequency distribution of symptoms and signs in different point in time in different groups, summarize their evolvement characteristics, and compare them among groups. The internal injury group was classified into lung system internal injury group, cardiac system internal injury group, kidney and bladder internal injury group, Xiaoke internal injury group, hepatobiliary system internal injury group. The special group, divided into pregnant women group and obesity group, was contained in no internal injury group. Each group above was classified into mild group, severe group and critically ill group. Frequency analysis was used to describe the frequency of39symptoms and9signs in each group. The symptoms of which frequencies were equal or greater than50%were regarded as primary symptoms and subsidiary symptoms for reference.
3Resul t
3.1no-internal injury group
The course of mild group was about10days. Beside pulmonary and body surface symptoms, the performances of mouth, nose, pharyngeal were obvious in primary symptoms. The course of severe group was about11days. Expectoration and rapid pulse became two primary symptoms. Blood-stained sputum and even pink bubble sputum can be seen in severe cases. The course of critically ill group was about18days. Moist rales and tachypnea appeared in primary symptoms, frequencies of blood-stained sputum and pink bubble sputum were increased, and the performances of dysthesia, coma and delirium, purpura and hemorrhagic spot can be seen in some cases.
3.2internal injury group
3.2. Hung system internal injury group
There was no mild case in this group. The course of severe group was about17days. Moist rales, languid, poor appetite, pharyngeal hyperemia and rhonchus became primary symptoms. The course of critically ill group was about16days. Frequencies of expectoration, moist rales and rhonchus and rapid pulse were significantly increased, and chest congestion, labored breathing, shortness of breath, languid, abdominal distension were newly appeared.
3.2.2cardiac system internal injury group
The course of mild group was about9days. Frequency of fever decreased, nasal congestion and running nose, headache, sweating, pharyngalgia, dry throat and tongue disappeared, and pharyngeal hyperemia became a primary symptom. The course of severe group was about10days. Moist rales, pharyngalgia and pharyngeal hyperemia became primary symptoms except rapid pulse. The course of critically ill group was about12days. Chest congestion, labored breathing, languid appeared in primary symptoms, and frequency of chest congestion, labored breathing was higher than tachypnea.
3.2.3kidney and bladder internal injury group
There was no mild case in this group too. The course of severe group was about8days. Pharyngeal hyperemia and moist rales became primary symptoms, and frequency of rapid pulse significantly increased. The course of critically ill group was about7days. Languid, poor appetite, palpitation, shortness of breath, edema became primary symptoms, and frequencies of chest congestion, labored breathing, moist rales, blood-stained sputum significantly increased.
3.2.4Xiaoke internal injury group
The course of mild group was about5days and only a few symptoms appeared. The longer course of severe group was about15days. Moist rales appeared and frequency of rapid pulse decreased. The course of critically ill group was about18days. There were obvious cough and tachypnea. fever was not prominent, and chest congestion, labored breathing, pharyngeal hyperemia, shortness of breath appeared. Frequency of rapid pulse decreased.
3.2.5hepatobiliary system internal injury group
The course of mild group was about14days. Expectoration, muscular soreness, diarrhea became primary symptoms. The course of severe group was about18days. The primary symptoms were the same as that in no internal injury group except rapid pulse. The course of critically ill group was about16days. Tachypnea and rapid pulse disappeared and yellow urine languid became primary symptoms comparing with that in no internal injury group.
3.3special groups
3.3.1pregnant women group
The course of mild group was about5days. Aversion to wind and cold appeared and frequencies of nasal congestion and running nose, sweating significantly increased. Headache, pharyngalgia, dry throat and tongue disappeared. The course of severe group was about7days. Headache, pharyngalgia became main symptoms and frequency of rapid pulse increased. The course of severe group was about13days. Frequencies of tachypnea and rapid pulse increased, while expectoration and moist rales decreased.
3.3.2obes i ty group
There was no mild case in this group. The course of severe group was about16days. Expectoration, moist, pharyngeal hyperemia, tachypnea were obvious. The course of severe group was about19days. Poor appetite, pharyngalgia, blood-stained sputum, tachypneawere prominent in primary symptoms while fever and rapid pulse not.
4conelusion
4. lno internal injury group
This group obey the law of defensive, energy, nutrients and blood transmission in general and lung is the focus location. It transmitted fast and the steps were clear.
The main syndrome characteristic of mild group was lung-defensive hit by wind-heat toxin evil. Turning point of the condition was in the third day and evil was relieved from defensive exterior.
The main syndrome characteristic of severe group was dominant heat in Qi system, producing phlegm and blood disturbance. Turning point of the condition was in the fifth day. The main change was the transmission from invisible Qi to visible phlegm. The evil was mainly relieved from Qi system, only a few from exterior, and no trend to blood system. The syndrome characteristic of severe group was dominant heat in Qi system, body fluid impairment and blood disturbance, heat, dampness, toxin, body fluid and blood mixing, and even obstruction of the lung and Qi exhaustion. Turning point of the condition was in the seventh day. The main pathogenesis change lay in suddenly increased visible phlegm, heat, dampness toxin and consumption of invisible Qi. The evil was mainly relieved from Qi system too, and in some cases with obvious exosmosis of body fluid and blood it was relieved from blood system, but no trend to exterior.
The key factor of blood trouble lay in not only blood-heat, but also dampness toxin, consumption of body fluid and qi deficiency.
4.2internal injury group
The cases in lung system internal injury group had serious condition and longer course, the prognosis is poor. The basic pathogenesis was being infected bywind-heat toxin evil on the basis of lung qi deficiency, latent phlegm and blood stasis. Turning point of severe group was in fifth day. The syndrome characteristic of this group lay in phlegm-heat obstructing lung, lung qi deficiency, lung-spleen qi deficiency and incoordination between the spleen and the stomach could be seen in some cases. Turning point of critically ill group was after the seventh day. Fever was not obvious and the main performance was exuberance of interior phlegm-dampness, lung-kidney qi deficiency, kidney dysfunction in qi holding and fu-qi impassable. They were in danger of stopping breathing due to tachypnea.
The course of cardiac system internal injury group was shorter and it had favourable prognosis in spite of intense condition. The main pathogenesis was pectoral qi obstruction due to infected based on heart-qi deficiency. Performance of pharyngeal hyperemia was obvious in mild groups and turning point was in the third day, evil was relieved from exterior. There were significant pharyngalgia and pharyngeal hyperemia in severe group. The turning point was in the fifth day and evil was relieved from qi system. The feeling of weakness, such as chest congestion, labored breathing, languid, obviously appeared in critically group. Turning point of the course was in the seventh day and the evil was relieved from qi system too, a few with trend to blood. The kidney and bladder internal injury group had a shorter course and serious condition. The basic pathogenesis was lung and heart invaded by water-qi due to infected by exogenous evil on basis of kidney qi deficiency. The significant performance was moist rales, chest congestion, labored breathing, blood-stained sputum, languid, palpitation and rapid pulse.
The condition of Xiaoke internal injury group was more serious and it had a poor prognosis. The progress was slow and longer. Body fluid impairment and consumption of qi was the basic pathogenesis due to being infected on the basis of deficiency of both qi and yin. The main syndrome of severe group was dampness-heat in qi system and fever was non-significant. The turning point was in the fifth day. Deficiency of both qi and yin was as obvious as exuberance of interior phlegm-dampness in critically ill group and the turning point was in the seventh day. It was in danger of stopping breathing due to tachypnea.
The course of hepatobiliary system internal injury group was longer, the condition was serious and it had a poor prognosis too. The significant characteristic was stagnation of shaoyang-qi activity. The performance of non-circulating exterior qi and stoppage of fu-qi could be seen not only in mild group but also in severe group. Cough and expectoration were not obvious in critically ill group and the significant performance was the stoppage of sanjiao and deficiency of spleen and kidney.
4.3special groups
4.3.1pregnant women group
The performance of disharmony between ying and wei, deficiency of qi and blood could be seen commonly in this group. Firstly, it performed evil in lung-defensive in mild group, and deficiency of weiqi was significant. The turning point was in the third day, and evil was relieved from lung-defensive along with sweating. The primary syndrome of severe group was phlegm-heat obstructing lung with some performance of non-circulating ying-qi, and the main location was in qisystem, only some in ying and blood system. The turning point was in the third day and evil was relieved from qi system. The significant performance of critically ill group was endogenetic water-dampness and particularly damaged qi and yin, especially in the first three days. Cases with blood syndrome performed dominant heat in blood system in the first seven days. The turning point was in the seventh day, and patients still need to be care to prevent recurrence during the second week. The chance of critically ill cases increased with the increasing of gestational weeks.
4.3.2obesity group
The significant performance of this group was phlegm-dampness obstructing lung and closing of lung-defensive qi at first. The condition was serious but the prognosis was well. The severe group performed mainly excess of evil and the turning point of it was in the third day. Turning point of critically ill group was in the fifth day. Deficiency of lung-spleen qi was as obvious as the performance of phlegm-dampness obstructing lung and closing of lung-defensive qi in this group at first. Change of pathogenesis lay in that the closed lung-defensive qi extended with reduction of phlegm-dampness.
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