【摘要】 目的 :根据重型肝炎发病的临床特点 ,探讨其中医辨证的原则和方法 ,制定重型肝炎的辨证标准。方法 :回顾性调查湖北中医学院附属医院 (国家中医肝病医疗中心 ) 1985年 1月～ 1999年 10月住院的 2 5 0例重型肝炎患者和 36 0例一般肝病患者 (对照组 )的临床症状和体征 ,采用计算机统计方法 ,得出各个证型的频数分布情况 ,并与对照组进行比较 ,采用 χ2检验、逐步判别分析法等予以分析 ,根据判别函数及判别系数归纳出各证型的主要症状、次要症状及辨证要求 ,最后得到重型肝炎的辨证标准。结果 :经检验所建立的各个判别函数对该组病例判别效果较好 ,诊断价值较高 ,其敏感度为 76 .7%～ 86 .7% ,特异度为 80 .0 %～ 83.3% ,准确度为80 .0 %～ 86 .7%。中医辨证分型标准具体体现为 4个主症及其 12个证型 :黄疸湿热壅盛、热毒炽盛、肝肾阴虚 ,腹水湿热弥漫三焦、阳虚水泛、气血瘀阻 ,出血热毒炽盛、脾不统血、气滞血瘀 ,昏迷热毒入营、湿浊弥漫、阴阳离脱。并得出每个证型的临床表现 ,主、次症及辨证要求。结论 :初步得出重型肝炎的中医辨证分型方案 ,为其临床诊断提供了一个较好的模式。但其研究方法尚须改进 ,并须得到进一步临床验证。更多还原

【Abstract】 Objective:To draw up a preliminary syndrome differ model of severe hepatitis according to the peculiarity of severe hepatitis based on inquiring into its principle and method of syndrome differ classification of traditional Chinese medicine(TCM).Methods:Retrospectively to investigate the clinical symptoms and signs of 250 patients with severe hepatitis and 360 patients with common hepatitis (control group) who were all hospitalized from January 1985 to October 1999 in the affiliated hospital of Hubei TCM College (the country′s liver disease curing center of TCM) the frequency symptoms and signs of every syndrome was analyzed with computer and compared with the control group by chisquare test,gradual discriminatory analysis,etc.Comparing the result of investigating group and control group,the effect of discriminatory function was known.At last,the main,secondary symptoms and syndrome differ model of sever hepatitis were synthesized.Results:After test the functions have very good effect in these cases,the diagnosis value is higher.The sensitivity is in 76 7%86 7% ,specificity is in 80 0%83 3% and accuracy is in 80 0%86 7%.A preliminary syndrome differ criterion of TCM is also drawn up displaying concretly as below:jaundicedampheat exuberant(湿热壅盛),heat toxin vigorous(热毒炽盛),deficiency of liveryin and kidneyyin(肝肾阴虚);ascitesdamp and heat overflowing triple burner(湿热弥漫三焦),Yang deficiency and water overflowing(阳虚水泛),Qi and blood extravasating(气血瘀阻);bloodingheat toxin vigorous(热毒炽盛),spleen failing to manageblood(脾不统血),Qi stagnant and blood stasis(气滞血瘀);comaheat toxin entering Ying aspect(热毒入营),Shizhuo overflowing(湿浊弥漫),dissociation of Yin and Yang(阴阳离脱).Every syndrome include clinic expression,main,secondary symptoms and syndrome differ demand.Conclusions:A preliminary syndrome differ criterion of TCM of severe hepatitis is established,providing a good model for clinic diagnosis.But its research method must be improved and tested steppedup clinically.更多还原