“咳嗽”的证候规范与证素特征研究
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摘要
目的:探讨咳嗽证素分布、组合及证素的本质。
方法:1.文献研究:系统复习整理古今文献,并对近十年咳嗽的相关文献进行统计学分析,了解咳嗽名称、病因病机、病位、证型分布特点与研究进展。2.临床流行病学调研:采用临床调研与中医计量诊断、多元统计分析结合的方法,对福州市区1095例咳嗽患者常见证素进行研究,探讨其证素分布、组合规律及对诊断有统计意义的重要症状。3.实验研究:通过对血常规、血脂、血糖等临床常用检测指标的分析,探讨其与痰、热证素之间的关系。
结果:1.文献研究:系统复习整理古今文献,了解古今对咳嗽含义,咳嗽名义叙述含糊、分类说法不一,咳嗽是作为症状,亦或为病存在较多的分歧,辨证分型多样,且多建立在临床报道和个人经验基础上,或从西医“病”的角度开展研究,根据疾病的病理特点而采用固定的证候分型,忽略了中医的整体辨证思维,亦不能满足临床实际需要,证素辨证符合系统论整体原理,能较近似的反映咳嗽的特点。
2.临床调研:通过临床调研,运用中医计量诊断的方法,对咳嗽证素的分布及组合规律进行了初步的探讨。结果显示:
(1)症状、体征分布:咳嗽主要以痰、热症状体征分布最多。
(2)变量聚类分析显示:咳嗽常见证素有:外风、气虚、寒、阳虚、痰、阴虚、火热、肺、表、脾、肾、心。并对外风、气虚、寒、阳虚、痰、火热、表证素进一步作主成分分析,找出每个证素的主症、次症。
(3)证素分布规律:病性证素痰和病位证素肺贯穿各个阶段,各个病程中火热多见;气虚在病程较长时出现的频率最高;病程较短时病位证素以表多见,病程较长时多影响致脾、肾、心。年龄越小,证素分布多以火热等实证证素多见,小儿常兼夹食积、动风,病位影响至胃、小肠、肝。年龄越大,以虚实夹杂证素多见,主要表现为气虚、阳虚夹痰、热、寒、饮,病位以肺脾肾为主,最终影响到心。
(4)结合证素在咳嗽各阶段的分布与组合特点:认为痰与肺是咳嗽发病的病理基础;外邪侵袭是主要诱因,热占主导地位;肾是咳嗽影响到心的中心环节。
3.临床实验研究:结果表明:咳嗽痰、热证素患者均存在着血常规异常;脂质代谢及糖代谢的异常;但两组间无显著差异。
结论:1.咳嗽是肺系病变的一个极常见症状,并常常是其主症,临床不宜直接以咳嗽作为病名。但可以咳嗽这一主症作为轴心来归类肺系病变,称为“咳嗽病类”。2.根据聚类分析,咳嗽的常见证素有:痰、火热、气虚、外风、阳虚、寒、肺、表。3.咳嗽证素分布组合复杂,多证素组合为主,肺、痰贯穿咳嗽的各阶段。不同病程,不同年龄组的病位、病性侧重不同。4.指标可作为辅助检查手段,但不能作为痰或热证素的特征指标,因此临床不能仅仅根据这些客观指标简单套中医的某个证。多因素信息处理是证实质研究的新方法。
Objective: To explore the distribution, combination and the essence of syndrome's elements of cough
Methods:1. Literature research: To systems review literature existed in the past and recent years and statistically analyze the cough-related documents in the past decade,to recognize the denotation ,etiological factors, pathogenesis ,syndromes distributions and research progression of cough . 2.Clinical and experimental research: Use the methods of the clinical investigation combining with diagnosis measurement of Traditional Chinese medicine (TCM) and multiple statistical analysis to research the common syndrome's elements of 1095 cough patients in FUZHOU. To approach the rules of its distribution and combination ,and the important symptoms which contribute to diagnosis statistically as well. 3.Empirical study :To approach the relationship between the detection indexes such as haemocyte, blood-fat, blood glucose ,which commonly used in clinics, and phlegm and heat syndrome's elements by analyze these indexes.
Results: 1. Literature research: By completely reviewing all the past literatures ,to know the descriptions of the significance and denotation of cough in the past and recent years are ambiguous, and the classifying methods aren't identical. There exist many dissensions of whether cough has to be regarded as a symptom or a disease, and in the differentiation of symptoms and signs for classification of syndrome, which mostly based on clinical reports and individual experience. Or to research cough by the point of view of the "disease" in modern medicine, and classify syndromes stably according to the pathology characteristic of the disease, these methods neglect the integer thinking of differentiation of syndromes of TCM, and also couldn't meet the clinical need. Differentiation of syndrome's elements accords with the Gestalt Principle of System Theory, and could reflect proximately the characters of cough.
2. Clinical research: Through clinical research, using the method of counting-diagnosis of TCM, to research the distribution, combination of the syndrome's elements of cough. The result:
(1) Symptoms and physical signs: the most symptoms and physical signs of cough is phlegm and heat.
(2) Variable clustering analysis: the common elements of syndrome of cough : exogenous wind-evil ,deficiency of Qi, cold, deficiency of Yang, insufficiency of yang, phlegm , heat and exterior. To do the principal component analysis to every elements of syndrome, find out the cardinal symptoms, subcardinal ones.
(3) Distribution regular of syndrome's elements : the characteristic syndrome's element phlegm and the position syndrome's element Lung appear in every phase of the disease, heat appears mostly in all course of the disease; when the course is long the frequency of the appearance of deficiency of Qi is the highest, and the spleen , the kidney and the heart are effected. When it is short the position syndrome's element exterior appears mostly. The patient is younger, the excess syndrome's elements such as heat appear more frequently. Concerning child the food retention and interior stirring-up of wind usually appear , whose stomach, small intestine, and liver are effected. The patient is older ,the syndrome's elements of simultaneous deficiency and excess appear more frequently, such as deficiency of Qi or Yang combining with phlegm, heat, cold, or retention of fluid ,whose lung, spleen and kidney are effected ,and the heart would be effected at last.
(4) Combination regular of elements of syndrome: Phlegm and lung is the pathology basement of cough, the exterior evil is the main motivation, and heat is in the primary place.
3.Clinical experiment research: the result shows: There exists haemocyte , lipid metabolism and glycometabolic abnormity in the patients of phlegm and heat cough, but there's no significant deviation between these two groups.
Conclusions: 1.Cough is the common even the primary symptom of lung diseases, so it's not suitable to regard "cough" as a name of a disease. But it could be called as "cough species" according to using the primary symptom cough as a core to classify lung diseases. 2. according to variable clustering analysis, the common syndrome's elements of cough are : exogenous wind-evil ,deficiency of Qi, cold, deficiency of Yang, insufficiency of yang, phlegm , heat and exterior. 3. The distribution and combination of syndrome's elements are very complicated, the combination of several syndrome's elements is major, lung and phlegm are present in every phase of cough. The disease position and characteristic is different between the groups of different courses and different ages. 4. The indexes could be used as auxiliary examination methods, without being regarded as the characteristic indexes of the syndrome's elements of phlegm and heat. So it can't be used alone to diagnose a syndrome in the clinic, several-factors treating is the new method for the research of syndrome's elements.
方法:1.文献研究:系统复习整理古今文献,并对近十年咳嗽的相关文献进行统计学分析,了解咳嗽名称、病因病机、病位、证型分布特点与研究进展。2.临床流行病学调研:采用临床调研与中医计量诊断、多元统计分析结合的方法,对福州市区1095例咳嗽患者常见证素进行研究,探讨其证素分布、组合规律及对诊断有统计意义的重要症状。3.实验研究:通过对血常规、血脂、血糖等临床常用检测指标的分析,探讨其与痰、热证素之间的关系。
结果:1.文献研究:系统复习整理古今文献,了解古今对咳嗽含义,咳嗽名义叙述含糊、分类说法不一,咳嗽是作为症状,亦或为病存在较多的分歧,辨证分型多样,且多建立在临床报道和个人经验基础上,或从西医“病”的角度开展研究,根据疾病的病理特点而采用固定的证候分型,忽略了中医的整体辨证思维,亦不能满足临床实际需要,证素辨证符合系统论整体原理,能较近似的反映咳嗽的特点。
2.临床调研:通过临床调研,运用中医计量诊断的方法,对咳嗽证素的分布及组合规律进行了初步的探讨。结果显示:
(1)症状、体征分布:咳嗽主要以痰、热症状体征分布最多。
(2)变量聚类分析显示:咳嗽常见证素有:外风、气虚、寒、阳虚、痰、阴虚、火热、肺、表、脾、肾、心。并对外风、气虚、寒、阳虚、痰、火热、表证素进一步作主成分分析,找出每个证素的主症、次症。
(3)证素分布规律:病性证素痰和病位证素肺贯穿各个阶段,各个病程中火热多见;气虚在病程较长时出现的频率最高;病程较短时病位证素以表多见,病程较长时多影响致脾、肾、心。年龄越小,证素分布多以火热等实证证素多见,小儿常兼夹食积、动风,病位影响至胃、小肠、肝。年龄越大,以虚实夹杂证素多见,主要表现为气虚、阳虚夹痰、热、寒、饮,病位以肺脾肾为主,最终影响到心。
(4)结合证素在咳嗽各阶段的分布与组合特点:认为痰与肺是咳嗽发病的病理基础;外邪侵袭是主要诱因,热占主导地位;肾是咳嗽影响到心的中心环节。
3.临床实验研究:结果表明:咳嗽痰、热证素患者均存在着血常规异常;脂质代谢及糖代谢的异常;但两组间无显著差异。
结论:1.咳嗽是肺系病变的一个极常见症状,并常常是其主症,临床不宜直接以咳嗽作为病名。但可以咳嗽这一主症作为轴心来归类肺系病变,称为“咳嗽病类”。2.根据聚类分析,咳嗽的常见证素有:痰、火热、气虚、外风、阳虚、寒、肺、表。3.咳嗽证素分布组合复杂,多证素组合为主,肺、痰贯穿咳嗽的各阶段。不同病程,不同年龄组的病位、病性侧重不同。4.指标可作为辅助检查手段,但不能作为痰或热证素的特征指标,因此临床不能仅仅根据这些客观指标简单套中医的某个证。多因素信息处理是证实质研究的新方法。
Objective: To explore the distribution, combination and the essence of syndrome's elements of cough
Methods:1. Literature research: To systems review literature existed in the past and recent years and statistically analyze the cough-related documents in the past decade,to recognize the denotation ,etiological factors, pathogenesis ,syndromes distributions and research progression of cough . 2.Clinical and experimental research: Use the methods of the clinical investigation combining with diagnosis measurement of Traditional Chinese medicine (TCM) and multiple statistical analysis to research the common syndrome's elements of 1095 cough patients in FUZHOU. To approach the rules of its distribution and combination ,and the important symptoms which contribute to diagnosis statistically as well. 3.Empirical study :To approach the relationship between the detection indexes such as haemocyte, blood-fat, blood glucose ,which commonly used in clinics, and phlegm and heat syndrome's elements by analyze these indexes.
Results: 1. Literature research: By completely reviewing all the past literatures ,to know the descriptions of the significance and denotation of cough in the past and recent years are ambiguous, and the classifying methods aren't identical. There exist many dissensions of whether cough has to be regarded as a symptom or a disease, and in the differentiation of symptoms and signs for classification of syndrome, which mostly based on clinical reports and individual experience. Or to research cough by the point of view of the "disease" in modern medicine, and classify syndromes stably according to the pathology characteristic of the disease, these methods neglect the integer thinking of differentiation of syndromes of TCM, and also couldn't meet the clinical need. Differentiation of syndrome's elements accords with the Gestalt Principle of System Theory, and could reflect proximately the characters of cough.
2. Clinical research: Through clinical research, using the method of counting-diagnosis of TCM, to research the distribution, combination of the syndrome's elements of cough. The result:
(1) Symptoms and physical signs: the most symptoms and physical signs of cough is phlegm and heat.
(2) Variable clustering analysis: the common elements of syndrome of cough : exogenous wind-evil ,deficiency of Qi, cold, deficiency of Yang, insufficiency of yang, phlegm , heat and exterior. To do the principal component analysis to every elements of syndrome, find out the cardinal symptoms, subcardinal ones.
(3) Distribution regular of syndrome's elements : the characteristic syndrome's element phlegm and the position syndrome's element Lung appear in every phase of the disease, heat appears mostly in all course of the disease; when the course is long the frequency of the appearance of deficiency of Qi is the highest, and the spleen , the kidney and the heart are effected. When it is short the position syndrome's element exterior appears mostly. The patient is younger, the excess syndrome's elements such as heat appear more frequently. Concerning child the food retention and interior stirring-up of wind usually appear , whose stomach, small intestine, and liver are effected. The patient is older ,the syndrome's elements of simultaneous deficiency and excess appear more frequently, such as deficiency of Qi or Yang combining with phlegm, heat, cold, or retention of fluid ,whose lung, spleen and kidney are effected ,and the heart would be effected at last.
(4) Combination regular of elements of syndrome: Phlegm and lung is the pathology basement of cough, the exterior evil is the main motivation, and heat is in the primary place.
3.Clinical experiment research: the result shows: There exists haemocyte , lipid metabolism and glycometabolic abnormity in the patients of phlegm and heat cough, but there's no significant deviation between these two groups.
Conclusions: 1.Cough is the common even the primary symptom of lung diseases, so it's not suitable to regard "cough" as a name of a disease. But it could be called as "cough species" according to using the primary symptom cough as a core to classify lung diseases. 2. according to variable clustering analysis, the common syndrome's elements of cough are : exogenous wind-evil ,deficiency of Qi, cold, deficiency of Yang, insufficiency of yang, phlegm , heat and exterior. 3. The distribution and combination of syndrome's elements are very complicated, the combination of several syndrome's elements is major, lung and phlegm are present in every phase of cough. The disease position and characteristic is different between the groups of different courses and different ages. 4. The indexes could be used as auxiliary examination methods, without being regarded as the characteristic indexes of the syndrome's elements of phlegm and heat. So it can't be used alone to diagnose a syndrome in the clinic, several-factors treating is the new method for the research of syndrome's elements.
引文
[1]章巨膺.咳嗽的辨证施治[J].上海中医药杂志,1963,(2):1.
[2]岳美中.外感咳嗽的认证与施治[J].中医杂志,1953,(8):32.
[3]张发荣.咳嗽名义考释[J].成都中医学院学报,1985,(1):6.
[4]高洪波,沈国江.论咳嗽[J].河南中医药学刊,1994,9(6):39-41.
[5]朱文锋.证、症、征等词的概念与应用[J].科技术语研究,2003,5(4):20.
[6]詹建君.陶念唐主任医师治咳经验介绍[J].山西临床医药杂志,1998,7(6):408-409.
[7]王永炎,晁恩祥主编.今日中医内科[M].第一版.北京:人民卫生出版社,2000:87-91.
[8]杨钦河,夏棣其,彭胜权.岭南外感咳嗽的中医证型研究,时珍国医国药2005,16(9):836-837.
[9]魏辉.名老中医治疗特殊类型咳嗽的经验探析[J].中医药临床杂志,2005,17(1):82-83.
[10]阮华沙.经抗生素治疗后咳嗽之证治初探[J].中华现代临床医学杂志,2005,3(3):254-256.
[11]翁心植.慢性阻塞性肺疾病与肺源性心脏病[M].北京:北京出版社,1999:17-25.
[12]孙洁民.慢性呼吸道疾病之湿热证发病的机理的实验研究[J].湖北中医杂志,1995,17(1):52.
[13]赵燕平.外感内伤引起咳证的病因学调查评析[J].中医药学刊,2001,19(4):307-308.
[14]唐雪春,彭胜权.外感久咳从湿论治浅析[J].河南中医药学刊,1999,14(2):10-11.
[15]赵玉哲,陈选平,强克礼.1040例咳嗽与时间关系的调查分析[J].陕西中医,1986(3):10.
[16]姜良铎,唐光华.论内伤基础上的外感咳嗽[J].北京中医药大学学报,2000,23(6):11-13.
[17]徐丽华,王俊,陈启光等.慢性支气管炎中医四诊信息调查及CFA分析[J].浙江中西医结合杂志,2003,13(11):668-669.
[18]刘龙,许玲,魏品康.“活血化瘀”法在治疗久咳中的应用[J].浙江中医学院学报,2003,27(6):8-9.
[19]姚春.脾胃咳浅析[J].陕西中医,2001,22(10):638.
[20]王志英,仇正南.浅述肾咳[J].陕西中医函授,2000,(2):3-4.
[21]蒋吉林,李承珍.中医辨证治疗顽固性咳嗽165例[J].河北中医,2002,24(3):177.
[22]薛汉荣.慢性咳嗽治疗之我见[J].江西中医药,1999,30(1):20.
[23]叶枫.浅述心肌炎伴咳嗽证治应注意的问题[J].光明中医,2003,18(4):10.
[24]桑小梅.从胃治顽咳[J].江苏中医,2000,21(3):40.
[25]王东方,干祖望,覃都安等.喉源性咳嗽病因学调查及其病理生理学基础[J].辽宁中医杂志,1995,22(4):145-146.
[26]王凡,卢世秀.喉源性咳嗽的中医药治疗近况[J].中国中医药信息杂志,1999,6(3):18-19.
[27]郭明阳,徐明.咽源性咳嗽的辨治经验,四川中医,2001,19(12):8.
[28]张强,区静,谢景文,等.巯甲丙脯酸临床致咳嗽的反应检测[J].中国药房,2000,11(4):180-181.
[29]姚晓峰.洪钦国教授治疗ACEI类药物致慢性肾衰病人咳嗽经验[J].新中医,2000,(8):23-24.
[30]朱文锋主编.中医诊断学[M].第一版.北京:中国中医药出版社,2000:87-91.
[31]姚乃礼主编.中医证候鉴别诊断学[M].第2版.北京:人民卫生出版社,2002:103-260.
[32]朱文锋,甘慧娟.证素内容的辨析[J].湖南中医药导报,2005:11(1):11-13.
[33]朱文锋,李灿东,甘慧娟.病位证素的特征[J].福建中医药,2005:36(4):1-4.
[34]王俊,徐丽华,闵捷.慢性支气管炎中医证型与理化指标的关系探要[J].中医药学刊,2004,22(4):605.
[35]朱启勇.辨证分型治疗慢性支气管炎632例[J].辽宁中医杂志,1999,26(9):401-402.
[36]原铁,李盈,刘小虹.哮喘中医证型微观化研究[J].中华实用中西医杂志,2003,3(16):1218-1222.
[37]欧阳茜,慢性肺心病急性发作期血糖水平与痰细菌培养水平分析[J].湖北中医杂志,2003,25(2):3-4。
[38]孙建芝,牛晓亚.痰浊证微观辨证指标的实验研究[J].河南中医,1996,16(2):21-22.
[39]#12
[40]魏俊英,宋庆宏.五子祛痰液治疗慢阻肺痰湿证的临床研究[J].中国中医药科技,2000,7(6):358-359.
[41]曹代娣.慢性支气管炎的中医分型与血液流变学的关系[J].辽宁中医杂.志,1992,5:20-23.
[42]丁学氏,等.气血失调证与血液流变学变化规律初探[J].衡阳医学院学报1985.4:24.
[43]徐锡鸿,韩冬,沈金美,等.肺气虚证患者的免疫功能探析[J].中医研究,1999,15(3):37-38.
[44]杨明华,陈婉姬,金祖汉,等.小鼠肺气虚证简易模型的复制及其护肺冲剂对其的作用[J].中国中医药科技,2000,7(5):275-276.
[45]高永翔,龚立,李群英等.虚证慢性支气管炎不同中医证型支气管肺泡灌洗液中免疫相关指标的比较研究[J].成都中医药大学学报,2006,29(1):5-7.
[46]赖清泉,李建南,陈世勇.中医咳证分型与慢支、肺炎的关系及CT表现[J].中国中西医结合影像学杂志,2006,4(1):38-39.
[47]陈梦麟.支气管哮喘x线胸片异常率与中医辨证分型的关系[J].辽宁中医杂志,1994,21(4):149.
[48]黄华,钟美娟。300例小儿肺炎中医临床证型的X线表现,上海中医药杂志,1993,10:34-35.
[49]郑筱萸.中药新药临床研究指导原则[M].第一版,北京:中国医药科技出版社,2002.
[50]朱文锋.中医(辅助)诊疗系统的研究[J].中国中医基础研究杂 志,2003,9(10):8.
[51]朱文锋.中医主症鉴别诊断学[M].长沙:湖南科学技术出版社,2000:316-331
[52]孟庆刚,郭书文.如何将数学方法应用于现代中医药学研究[J].中国中医药信息杂志,2000,7(8):21-22.
[53]何裕民,王莉,石凤亭,等.体质的聚类研究[J].中国中医基础医学杂志,1996,2(5):7.
[54]梁伟雄,温泽淮,欧爱华,等.中风病急性期中医证候多元分析[J].广州中医药大学学报,1998,15(4):293.
[55]王顺道,任战利,社梦华,等.中风病始发态证候发生与组合规律的临床研究[J].中国医药学报,1996,11(3):17-20.
[56]王雁翔,王灵台,高月求.脂肪肝中医证型流行病学调查及中医病因病机初探[J].中国中西医结合杂志.2005,25(2):126-128.
[57]刘莺,朱文锋,卢芳国.152例胃癌患者术前病证聚类与主成份分析[J].江苏中医药 2004,6(25):20-23.
[58]金丕焕.医用统计方法[M].上海:复旦大学出版社,2002.
[59]祝世讷.中医系统论与系统工程学[M].第一版.中国中医药科技出版社,2002,2.
[60]张惠勇,吴定中,鹿振辉,等.利肺片治疗肺肾两虚型慢性支气管炎临床研究[J].上海中医药杂志,2006,40(2):12-14.
[61]谢学知.谈谈痰浊与咳嗽的关系[J].新中医,1991,2:9.
[62]王会宁.李秀亮教授从痰治咳经验撷英[J].中医药学刊,2004,22(5):803.
[63]钟新渊.泛谈咳嗽以治痰为先[J].江西中医药,1991,22(1):11-12.
[64]朱仲余.论活血祛痰治疗慢支的临床指导意义[J].中华现代中西医杂志,2003,1(4):350-351.
[65]李华安.寒热虚实100例:关于辨证客观化指标的探讨[J].山东中医杂志,1986,(3):19.
[66]雷静月,邵浙新.红细胞参数的改变对部分血流变指标的影响[J].陕西医学检验,2000,15(4):58-59.
[67]李志坚,李幼姬.血小板与肾小球肾炎[J].国外医学·内科学分册,1998,25(11):486-488.
[68]肖改娥,马超锋,计玉仙.肝病患者血小板参数分析[J].实用医技杂志,2005,12(9):2360-2361.
[69]陈君浩,王以立.血细胞分析仪血小板参数的测定及临床意义[J].临床检验信息导报,1996,3(3):89-91.
[70]肖文秀,赵祥文,黄健宝,等.急性感染患儿危重病例评分与血小板数量关系[J].小儿急救医学,2002,9(3):151.
[71]李文志.哮喘患者血小板参数的测定及意义[J].中国实用医学研究杂志,2003,2(6):708.
[72]邓家栋,主编.临床血液学[M].上海:上海科学技术出版社,1985:948-952
[73]徐济民,等.痰浊型冠心病与血脂水平的探讨[J].中西医结合杂志,1984,4(5):265.
[74]沈礼勇,等.冠心病痰浊型与血清载脂蛋白、脂蛋白组分的关系[J].中国医药学报,1991,6(1):36.
[75]程小曲,等.痰浊型冠心病与血脂脂蛋白载脂蛋白的关系及痰浊形成机理的 探讨[J].新中医,1994,(3):7.
[76]罗凤鸣,郑玉琼,潘涛等.慢性阻塞性肺气肿痰湿证与非痰湿证血液流变学、血脂代谢研究[J].中医研究,2001,14(4):25-26.
[77]吴松鹰,杨持.影响脂质代谢中医因素的多元分析,福建中医学院学报,1998,8(2):5-6.
[78]苏庆民,等.肥胖人痰湿型体质血脂、血糖、胰岛素及红细胞Na+-K+-ATP酶活性的检测及特征[J].中国中医基础医学杂志,1995,1(2):39.
[1]中医研究院西苑医院.岳美中医话集.北京:中医古籍出版社,1984:62.
[2]姜春华.咳嗽的治疗[J].中华内科杂志,1977(2):106.
[3]李今庸.李今庸临床经验辑要.北京:中国医药科技出版社,1998:62.
[4]王永炎.中医内科学[M].上海:上海科学技术出版社,2001:57.
[5]翁心植.慢性阻塞性肺疾病与肺源性心脏病[M].北京:北京出版社,1999:17-25.
[6]孙洁民.慢性呼吸道疾病之湿热证发病的机理的实验研究[J].湖北中医杂志,1995,17(1):52.
[7]唐雪春,彭胜权.外感久咳从湿论治浅析[J].河南中医药学刊,1999,14(2):10-11.
[8]赵燕平.外感内伤引起咳证的病因学调查评析[J].中医药学刊,2001,19(4):307-308.
[9]赵玉哲,陈选平,强克礼.1040例咳嗽与时间关系的调查分析[J].陕西中医,1986(3):10.
[10]姜良铎,唐光华.论内伤基础上的外感咳嗽[J].北京中医药大学学报,2000,23(6):11-13.
[11]刘龙,许玲,魏品康.“活血化瘀”法在治疗久咳中的应用[J].浙江中医学院学报,2003,27(6):8-9.
[12]姚春.脾胃咳浅析[J].陕西中医,2001,22(10):638.
[13]王志英,仇正南.浅述肾咳[J].陕西中医函授,2000,(2):3-4.
[14]蒋吉林,李承珍.中医辨证治疗顽固性咳嗽165例[J].河北中医,2002,24(3):177.
[15]薛汉荣.慢性咳嗽治疗之我见[J].江西中医药,1999,30(1):20.
[16]叶枫.浅述心肌炎伴咳嗽证治应注意的问题[J].光明中医,2003,18(4):10.
[17]桑小梅.从胃治顽咳[J].江苏中医,2000,21(3):40.
[18]王东方,干祖望,覃都安,等.喉源性咳嗽病因学调查及其病理生理学基础[J].辽宁中医杂志,1995,22(4):145-146.
[19]王凡,卢世秀.喉源性咳嗽的中医药治疗近况[J].中国中医药信息杂志,1999;6(3):18-19.
[20]张强,区静,谢景文,等.巯甲丙脯酸临床致咳嗽的反应监测[J].中国药房,2000,11(4):180-181.
[21]姚晓峰.洪钦国教授治疗ACEI类药物致慢性肾衰病人咳嗽经验[J].新中医,2000,(8):23-24.
[22]王秀珍,武春玲,刘月英,等.纤维支气管镜检查致咳嗽晕厥综合症1例[J].山西护理杂志,1998,(2):92.
[23]徐丽华,王俊,陈启光等.慢性支气管炎中医四诊信息调查及CFA分析[J]. 浙江中西医结合杂志,2003,13(11):668-669.
[24]魏辉.名老中医治疗特殊类型咳嗽的经验探析[J].中医药临床杂志,2005,17(1):82-83.
[25]阮华沙.经抗生素治疗后咳嗽之证治初探[J].中华现代临床医学杂志,2005,3(3):254-256.
[26]詹建君.陶念唐主任医师治咳经验介绍[J].山西临床医药杂志,1998,7(6):408-409.
[27]王永炎,晁恩祥主编.今日中医内科[M].第一版.北京:人民出版社,2000:87-91.
[2]岳美中.外感咳嗽的认证与施治[J].中医杂志,1953,(8):32.
[3]张发荣.咳嗽名义考释[J].成都中医学院学报,1985,(1):6.
[4]高洪波,沈国江.论咳嗽[J].河南中医药学刊,1994,9(6):39-41.
[5]朱文锋.证、症、征等词的概念与应用[J].科技术语研究,2003,5(4):20.
[6]詹建君.陶念唐主任医师治咳经验介绍[J].山西临床医药杂志,1998,7(6):408-409.
[7]王永炎,晁恩祥主编.今日中医内科[M].第一版.北京:人民卫生出版社,2000:87-91.
[8]杨钦河,夏棣其,彭胜权.岭南外感咳嗽的中医证型研究,时珍国医国药2005,16(9):836-837.
[9]魏辉.名老中医治疗特殊类型咳嗽的经验探析[J].中医药临床杂志,2005,17(1):82-83.
[10]阮华沙.经抗生素治疗后咳嗽之证治初探[J].中华现代临床医学杂志,2005,3(3):254-256.
[11]翁心植.慢性阻塞性肺疾病与肺源性心脏病[M].北京:北京出版社,1999:17-25.
[12]孙洁民.慢性呼吸道疾病之湿热证发病的机理的实验研究[J].湖北中医杂志,1995,17(1):52.
[13]赵燕平.外感内伤引起咳证的病因学调查评析[J].中医药学刊,2001,19(4):307-308.
[14]唐雪春,彭胜权.外感久咳从湿论治浅析[J].河南中医药学刊,1999,14(2):10-11.
[15]赵玉哲,陈选平,强克礼.1040例咳嗽与时间关系的调查分析[J].陕西中医,1986(3):10.
[16]姜良铎,唐光华.论内伤基础上的外感咳嗽[J].北京中医药大学学报,2000,23(6):11-13.
[17]徐丽华,王俊,陈启光等.慢性支气管炎中医四诊信息调查及CFA分析[J].浙江中西医结合杂志,2003,13(11):668-669.
[18]刘龙,许玲,魏品康.“活血化瘀”法在治疗久咳中的应用[J].浙江中医学院学报,2003,27(6):8-9.
[19]姚春.脾胃咳浅析[J].陕西中医,2001,22(10):638.
[20]王志英,仇正南.浅述肾咳[J].陕西中医函授,2000,(2):3-4.
[21]蒋吉林,李承珍.中医辨证治疗顽固性咳嗽165例[J].河北中医,2002,24(3):177.
[22]薛汉荣.慢性咳嗽治疗之我见[J].江西中医药,1999,30(1):20.
[23]叶枫.浅述心肌炎伴咳嗽证治应注意的问题[J].光明中医,2003,18(4):10.
[24]桑小梅.从胃治顽咳[J].江苏中医,2000,21(3):40.
[25]王东方,干祖望,覃都安等.喉源性咳嗽病因学调查及其病理生理学基础[J].辽宁中医杂志,1995,22(4):145-146.
[26]王凡,卢世秀.喉源性咳嗽的中医药治疗近况[J].中国中医药信息杂志,1999,6(3):18-19.
[27]郭明阳,徐明.咽源性咳嗽的辨治经验,四川中医,2001,19(12):8.
[28]张强,区静,谢景文,等.巯甲丙脯酸临床致咳嗽的反应检测[J].中国药房,2000,11(4):180-181.
[29]姚晓峰.洪钦国教授治疗ACEI类药物致慢性肾衰病人咳嗽经验[J].新中医,2000,(8):23-24.
[30]朱文锋主编.中医诊断学[M].第一版.北京:中国中医药出版社,2000:87-91.
[31]姚乃礼主编.中医证候鉴别诊断学[M].第2版.北京:人民卫生出版社,2002:103-260.
[32]朱文锋,甘慧娟.证素内容的辨析[J].湖南中医药导报,2005:11(1):11-13.
[33]朱文锋,李灿东,甘慧娟.病位证素的特征[J].福建中医药,2005:36(4):1-4.
[34]王俊,徐丽华,闵捷.慢性支气管炎中医证型与理化指标的关系探要[J].中医药学刊,2004,22(4):605.
[35]朱启勇.辨证分型治疗慢性支气管炎632例[J].辽宁中医杂志,1999,26(9):401-402.
[36]原铁,李盈,刘小虹.哮喘中医证型微观化研究[J].中华实用中西医杂志,2003,3(16):1218-1222.
[37]欧阳茜,慢性肺心病急性发作期血糖水平与痰细菌培养水平分析[J].湖北中医杂志,2003,25(2):3-4。
[38]孙建芝,牛晓亚.痰浊证微观辨证指标的实验研究[J].河南中医,1996,16(2):21-22.
[39]#12
[40]魏俊英,宋庆宏.五子祛痰液治疗慢阻肺痰湿证的临床研究[J].中国中医药科技,2000,7(6):358-359.
[41]曹代娣.慢性支气管炎的中医分型与血液流变学的关系[J].辽宁中医杂.志,1992,5:20-23.
[42]丁学氏,等.气血失调证与血液流变学变化规律初探[J].衡阳医学院学报1985.4:24.
[43]徐锡鸿,韩冬,沈金美,等.肺气虚证患者的免疫功能探析[J].中医研究,1999,15(3):37-38.
[44]杨明华,陈婉姬,金祖汉,等.小鼠肺气虚证简易模型的复制及其护肺冲剂对其的作用[J].中国中医药科技,2000,7(5):275-276.
[45]高永翔,龚立,李群英等.虚证慢性支气管炎不同中医证型支气管肺泡灌洗液中免疫相关指标的比较研究[J].成都中医药大学学报,2006,29(1):5-7.
[46]赖清泉,李建南,陈世勇.中医咳证分型与慢支、肺炎的关系及CT表现[J].中国中西医结合影像学杂志,2006,4(1):38-39.
[47]陈梦麟.支气管哮喘x线胸片异常率与中医辨证分型的关系[J].辽宁中医杂志,1994,21(4):149.
[48]黄华,钟美娟。300例小儿肺炎中医临床证型的X线表现,上海中医药杂志,1993,10:34-35.
[49]郑筱萸.中药新药临床研究指导原则[M].第一版,北京:中国医药科技出版社,2002.
[50]朱文锋.中医(辅助)诊疗系统的研究[J].中国中医基础研究杂 志,2003,9(10):8.
[51]朱文锋.中医主症鉴别诊断学[M].长沙:湖南科学技术出版社,2000:316-331
[52]孟庆刚,郭书文.如何将数学方法应用于现代中医药学研究[J].中国中医药信息杂志,2000,7(8):21-22.
[53]何裕民,王莉,石凤亭,等.体质的聚类研究[J].中国中医基础医学杂志,1996,2(5):7.
[54]梁伟雄,温泽淮,欧爱华,等.中风病急性期中医证候多元分析[J].广州中医药大学学报,1998,15(4):293.
[55]王顺道,任战利,社梦华,等.中风病始发态证候发生与组合规律的临床研究[J].中国医药学报,1996,11(3):17-20.
[56]王雁翔,王灵台,高月求.脂肪肝中医证型流行病学调查及中医病因病机初探[J].中国中西医结合杂志.2005,25(2):126-128.
[57]刘莺,朱文锋,卢芳国.152例胃癌患者术前病证聚类与主成份分析[J].江苏中医药 2004,6(25):20-23.
[58]金丕焕.医用统计方法[M].上海:复旦大学出版社,2002.
[59]祝世讷.中医系统论与系统工程学[M].第一版.中国中医药科技出版社,2002,2.
[60]张惠勇,吴定中,鹿振辉,等.利肺片治疗肺肾两虚型慢性支气管炎临床研究[J].上海中医药杂志,2006,40(2):12-14.
[61]谢学知.谈谈痰浊与咳嗽的关系[J].新中医,1991,2:9.
[62]王会宁.李秀亮教授从痰治咳经验撷英[J].中医药学刊,2004,22(5):803.
[63]钟新渊.泛谈咳嗽以治痰为先[J].江西中医药,1991,22(1):11-12.
[64]朱仲余.论活血祛痰治疗慢支的临床指导意义[J].中华现代中西医杂志,2003,1(4):350-351.
[65]李华安.寒热虚实100例:关于辨证客观化指标的探讨[J].山东中医杂志,1986,(3):19.
[66]雷静月,邵浙新.红细胞参数的改变对部分血流变指标的影响[J].陕西医学检验,2000,15(4):58-59.
[67]李志坚,李幼姬.血小板与肾小球肾炎[J].国外医学·内科学分册,1998,25(11):486-488.
[68]肖改娥,马超锋,计玉仙.肝病患者血小板参数分析[J].实用医技杂志,2005,12(9):2360-2361.
[69]陈君浩,王以立.血细胞分析仪血小板参数的测定及临床意义[J].临床检验信息导报,1996,3(3):89-91.
[70]肖文秀,赵祥文,黄健宝,等.急性感染患儿危重病例评分与血小板数量关系[J].小儿急救医学,2002,9(3):151.
[71]李文志.哮喘患者血小板参数的测定及意义[J].中国实用医学研究杂志,2003,2(6):708.
[72]邓家栋,主编.临床血液学[M].上海:上海科学技术出版社,1985:948-952
[73]徐济民,等.痰浊型冠心病与血脂水平的探讨[J].中西医结合杂志,1984,4(5):265.
[74]沈礼勇,等.冠心病痰浊型与血清载脂蛋白、脂蛋白组分的关系[J].中国医药学报,1991,6(1):36.
[75]程小曲,等.痰浊型冠心病与血脂脂蛋白载脂蛋白的关系及痰浊形成机理的 探讨[J].新中医,1994,(3):7.
[76]罗凤鸣,郑玉琼,潘涛等.慢性阻塞性肺气肿痰湿证与非痰湿证血液流变学、血脂代谢研究[J].中医研究,2001,14(4):25-26.
[77]吴松鹰,杨持.影响脂质代谢中医因素的多元分析,福建中医学院学报,1998,8(2):5-6.
[78]苏庆民,等.肥胖人痰湿型体质血脂、血糖、胰岛素及红细胞Na+-K+-ATP酶活性的检测及特征[J].中国中医基础医学杂志,1995,1(2):39.
[1]中医研究院西苑医院.岳美中医话集.北京:中医古籍出版社,1984:62.
[2]姜春华.咳嗽的治疗[J].中华内科杂志,1977(2):106.
[3]李今庸.李今庸临床经验辑要.北京:中国医药科技出版社,1998:62.
[4]王永炎.中医内科学[M].上海:上海科学技术出版社,2001:57.
[5]翁心植.慢性阻塞性肺疾病与肺源性心脏病[M].北京:北京出版社,1999:17-25.
[6]孙洁民.慢性呼吸道疾病之湿热证发病的机理的实验研究[J].湖北中医杂志,1995,17(1):52.
[7]唐雪春,彭胜权.外感久咳从湿论治浅析[J].河南中医药学刊,1999,14(2):10-11.
[8]赵燕平.外感内伤引起咳证的病因学调查评析[J].中医药学刊,2001,19(4):307-308.
[9]赵玉哲,陈选平,强克礼.1040例咳嗽与时间关系的调查分析[J].陕西中医,1986(3):10.
[10]姜良铎,唐光华.论内伤基础上的外感咳嗽[J].北京中医药大学学报,2000,23(6):11-13.
[11]刘龙,许玲,魏品康.“活血化瘀”法在治疗久咳中的应用[J].浙江中医学院学报,2003,27(6):8-9.
[12]姚春.脾胃咳浅析[J].陕西中医,2001,22(10):638.
[13]王志英,仇正南.浅述肾咳[J].陕西中医函授,2000,(2):3-4.
[14]蒋吉林,李承珍.中医辨证治疗顽固性咳嗽165例[J].河北中医,2002,24(3):177.
[15]薛汉荣.慢性咳嗽治疗之我见[J].江西中医药,1999,30(1):20.
[16]叶枫.浅述心肌炎伴咳嗽证治应注意的问题[J].光明中医,2003,18(4):10.
[17]桑小梅.从胃治顽咳[J].江苏中医,2000,21(3):40.
[18]王东方,干祖望,覃都安,等.喉源性咳嗽病因学调查及其病理生理学基础[J].辽宁中医杂志,1995,22(4):145-146.
[19]王凡,卢世秀.喉源性咳嗽的中医药治疗近况[J].中国中医药信息杂志,1999;6(3):18-19.
[20]张强,区静,谢景文,等.巯甲丙脯酸临床致咳嗽的反应监测[J].中国药房,2000,11(4):180-181.
[21]姚晓峰.洪钦国教授治疗ACEI类药物致慢性肾衰病人咳嗽经验[J].新中医,2000,(8):23-24.
[22]王秀珍,武春玲,刘月英,等.纤维支气管镜检查致咳嗽晕厥综合症1例[J].山西护理杂志,1998,(2):92.
[23]徐丽华,王俊,陈启光等.慢性支气管炎中医四诊信息调查及CFA分析[J]. 浙江中西医结合杂志,2003,13(11):668-669.
[24]魏辉.名老中医治疗特殊类型咳嗽的经验探析[J].中医药临床杂志,2005,17(1):82-83.
[25]阮华沙.经抗生素治疗后咳嗽之证治初探[J].中华现代临床医学杂志,2005,3(3):254-256.
[26]詹建君.陶念唐主任医师治咳经验介绍[J].山西临床医药杂志,1998,7(6):408-409.
[27]王永炎,晁恩祥主编.今日中医内科[M].第一版.北京:人民出版社,2000:87-91.