摘要
目的:从临床实际出发,通过常规临床辨证方法,进行大样本量临床调查,总结胃癌中医证候的主次构成。方法:以前期课题组研究得出的6种证型分类为依据,由两名主治医师同时床边分别辨证,保证辨证的无偏倚性,多中心运用临床辨证调查表(由流行病学专家指导设计完成)进行调查,详细记录,以Excel电子表格进行数据管理,对症状体征进行赋值后统计计算。结果:肝胃不和型证候构成由主至次依次为:胀痛、弦脉、嗳气、疼痛与情绪有关、心烦易怒、泛酸、呃逆、饱胀感或稍食即胀、头晕、细脉、腹部胀大、进食梗阻感、疼痛不固定、涩脉;胃热伤阴型证候构成由主至次依次为:舌色红绛、苔少甚则舌面光、灼痛、数脉、肛门灼热、口干、裂纹舌、细脉、午后潮热、呕吐、盗汗;脾胃虚寒型证候构成由主至次依次为:舌苔嫩、进食梗阻感、迟脉、缓脉、促脉、情绪如常、腹痛、腹泻、四末不温、下肢浮肿、畏寒怕冷、面色(?)白、头晕、消瘦、嗳气、沉默寡言、恶心、涩脉、泛酸、饱胀或稍食即胀、呕吐、便秘;瘀毒内阻型证候构成由主至次依次为:涩脉、刺痛、舌下脉络迂曲、舌色青紫或紫暗、疼痛固定、黑便或便色为暗红色、呕吐物为暗红色血液、面色晦暗、口干不欲饮、疼痛、弦脉、舌苔白、恶心、舌苔薄、绞痛、嗳气、头晕、泛酸、口苦、缓脉、促脉、细脉、腹痛喜按;痰湿凝结型证候构成由主至次依次为:滑脉、舌苔腻、舌苔厚、口干不欲饮、呕吐胆汁、恶心、口苦、饱胀感或稍食即胀、绞痛、嗳气;气血双亏型证候构成由主至次依次为:腹痛喜按、地图舌、细脉、乏力、面色萎黄、头晕、自汗、裂纹舌、上腹部不适、盗汗、消瘦、畏寒怕冷、便秘、恶心、舌神枯。结论:所得出的胃癌证候较为贴合临床实际,本课题组认为可以作为临床辨证的依据。
Objective：The present study is a summary of syndrome types of gastric cancer in order of priority based on clinical practical situations,routine clinical syndrome differentiation and a large-sample clinical survey in 767 patients with gastric cancer. Methods：Based on the six-type classification of gastric cancer in a previous study,a bedside syndrome differentiation diagnosis was made simultaneously by two attending doctors of traditional Chinese medicine （TCM） to avoid possible diagnostic bias.A clinical differentiation survey form designed under the direction of epidemiologists was filled out by patients with gastric cancer in multiple centers,and the results were digitally valued and statistically analyzed. Results：The symptoms and signs in each syndrome type of gastric cancer were ranked in order of priority as follows：distended pain,stringy pulse,eructation,mood-related pain,susceptibility to anger,acid regurgitation, hiccup,fullness sensation or distension after eating just a little,dizziness,thin pulse,abdominal enlargement,obstruction sensation after eating,moving pain,and uneven pulse in disharmony between liver and stomach;dark red tongue with little fur or a smooth surface,burning pain,rapid pulse,associated burning heat in anus,dry mouth,fissured tongue,thin pulse,tidal fever in the afternoon,nausea and vomiting,and night sweating in impairment of yin due to stomach heat;slender tongue fur,obstruction after eating,slow pulse,moderate pulse,rapid and irregular pulse,normal mood,abdominal pain,diarrhea,cold extremities,lower-extremity edema,cold intolerance,pale complexion,dizziness,emaciation,hiccup, silence,nausea,uneven pulse,acid regurgitation,fullness sensation or distension after eating just a little, vomiting,and constipation in deficiency-cold in spleen and stomach;uneven pulse,stabbing pain,tortuous sublingual vein,blue or purplish tongue,fixed pain,tarry stool or dark red stool,vomiting of dark red fluid, pale complexion,dry mouth without desire to drink,stringy pulse,white tongue fur,nausea,thin tongue fur, colic pain,hiecup,dizziness,acid regurgitation,bitter taste in mouth,slow pulse,rapid and irregular pulse, thin pulse,and pain relief by pressing in interior retention of toxin stagnation;slippery pulse,greasy and thick tongue fur,dry mouth without desire to drink,vomiting of bilious fluid,nausea,bitter taste in mouth,fullness sensation or distension after eating just a little,colic pain,and hiccup in stagnation of phlegm-dampness; abdominal pain relief by pressing,map-like tongue,thin pulse,weakness,yellowish complexion,dizziness, spontaneous sweating,fissured tongue,epigastric discomfort,night sweating,emaciation,cold intolerance, constipation,nausea,and dry tongue in deficiency of both qi and blood. Conclusion：The summarized syndrome types of gastric cancer from this study are consistent with the clinical situations and would prove to be more referential for TCM syndrome differentiation diagnosis and treatment of gastric cancer.
出处
《中西医结合学报》
CAS
2010年第4期332-340,共9页
Journal of Chinese Integrative Medicine
基金
国家自然科学基金资助项目(No.30271626)
关键词
胃癌
证候
中医学
gastric cancer
syndrome
traditional Chinese medicine
