台湾台北地区外感咳嗽的中医证型研究
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摘要
咳嗽是指肺失宣降,肺气上逆,发出咳声,或咳吐痰液的一种肺系病证。咳嗽为内科门急诊中最为常见的病证之一,发病率甚高,据统计发病率为3%—5%,在老年人中的发病率可达10%-15%,尤以寒冷地区发病率更高。咳嗽既是肺系疾病的主要症状之一,也是独立性的疾病；其症状表现多样,可导致多种併发症,常见的有胸壁与腹壁疼痛以及疲劳、尿失禁,若久咳不愈容易发展为慢性支气管炎、哮喘等疾病,严重影响人们的生活和工作。
俗谚：“水泥匠怕补屋漏,医生怕治咳嗽。”这是由于咳嗽的病因不一,容易施治误治传变,影响诊断的正确性；如清徐灵胎谓：“诸病之中,惟咳嗽之病因各殊而最难愈,治或稍误,即遗害无穷。余以此证考求四十余年,而后始能措手。”由此可见咳嗽病因与症状的复杂性,其证治规律不易掌握,必须审证求因,才能对症治疗。中医早就对咳嗽的病因病机进行了一系列的论述,对于咳嗽的治疗也积累了大量
的临床经验。《河间六书·咳嗽论》谓：“寒、暑、湿、燥、风、火六气,皆令人咳嗽”《景岳全书·咳嗽》说：“外感之嗽,必因风寒。”《素问·咳论》说：“五脏六腑皆令人咳,非独肺也。”说明咳嗽的病变脏腑不限于肺。咳嗽的病因可分为外感和内伤两类,外感咳嗽由风、寒、暑、湿、燥、火等六淫外邪犯肺所致；内伤咳嗽则因饮食不节、情志内伤使肺脏虚损或其它脏腑病变累及肺脏所致。药物治疗上根据不同的病因病机,辨证论治,外邪伤肺咳嗽,治以宣肺清肺止咳,兼以疏风、散寒、清热、泻火、润燥、化痰等药物；内邪伤肺咳嗽,则多以祛邪扶正,标本兼顾为法,常用清火、去痰、益气、养血、滋阴、补阳等药物。中医对本病进行了大量研究,在病因病机和预防治疗方面取得了很大进展,在辨
证分型特点方面,由于地域性的差异,各地对外感咳嗽的辨证分型有不同的认识。目前相关报道多限于临床和实验研究,缺乏辨证分型规律的大样本调查研究,本研究根据文献报导,参考台北地区的地理特性,以及肺的生理特性,以风寒犯肺型,风热犯肺型,风燥伤肺型等证型研究；由于台湾地区地处北回归线两侧,为亚热带地区,属岭南医学范围,因此参考岭南地区特点,再加上痰湿郁肺型、痰热蕴肺型研究。本研究通过对台北地区252例外感咳嗽的临床表现观察,研究探讨台北地区外感咳嗽的中医辨证分型特点,为进一步规范其临床诊疗、提高防治水平提供临床依据。方法使用横断面调查方法,调查台北地区外感咳嗽的中医证型特点。
1文献检索,查阅相关文献,归纳外感咳嗽的发病因素。
2根据《中华人民共和国中医药行业标准—中医症状证候诊断疗效标准》、《中药新药临床研究指导原则》及《中医内科学》制订外感咳嗽的中医证候诊断标准及中医证候调查表。
3调查表包含姓名、年龄、日期、性别、病史、居住地址、联络电话、纳入标准、排除标准、中医证型分型标准。
4培训参与调查人员(皆为台北地区执业中医师),且事先学习、正确掌握统一的诊断及辨证标准、纳入标准、排除标准。
5填写调查表,针对台北地区外感咳嗽患者由专职医师诊断填写。
6统计分析。
结果通过描述性分析显示：本地区的外感咳嗽以风燥伤肺为主有94例(37.3%),其次依次为风热犯肺89例(35.3%),风寒犯肺64例(25.4%),痰热郁肺4例(1.6%)痰湿蕴肺1例(0.4%),说明风燥伤肺、风热犯肺是台北地区咳嗽的常见证型。
风寒犯肺的病人主症必备,在次证中以舌苔薄白(85.9%)和鼻塞或喷涕或流清涕(84.4%)最为常见；其次是恶寒重发热轻(67.2%)、头痛或身痛(45.3%)、口不渴(45.3%),脉浮紧则比较少(15.6%)。
风寒咳嗽的特点大多数属中度以下的痒咳或痰咳,咳嗽加重时间差异不大,伴随症状以咯痰不爽、咳引头痛比较明显,咳甚则喘,咳嗽声音嘶哑、声重气急、气逆呛咳阵作、咳引胸痛、咳时面红目赤则比较少。部分伴有神疲乏力或头痛症状,发热或恶热的情况不多,大部分皆有程度不等的恶寒,一半以上的人无汗,鼻部症状多见鼻塞、喷嚏、流清涕,咽部症状以咽痒明显,咽干咽痛很少见,少数人出现胸闷胃胀症状,饮食、口味、饮水、二便、睡眠大部分皆正常不受影响,舌苔多见薄黄苔,舌质以舌淡红或淡白为主,部分有齿痕。
饮食习惯上,风寒犯肺的病人爱吃甜食的比例显着高于风热犯肺和风燥伤肺,全身神疲乏力以及气短懒言的比例最高,痰咳或同时发生痒咳和痰咳的比例也比较高,较常发生恶寒的情况,喷嚏流清涕的症状在风寒犯肺的病人中较常见,自汗、盗汗以及咳痰不爽的状况比风热犯肺和风燥伤肺明显。
风热犯肺的病人主症必备,在次证中以鼻塞或流浊涕所占的比例最高(83.7%),其次为脉浮数(73.9%)。舌边尖红(47.8%)、口干欲饮水(45.7%)、舌苔薄黄(44.6%)；而发热重恶寒轻(12.0%)、汗出(10.9%)则比较少。
风热咳嗽的特点,大多数表现为中度以下的痒咳或痰咳,咳嗽加重时间没有差异,神疲乏力的不多,有一部分人咳嗽遇冷风加重。咳嗽伴随症状以声音嘶哑、声重气急、咳引胸痛比较明显,咯痰不爽、咳引头痛的较少。一半以上的人咽喉肿痛、咽痒明显,鼻塞、流浊涕突出,汗出、恶寒、发热或恶热的情况不多,大部分患者的食欲、饮水、大小便以及睡眠的变化都不明显,舌象多见淡红舌或舌边尖红,舌红的较少,淡白舌很少见,大部分以薄黄苔为主,舌有齿痕突出。
风燥伤肺的病人主症必备,在次证中以咽痒90.5%所占的比例最高,其次依序为苔薄白或薄黄(69.5%)、脉浮数(59.0%)、口干欲饮(56.8%),头身痛(25.3%)舌干少津(19.0%)身热微恶风寒(14.7%)痰中带血(3.2%)。
风燥咳嗽的特点,大多数表现为轻度的痒咳或干咳,咳嗽加重时间不明显；有一部分人咳嗽遇冷风加重,咳嗽的伴随症状以声音嘶哑、咳引胸痛、咳引头痛较常见,少数患者有身疲乏力现象,汗出、恶寒、发热或恶热的情况很少,鼻部症状以鼻塞较明显,部分有浊涕,喷嚏、清涕较少见；咽痒、咽痛突出,食欲、饮水、大小便以及睡眠的变化都不明显；多见舌淡红或舌边尖红,舌红的较少,淡白舌很少见。大部分以薄黄苔为主,舌有齿痕明显。
痰热郁肺的病人主症必备,在次证中以脉浮数占4例(100%)、舌红(75.0%)烦热口干(50.0%、)苔黄腻(25.0%)。痰湿蕴肺主证次证全具。
台北地区外感咳嗽中医证型特点以风燥伤肺、风热犯肺为主,其次为风寒犯肺,痰热郁肺及痰湿蕴肺病例很少。这与国内的多数文献研究不一太致,由于四时六气不同,外感咳嗽容易表现为风寒、风热、温燥等不同证候,在疾病发展过程中也可见寒热的转化以及错杂。由于台北热岛效应,气候有高温化、干燥化的表现,当风、寒、湿、燥之邪侵肺时,极易化热,出现咳嗽痰黄、口干、脉数等风热之征。体质阴津易亏者,由于干燥化的影响,可出现咳嗽无痰或痰少难出、鼻咽干燥、口干、舌干少津等风燥之证。因此热岛效应的高温化、干燥化,影响台北地区的外感咳嗽证型多见风燥伤肺和风热犯肺。
台北地区为亚热带气候,夏季长冬季短,湿润多雨,气候炎热,人们喜食生冷冰品与肥甘厚腻食物,长期的湿热气候和生活习惯,应会影响脾胃运化功能而有湿、热的表现；但由于热岛效应的干燥化对台北地区有一定的影响,使得潮湿多雨的气候对机体的影响较小,所以痰热郁肺及痰湿蕴肺的症状并不明显,这与岭南地区外感咳嗽症候特点有所不同。
结论本研究探讨了台北地区252例外感咳嗽的中医辨证分型特点,通过临床及有关研究,初步得出以下结论：
(1)台北地区外感咳嗽中医证型特点以风燥伤肺、风热犯肺为主。
(2)台北地区的人群体质特点为脾肺气虚、肺阴虚。
(3)影响台北地区外感咳嗽证型特点的因素是多方面的,可能是台北地区特殊的盆地地理环境,多变炎热的气候,脾肺气虚、肺阴虚的体质因素,不良的生活饮食习惯所造成的。从一侧面证实了外感咳嗽有其地域特点,观点符合中医天人相应学说。
本研究首次针对台北地区人群,研究外感咳嗽的中医辨证分型特点以及体质特点,对外感咳嗽证候做了深入的探索,在辨证治疗上做到更规范化,为提高防治水平,提供进一步理论依据。
以上结论将对台北地区外感咳嗽辨证分型有一定的帮助,许多学者对本病防治进行大量的研究,不论病因病机或影响因素都提出一些观点,未来可以通过流行病学调查方法,以前瞻性、大样本的调查,研究发病机理,寻找中医证型特点,在治疗体系上做到更规范化,统一外感咳嗽的辩证分型标准,提高中医对外感咳嗽的治疗水平。
Vision is the loss of lung cough drop, lung Shangni issue Ke Sheng, or a liquid cough spit of Pulmonary Diseases. Cough Medicine and Emergency Department of one of the most common disease and syndrome, high incidence, according to statistics the incidence rate of 3% to 5% incidence in the elderly up to 10% to 15%, especially in cold area of disease rate higher. Cough is the main symptoms of lung diseases, is also independent of disease; its diverse symptoms, complications can lead to multiple Merger, often with abdominal and chest wall pain, and fatigue, urinary incontinence, if prone to develop Cough chronic bronchitis, asthma and other diseases seriously affect people's lives and work.
Very early on cough medicine pathogenesis conducted a series of expositions, for the treatment of cough and accumulated a lot of clinical experience. "River of six-books·cough" that:"cold, heat, dampness, dryness, wind, fire six gases, are people coughing, " "Jing Yue Quan Shu·coughing, " said:"Exogenous the cough, will be due to cold. " "Plain Questions·cough of" said:"The internal organs are people cough, lungs are non-exclusive. " description cough organs are not limited to lung disease. Cause of cough can be divided into two types of exogenous and internal injuries, common cough by the wind, cold, heat, dampness, dryness, fire, etc. Fanfei six disease caused by exogenous pathogens; internal injuries cough due to improper diet, emotions and internal injuries to the lungs empty loss or other organs caused by lesions involving the lung. Drug treatment on the basis of different pathogenesis, diagnosis and treatment, exogenous pathogens cough lung injury, treatment with Xuanfei lung to relieve cough and to disperse wind, and cold, heat, purging fire, moistening, phlegm other drugs; in evil injured lung cough, is more of dispelling evil head of the CIA both samples for the law, common clearing fire, Qu Tan, Qi, blood, yin, yang and other drugs.
Chinese medicine for this disease has been studied, the disease and its prevention and treatment has made great progress in syndrome differentiation characteristics, due to regional differences, the external parts of the dialectical sense of cough have a different understanding of type. Present relevant reports are mostly clinical and experimental research, the lack of syndrome differentiation rules in large sample survey research, this study reports the literature, reference to the geographical characteristics of the Taipei area, and the physiological characteristics of the lungs to cold Fanfei type, wind-heat Fanfei type, air dry lung injury syndromes such as study type; as the Tropic of Cancer is located on both sides of the Taiwan region for subtropical regions, is a South Medical range, and so the Lingnan area characteristics, together with lung phlegm depression type, phlegm Yun-lung type of. In this study, except by a sense of Taipei 252 observation of clinical manifestations of cough, cough study Taipei exogenous characteristics of syndrome differentiation of TCM, to further standardize its clinical diagnosis and treatment, improving prevention and treatment for clinical basis.
Methods:Using cross-sectional survey method to investigate Taipei cough syndromes exogenous characteristics.
1, document retrieval, access to relevant literature, the incidence of cough induction of exogenous factor.
2, according to "The People's Republic of China Traditional Chinese Medicine industry standard symptoms of a syndrome of Lung Cancer, " "guiding principles for new drug clinical research of Chinese medicine" and "Traditional Chinese Medicine in Science" exogenous cough developed diagnostic criteria and TCM Syndrome Questionnaire.
3, the questionnaire include name, age, date, gender, medical history, residential address, telephone, inclusion criteria, exclusion criteria, TCM typing standard.
4, the training staff involved in the investigation (all TCM practitioners in the Taipei area), and prior learning, the correct diagnosis and differentiation control a unified standard, the inclusion criteria and exclusion criteria.
5, fill out the questionnaire, patients in Taipei common cough filled by a full-time physician.
6, statistical analysis.
The descriptive analysis showed that:the region's exogenous to the wind dry cough mainly lung injury,94 cases (37.3%), followed by wind-heat Fanfei were 89 cases (35.3%), cold Fanfei 64 cases (25.4%), phlegm Yu lung in 4 cases (1.6%), phlegm retention in the lung in 1 case (0.4%), indicating that lung injury dry wind, the wind is hot Fanfei Taipei cough syndromes. Cold Fanfei main symptoms of patients cough, sputum thin white, the course is short necessary, in the second card in order to thin white fur (85.9%) and nasal congestion or nasal discharge or jet stream clear nasal discharge (84.4%) most common; Second, aversion to cold and heat light weight (67.2%), headache or body pain (45.3%), I thirst (45.3%), floating and tight pulse is relatively small (15.6%).
Most of the characteristics of cold cough moderate itching cough or sputum following cough, cough increased time is insignificant, with the uncomfortable symptoms cough, headache, cough cited more obvious, if extreme, dyspnea cough, cough, hoarseness, shortness of breath sound of heavy, inverse matrix for gas cough, cough cited chest pain, cough when the face is less red red eyes. Some have Shenpi weakness or headache associated with symptoms of fever or bad there is not much heat, most Jieyou varying degrees of aversion to cold, more than half no sweat, nasal symptoms more common nasal congestion, sneezing, clear nasal discharge, itchy throat clear throat symptoms, throat sore throat is rare, a few symptoms of chest tightness fullness, diet, taste, drinking water, the second will be, normal sleep were not affected much, more common thin yellow tongue coating, tongue tongue pink or pale quality to the main part of a scalloped.
Wind-heat Fanfei main symptoms of patients cough, phlegm or sputum accurate viscous yellow, itchy throat or sore throat, acute onset, short course necessary, in the second card in the turbid stream of nasal obstruction or nasal discharge have the highest proportion (83.7%), followed by a floating pulse number (73.9%). Red tongue tip side (47.8%), dry mouth For drinking water (45.7%), thin yellow tongue coating (44.6%); and fever chills light weight (12.0%), sweating (10.9%) were relatively small. The characteristics of wind-heat cough, most showed moderate degree of itching cough cough or phlegm, cough without increasing the time difference, Shenpi fatigue much, some people cough and cold increased opportunities. Cough and symptoms associated with a hoarse voice, sound reproduction shortness of breath, chest pain, cough cited more obvious, cough unhappy, cough headache less cited. More than half of sore throat, itchy throat clear, nasal congestion, nasal discharge flow turbidity prominent, sweating, aversion to cold, fever or bad there is not much heat, most of the patients appetite, drinking water, toilet, and sleep did not change obvious, more common pink tongue tip side of the tongue or the tongue red, red tongue, the less, pale tongue is rare, and most of the main thin yellow coating of tongue has scalloped highlights.
Air dry lung injury main symptoms of patients cough, no sputum or sputum less viscous quality hard out, nasopharyngeal dry, the course is short necessary, in the second card to the pharyngeal itching in the highest proportion of 90.5%, followed by order for the coating of thin white or thin yellow (69.5%), and a floating pulse number (59.0%), dry mouth, want to drink (56.8%), head and body pain (25.3%), dry tongue, low-chun (19.0%), fever micro bad cold (14.7%), bloody sputum (3.2%). The characteristics of the wind dry cough, most showed mild itching or dry cough cough, cough increase the time was not obvious; that some people cough, cold case of worsened symptoms of cough associated with hoarseness, cough cited chest pain, headache and cough more frequently cited, the phenomenon of fatigue strength emits a small number of patients, sweating, aversion to cold, fever or bad heat rarely, nasal symptoms of nasal obstruction is obvious, some have voiced nasal discharge, sneezing, clear nasal discharge is less common; pharyngeal itching, sore throat prominent appetite, drinking water, toilet, and sleep did not change significantly; more common pink tongue tip or tongue side of red, red tongue of less pale tongue is rare. With thin yellow coating most of the main tongue has scalloped obvious.
Yu phlegm cough lung disease patients in the primary rough, thick yellow phlegm, acute onset, short duration necessary, in order to clock in the second card in the floating and accounted for 4 cases (100%), red tongue (75.0%) vexed hot mouth dry (50.0%), yellow and greasy fur (25.0%). Phlegm retention in the lung primary card Kesheng muddy, color white phlegm, chest tightness, nausea bloating, acute onset, short duration necessary; time permits head weight, pay less, greasy tongue coating, slippery pulse, or How the whole slide with. A high incidence of dry air for the lung injury, the wind and the cold heat syndrome due to clinical symptoms syndrome due to statistics, more often a result of cold syndrome due to smoke-induced cough, the common aversion to cold, sneezing, clear nasal discharge, body pain, Shenpi fatigue, shortness of breath lazy words spontaneous sweating, night sweats, thin white coating, and while there is itching symptoms such as cough and phlegm cough. Syndrome due to wind-heat type is more often caused by the change due to weather, temperature and cough, cold, common sore throat, nasal discharge turbid stream, with the sound of heavy coughing and shortness of breath, a hoarse voice symptoms. Air dry the lung injury more common itchy cough, dry cough, stuffy nose, itchy throat, dizziness, dry mouth, want to drink warm water, bloating, stomach pain, stomach acid, Shezao with scalloped symptoms. Taipei common cough TCM to air dry feature of lung injury, wind heat Fan Fei, followed by the cold Fanfei, phlegm and dampness Yun Lung Lung Yu few cases. This country is too divided most of literature addressed, as 4:06 gas different common cough easily showed the cold wind-heat, warm dry various syndromes, in the course of disease is also seen the transformation of cold and heat, and mixed. The Taipei-heat island effect, climate, temperature and drying of the performance, when the wind, cold, wet, dry the evil invasion of the lung, the easily of heat, cough yellow sputum, dry mouth, rapid pulse and other wind-heat of the levy. Yin Jin Yi losses were physical, due to the impact of desiccation can cough without sputum or phlegm out less difficult, nasopharyngeal dry, dry mouth, dry tongue, dry season of less-chun, the wind permits. Therefore, the high temperature of heat island effect, desiccation, affect the Taipei area, common cough syndrome more common hot air dry and wind Fanfei lung injury.
Taipei is subtropical climate, long winter, short summer, humid and rainy, hot weather, people like to eat thick Health Leng Bing tired of food products and Fei Gan, long-term hot and humid climate and lifestyle, should affect the operation of the spleen and stomach function while wet, hot performance; but because the heat island effect of desiccation on the Taipei area to a certain extent, so wet and rainy weather has little effect on the body, so phlegm and phlegm Yun Yu Lung lung symptoms and signs, which Lingnan region exogenous characteristics of cough symptoms are different.
Conclusion:This study investigated the exceptional sense of Taipei 252 cough characteristics of TCM syndrome differentiation, through clinical and related research, the following conclusions:(1) Taipei common cough syndromes characteristic of lung injury to dryness, wind-heat Fan Fei-based. (2) physical characteristics of the population in Taipei for the Insufficiency of Qi, lung yin deficiency. (3) The impact of exogenous Taipei cough syndrome characterized by many factors, may be unique in Taipei basin geography, changing the hot climate, Insufficiency of qi deficiency, lung yin deficiency of physical factors, poor dietary habits of life. From the side confirmed the common cough has its geographical features, view is consistent with the corresponding theory of Chinese medicine Heaven.
This is the first population in Taipei to study the exogenous cough syndrome differentiation type characteristics and physical characteristics of the external sense of cough syndrome do in-depth exploration of the dialectical treatment to achieve a more standardized, in order to improve the prevention and treatment, provide further theoretical basis. These conclusions will be Taipei common cough Syndromes be helpful, many scholars prevention of this disease a lot of research, regardless of etiology and pathogenesis or affect the factors that make some point in the future through the epidemiological investigation, forward-looking, large sample survey of pathogenesis, to find characteristics of TCM in the treatment of systemic to do more standardized, the dialectical unity of common cough type standard, to improve the treatment of cough medicine level of the external sense.
俗谚：“水泥匠怕补屋漏,医生怕治咳嗽。”这是由于咳嗽的病因不一,容易施治误治传变,影响诊断的正确性；如清徐灵胎谓：“诸病之中,惟咳嗽之病因各殊而最难愈,治或稍误,即遗害无穷。余以此证考求四十余年,而后始能措手。”由此可见咳嗽病因与症状的复杂性,其证治规律不易掌握,必须审证求因,才能对症治疗。中医早就对咳嗽的病因病机进行了一系列的论述,对于咳嗽的治疗也积累了大量
的临床经验。《河间六书·咳嗽论》谓：“寒、暑、湿、燥、风、火六气,皆令人咳嗽”《景岳全书·咳嗽》说：“外感之嗽,必因风寒。”《素问·咳论》说：“五脏六腑皆令人咳,非独肺也。”说明咳嗽的病变脏腑不限于肺。咳嗽的病因可分为外感和内伤两类,外感咳嗽由风、寒、暑、湿、燥、火等六淫外邪犯肺所致；内伤咳嗽则因饮食不节、情志内伤使肺脏虚损或其它脏腑病变累及肺脏所致。药物治疗上根据不同的病因病机,辨证论治,外邪伤肺咳嗽,治以宣肺清肺止咳,兼以疏风、散寒、清热、泻火、润燥、化痰等药物；内邪伤肺咳嗽,则多以祛邪扶正,标本兼顾为法,常用清火、去痰、益气、养血、滋阴、补阳等药物。中医对本病进行了大量研究,在病因病机和预防治疗方面取得了很大进展,在辨
证分型特点方面,由于地域性的差异,各地对外感咳嗽的辨证分型有不同的认识。目前相关报道多限于临床和实验研究,缺乏辨证分型规律的大样本调查研究,本研究根据文献报导,参考台北地区的地理特性,以及肺的生理特性,以风寒犯肺型,风热犯肺型,风燥伤肺型等证型研究；由于台湾地区地处北回归线两侧,为亚热带地区,属岭南医学范围,因此参考岭南地区特点,再加上痰湿郁肺型、痰热蕴肺型研究。本研究通过对台北地区252例外感咳嗽的临床表现观察,研究探讨台北地区外感咳嗽的中医辨证分型特点,为进一步规范其临床诊疗、提高防治水平提供临床依据。方法使用横断面调查方法,调查台北地区外感咳嗽的中医证型特点。
1文献检索,查阅相关文献,归纳外感咳嗽的发病因素。
2根据《中华人民共和国中医药行业标准—中医症状证候诊断疗效标准》、《中药新药临床研究指导原则》及《中医内科学》制订外感咳嗽的中医证候诊断标准及中医证候调查表。
3调查表包含姓名、年龄、日期、性别、病史、居住地址、联络电话、纳入标准、排除标准、中医证型分型标准。
4培训参与调查人员(皆为台北地区执业中医师),且事先学习、正确掌握统一的诊断及辨证标准、纳入标准、排除标准。
5填写调查表,针对台北地区外感咳嗽患者由专职医师诊断填写。
6统计分析。
结果通过描述性分析显示：本地区的外感咳嗽以风燥伤肺为主有94例(37.3%),其次依次为风热犯肺89例(35.3%),风寒犯肺64例(25.4%),痰热郁肺4例(1.6%)痰湿蕴肺1例(0.4%),说明风燥伤肺、风热犯肺是台北地区咳嗽的常见证型。
风寒犯肺的病人主症必备,在次证中以舌苔薄白(85.9%)和鼻塞或喷涕或流清涕(84.4%)最为常见；其次是恶寒重发热轻(67.2%)、头痛或身痛(45.3%)、口不渴(45.3%),脉浮紧则比较少(15.6%)。
风寒咳嗽的特点大多数属中度以下的痒咳或痰咳,咳嗽加重时间差异不大,伴随症状以咯痰不爽、咳引头痛比较明显,咳甚则喘,咳嗽声音嘶哑、声重气急、气逆呛咳阵作、咳引胸痛、咳时面红目赤则比较少。部分伴有神疲乏力或头痛症状,发热或恶热的情况不多,大部分皆有程度不等的恶寒,一半以上的人无汗,鼻部症状多见鼻塞、喷嚏、流清涕,咽部症状以咽痒明显,咽干咽痛很少见,少数人出现胸闷胃胀症状,饮食、口味、饮水、二便、睡眠大部分皆正常不受影响,舌苔多见薄黄苔,舌质以舌淡红或淡白为主,部分有齿痕。
饮食习惯上,风寒犯肺的病人爱吃甜食的比例显着高于风热犯肺和风燥伤肺,全身神疲乏力以及气短懒言的比例最高,痰咳或同时发生痒咳和痰咳的比例也比较高,较常发生恶寒的情况,喷嚏流清涕的症状在风寒犯肺的病人中较常见,自汗、盗汗以及咳痰不爽的状况比风热犯肺和风燥伤肺明显。
风热犯肺的病人主症必备,在次证中以鼻塞或流浊涕所占的比例最高(83.7%),其次为脉浮数(73.9%)。舌边尖红(47.8%)、口干欲饮水(45.7%)、舌苔薄黄(44.6%)；而发热重恶寒轻(12.0%)、汗出(10.9%)则比较少。
风热咳嗽的特点,大多数表现为中度以下的痒咳或痰咳,咳嗽加重时间没有差异,神疲乏力的不多,有一部分人咳嗽遇冷风加重。咳嗽伴随症状以声音嘶哑、声重气急、咳引胸痛比较明显,咯痰不爽、咳引头痛的较少。一半以上的人咽喉肿痛、咽痒明显,鼻塞、流浊涕突出,汗出、恶寒、发热或恶热的情况不多,大部分患者的食欲、饮水、大小便以及睡眠的变化都不明显,舌象多见淡红舌或舌边尖红,舌红的较少,淡白舌很少见,大部分以薄黄苔为主,舌有齿痕突出。
风燥伤肺的病人主症必备,在次证中以咽痒90.5%所占的比例最高,其次依序为苔薄白或薄黄(69.5%)、脉浮数(59.0%)、口干欲饮(56.8%),头身痛(25.3%)舌干少津(19.0%)身热微恶风寒(14.7%)痰中带血(3.2%)。
风燥咳嗽的特点,大多数表现为轻度的痒咳或干咳,咳嗽加重时间不明显；有一部分人咳嗽遇冷风加重,咳嗽的伴随症状以声音嘶哑、咳引胸痛、咳引头痛较常见,少数患者有身疲乏力现象,汗出、恶寒、发热或恶热的情况很少,鼻部症状以鼻塞较明显,部分有浊涕,喷嚏、清涕较少见；咽痒、咽痛突出,食欲、饮水、大小便以及睡眠的变化都不明显；多见舌淡红或舌边尖红,舌红的较少,淡白舌很少见。大部分以薄黄苔为主,舌有齿痕明显。
痰热郁肺的病人主症必备,在次证中以脉浮数占4例(100%)、舌红(75.0%)烦热口干(50.0%、)苔黄腻(25.0%)。痰湿蕴肺主证次证全具。
台北地区外感咳嗽中医证型特点以风燥伤肺、风热犯肺为主,其次为风寒犯肺,痰热郁肺及痰湿蕴肺病例很少。这与国内的多数文献研究不一太致,由于四时六气不同,外感咳嗽容易表现为风寒、风热、温燥等不同证候,在疾病发展过程中也可见寒热的转化以及错杂。由于台北热岛效应,气候有高温化、干燥化的表现,当风、寒、湿、燥之邪侵肺时,极易化热,出现咳嗽痰黄、口干、脉数等风热之征。体质阴津易亏者,由于干燥化的影响,可出现咳嗽无痰或痰少难出、鼻咽干燥、口干、舌干少津等风燥之证。因此热岛效应的高温化、干燥化,影响台北地区的外感咳嗽证型多见风燥伤肺和风热犯肺。
台北地区为亚热带气候,夏季长冬季短,湿润多雨,气候炎热,人们喜食生冷冰品与肥甘厚腻食物,长期的湿热气候和生活习惯,应会影响脾胃运化功能而有湿、热的表现；但由于热岛效应的干燥化对台北地区有一定的影响,使得潮湿多雨的气候对机体的影响较小,所以痰热郁肺及痰湿蕴肺的症状并不明显,这与岭南地区外感咳嗽症候特点有所不同。
结论本研究探讨了台北地区252例外感咳嗽的中医辨证分型特点,通过临床及有关研究,初步得出以下结论：
(1)台北地区外感咳嗽中医证型特点以风燥伤肺、风热犯肺为主。
(2)台北地区的人群体质特点为脾肺气虚、肺阴虚。
(3)影响台北地区外感咳嗽证型特点的因素是多方面的,可能是台北地区特殊的盆地地理环境,多变炎热的气候,脾肺气虚、肺阴虚的体质因素,不良的生活饮食习惯所造成的。从一侧面证实了外感咳嗽有其地域特点,观点符合中医天人相应学说。
本研究首次针对台北地区人群,研究外感咳嗽的中医辨证分型特点以及体质特点,对外感咳嗽证候做了深入的探索,在辨证治疗上做到更规范化,为提高防治水平,提供进一步理论依据。
以上结论将对台北地区外感咳嗽辨证分型有一定的帮助,许多学者对本病防治进行大量的研究,不论病因病机或影响因素都提出一些观点,未来可以通过流行病学调查方法,以前瞻性、大样本的调查,研究发病机理,寻找中医证型特点,在治疗体系上做到更规范化,统一外感咳嗽的辩证分型标准,提高中医对外感咳嗽的治疗水平。
Vision is the loss of lung cough drop, lung Shangni issue Ke Sheng, or a liquid cough spit of Pulmonary Diseases. Cough Medicine and Emergency Department of one of the most common disease and syndrome, high incidence, according to statistics the incidence rate of 3% to 5% incidence in the elderly up to 10% to 15%, especially in cold area of disease rate higher. Cough is the main symptoms of lung diseases, is also independent of disease; its diverse symptoms, complications can lead to multiple Merger, often with abdominal and chest wall pain, and fatigue, urinary incontinence, if prone to develop Cough chronic bronchitis, asthma and other diseases seriously affect people's lives and work.
Very early on cough medicine pathogenesis conducted a series of expositions, for the treatment of cough and accumulated a lot of clinical experience. "River of six-books·cough" that:"cold, heat, dampness, dryness, wind, fire six gases, are people coughing, " "Jing Yue Quan Shu·coughing, " said:"Exogenous the cough, will be due to cold. " "Plain Questions·cough of" said:"The internal organs are people cough, lungs are non-exclusive. " description cough organs are not limited to lung disease. Cause of cough can be divided into two types of exogenous and internal injuries, common cough by the wind, cold, heat, dampness, dryness, fire, etc. Fanfei six disease caused by exogenous pathogens; internal injuries cough due to improper diet, emotions and internal injuries to the lungs empty loss or other organs caused by lesions involving the lung. Drug treatment on the basis of different pathogenesis, diagnosis and treatment, exogenous pathogens cough lung injury, treatment with Xuanfei lung to relieve cough and to disperse wind, and cold, heat, purging fire, moistening, phlegm other drugs; in evil injured lung cough, is more of dispelling evil head of the CIA both samples for the law, common clearing fire, Qu Tan, Qi, blood, yin, yang and other drugs.
Chinese medicine for this disease has been studied, the disease and its prevention and treatment has made great progress in syndrome differentiation characteristics, due to regional differences, the external parts of the dialectical sense of cough have a different understanding of type. Present relevant reports are mostly clinical and experimental research, the lack of syndrome differentiation rules in large sample survey research, this study reports the literature, reference to the geographical characteristics of the Taipei area, and the physiological characteristics of the lungs to cold Fanfei type, wind-heat Fanfei type, air dry lung injury syndromes such as study type; as the Tropic of Cancer is located on both sides of the Taiwan region for subtropical regions, is a South Medical range, and so the Lingnan area characteristics, together with lung phlegm depression type, phlegm Yun-lung type of. In this study, except by a sense of Taipei 252 observation of clinical manifestations of cough, cough study Taipei exogenous characteristics of syndrome differentiation of TCM, to further standardize its clinical diagnosis and treatment, improving prevention and treatment for clinical basis.
Methods:Using cross-sectional survey method to investigate Taipei cough syndromes exogenous characteristics.
1, document retrieval, access to relevant literature, the incidence of cough induction of exogenous factor.
2, according to "The People's Republic of China Traditional Chinese Medicine industry standard symptoms of a syndrome of Lung Cancer, " "guiding principles for new drug clinical research of Chinese medicine" and "Traditional Chinese Medicine in Science" exogenous cough developed diagnostic criteria and TCM Syndrome Questionnaire.
3, the questionnaire include name, age, date, gender, medical history, residential address, telephone, inclusion criteria, exclusion criteria, TCM typing standard.
4, the training staff involved in the investigation (all TCM practitioners in the Taipei area), and prior learning, the correct diagnosis and differentiation control a unified standard, the inclusion criteria and exclusion criteria.
5, fill out the questionnaire, patients in Taipei common cough filled by a full-time physician.
6, statistical analysis.
The descriptive analysis showed that:the region's exogenous to the wind dry cough mainly lung injury,94 cases (37.3%), followed by wind-heat Fanfei were 89 cases (35.3%), cold Fanfei 64 cases (25.4%), phlegm Yu lung in 4 cases (1.6%), phlegm retention in the lung in 1 case (0.4%), indicating that lung injury dry wind, the wind is hot Fanfei Taipei cough syndromes. Cold Fanfei main symptoms of patients cough, sputum thin white, the course is short necessary, in the second card in order to thin white fur (85.9%) and nasal congestion or nasal discharge or jet stream clear nasal discharge (84.4%) most common; Second, aversion to cold and heat light weight (67.2%), headache or body pain (45.3%), I thirst (45.3%), floating and tight pulse is relatively small (15.6%).
Most of the characteristics of cold cough moderate itching cough or sputum following cough, cough increased time is insignificant, with the uncomfortable symptoms cough, headache, cough cited more obvious, if extreme, dyspnea cough, cough, hoarseness, shortness of breath sound of heavy, inverse matrix for gas cough, cough cited chest pain, cough when the face is less red red eyes. Some have Shenpi weakness or headache associated with symptoms of fever or bad there is not much heat, most Jieyou varying degrees of aversion to cold, more than half no sweat, nasal symptoms more common nasal congestion, sneezing, clear nasal discharge, itchy throat clear throat symptoms, throat sore throat is rare, a few symptoms of chest tightness fullness, diet, taste, drinking water, the second will be, normal sleep were not affected much, more common thin yellow tongue coating, tongue tongue pink or pale quality to the main part of a scalloped.
Wind-heat Fanfei main symptoms of patients cough, phlegm or sputum accurate viscous yellow, itchy throat or sore throat, acute onset, short course necessary, in the second card in the turbid stream of nasal obstruction or nasal discharge have the highest proportion (83.7%), followed by a floating pulse number (73.9%). Red tongue tip side (47.8%), dry mouth For drinking water (45.7%), thin yellow tongue coating (44.6%); and fever chills light weight (12.0%), sweating (10.9%) were relatively small. The characteristics of wind-heat cough, most showed moderate degree of itching cough cough or phlegm, cough without increasing the time difference, Shenpi fatigue much, some people cough and cold increased opportunities. Cough and symptoms associated with a hoarse voice, sound reproduction shortness of breath, chest pain, cough cited more obvious, cough unhappy, cough headache less cited. More than half of sore throat, itchy throat clear, nasal congestion, nasal discharge flow turbidity prominent, sweating, aversion to cold, fever or bad there is not much heat, most of the patients appetite, drinking water, toilet, and sleep did not change obvious, more common pink tongue tip side of the tongue or the tongue red, red tongue, the less, pale tongue is rare, and most of the main thin yellow coating of tongue has scalloped highlights.
Air dry lung injury main symptoms of patients cough, no sputum or sputum less viscous quality hard out, nasopharyngeal dry, the course is short necessary, in the second card to the pharyngeal itching in the highest proportion of 90.5%, followed by order for the coating of thin white or thin yellow (69.5%), and a floating pulse number (59.0%), dry mouth, want to drink (56.8%), head and body pain (25.3%), dry tongue, low-chun (19.0%), fever micro bad cold (14.7%), bloody sputum (3.2%). The characteristics of the wind dry cough, most showed mild itching or dry cough cough, cough increase the time was not obvious; that some people cough, cold case of worsened symptoms of cough associated with hoarseness, cough cited chest pain, headache and cough more frequently cited, the phenomenon of fatigue strength emits a small number of patients, sweating, aversion to cold, fever or bad heat rarely, nasal symptoms of nasal obstruction is obvious, some have voiced nasal discharge, sneezing, clear nasal discharge is less common; pharyngeal itching, sore throat prominent appetite, drinking water, toilet, and sleep did not change significantly; more common pink tongue tip or tongue side of red, red tongue of less pale tongue is rare. With thin yellow coating most of the main tongue has scalloped obvious.
Yu phlegm cough lung disease patients in the primary rough, thick yellow phlegm, acute onset, short duration necessary, in order to clock in the second card in the floating and accounted for 4 cases (100%), red tongue (75.0%) vexed hot mouth dry (50.0%), yellow and greasy fur (25.0%). Phlegm retention in the lung primary card Kesheng muddy, color white phlegm, chest tightness, nausea bloating, acute onset, short duration necessary; time permits head weight, pay less, greasy tongue coating, slippery pulse, or How the whole slide with. A high incidence of dry air for the lung injury, the wind and the cold heat syndrome due to clinical symptoms syndrome due to statistics, more often a result of cold syndrome due to smoke-induced cough, the common aversion to cold, sneezing, clear nasal discharge, body pain, Shenpi fatigue, shortness of breath lazy words spontaneous sweating, night sweats, thin white coating, and while there is itching symptoms such as cough and phlegm cough. Syndrome due to wind-heat type is more often caused by the change due to weather, temperature and cough, cold, common sore throat, nasal discharge turbid stream, with the sound of heavy coughing and shortness of breath, a hoarse voice symptoms. Air dry the lung injury more common itchy cough, dry cough, stuffy nose, itchy throat, dizziness, dry mouth, want to drink warm water, bloating, stomach pain, stomach acid, Shezao with scalloped symptoms. Taipei common cough TCM to air dry feature of lung injury, wind heat Fan Fei, followed by the cold Fanfei, phlegm and dampness Yun Lung Lung Yu few cases. This country is too divided most of literature addressed, as 4:06 gas different common cough easily showed the cold wind-heat, warm dry various syndromes, in the course of disease is also seen the transformation of cold and heat, and mixed. The Taipei-heat island effect, climate, temperature and drying of the performance, when the wind, cold, wet, dry the evil invasion of the lung, the easily of heat, cough yellow sputum, dry mouth, rapid pulse and other wind-heat of the levy. Yin Jin Yi losses were physical, due to the impact of desiccation can cough without sputum or phlegm out less difficult, nasopharyngeal dry, dry mouth, dry tongue, dry season of less-chun, the wind permits. Therefore, the high temperature of heat island effect, desiccation, affect the Taipei area, common cough syndrome more common hot air dry and wind Fanfei lung injury.
Taipei is subtropical climate, long winter, short summer, humid and rainy, hot weather, people like to eat thick Health Leng Bing tired of food products and Fei Gan, long-term hot and humid climate and lifestyle, should affect the operation of the spleen and stomach function while wet, hot performance; but because the heat island effect of desiccation on the Taipei area to a certain extent, so wet and rainy weather has little effect on the body, so phlegm and phlegm Yun Yu Lung lung symptoms and signs, which Lingnan region exogenous characteristics of cough symptoms are different.
Conclusion:This study investigated the exceptional sense of Taipei 252 cough characteristics of TCM syndrome differentiation, through clinical and related research, the following conclusions:(1) Taipei common cough syndromes characteristic of lung injury to dryness, wind-heat Fan Fei-based. (2) physical characteristics of the population in Taipei for the Insufficiency of Qi, lung yin deficiency. (3) The impact of exogenous Taipei cough syndrome characterized by many factors, may be unique in Taipei basin geography, changing the hot climate, Insufficiency of qi deficiency, lung yin deficiency of physical factors, poor dietary habits of life. From the side confirmed the common cough has its geographical features, view is consistent with the corresponding theory of Chinese medicine Heaven.
This is the first population in Taipei to study the exogenous cough syndrome differentiation type characteristics and physical characteristics of the external sense of cough syndrome do in-depth exploration of the dialectical treatment to achieve a more standardized, in order to improve the prevention and treatment, provide further theoretical basis. These conclusions will be Taipei common cough Syndromes be helpful, many scholars prevention of this disease a lot of research, regardless of etiology and pathogenesis or affect the factors that make some point in the future through the epidemiological investigation, forward-looking, large sample survey of pathogenesis, to find characteristics of TCM in the treatment of systemic to do more standardized, the dialectical unity of common cough type standard, to improve the treatment of cough medicine level of the external sense.
引文
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