慢性乙型肝炎中医临床辨证舌脉象客观化研究

【作者】 位庚；

【导师】 赵莺；

【作者基本信息】 成都中医药大学 ， 中医诊断学， 2007， 硕士

【摘要】 目的:通过观察慢性乙型肝炎患者常见中医证型舌象、脉象特点和舌脉象参数的变化,探讨慢性乙型肝炎中医证型与舌脉象参数的相关性,以期将舌脉象参数引入慢性乙型肝炎的辨证之中,为慢性乙型肝炎中医辨证客观化、规范化作出努力。方法:将394例慢性乙型肝炎患者按《中药新药临床研究指导原则（试行）》2002版标准分为肝胆湿热、湿邪困脾、肝郁脾虚、肝郁血瘀、肝肾阴虚五个常见证型,采用Tp-1型中医舌脉象数字化分析仪对五组慢性乙型肝炎患者的舌象和脉象进行测定,并与142例正常人对比,分析各组的舌脉象特点及舌脉象参数的变化。结果:1.慢性乙型肝炎患者多见紫类舌和淡红舌;舌苔多见白腻苔和淡黄腻苔。脉象多见弦类脉和滑类脉。2.慢性乙型肝炎五证型舌脉象特异性指标如下:（1）肝胆湿热组以红类舌,淡黄腻苔和黄腻苔为主,脉象以弦脉、弦滑数脉为主。舌象参数中舌苔的厚薄指数较其他四型明显升高,苔色指数、润燥指数较其他四型明显降低:脉象参数中LPSR₂、RPSR₂较其他四组明显升高,LCSR₃、RPSR₁、RCSR₄、RLMP₃较其他四组明显降低。（2）湿邪困脾组以淡白舌,白腻苔和淡黄腻苔为主,脉象以弦脉、弦滑脉为主。舌象参数中苔色指数、润燥指数、胖瘦指数、腐腻指数较其他四型明显升高;脉象参数中LCSR₃、RCSR₄、RCSOR较其他四组明显升高,RCSR₁较其他四组明显降低。（3）肝郁脾虚组以淡白舌和淡红舌,白腻苔和淡黄腻苔为主,脉象以弦脉、沉脉为主。舌色指数较其他四型明显升高;脉象参数中LPSR₁、RPSR₁、RCSR₂较其他四组明显升高,LPSR₂、RPSR₂较其他四组明显降低。（4）肝郁血瘀组以紫类舌,白腻苔为主,脉象以弦脉、沉脉为主。舌色指数、较其他四型明显升高;脉象参数中LBF、RCSR₂、RBF较其他四组明显降低。（5）肝肾阴虚组以红类舌和紫类舌,白腻苔和淡黄腻苔为主,脉象以弦脉和弦数脉为主。舌象参数中裂纹指数较其他四型明显升高,厚薄指数、腐腻指数较其他四型明显降低;脉象参数中LBF、RCSR₁、RBF较其他四组明显升高,LPSR₁、LCSR3、RCSOR较其他四组明显降低。结论:1.紫类舌、淡红舌、白腻苔、淡黄腻苔为慢性乙型肝炎的常见舌象,弦类脉和滑类脉为慢性乙型肝炎的常见脉象,此几类舌脉象可能为慢性乙型肝炎提供一定的辅助诊断依据。2.舌象参数中舌色指数、苔色指数、厚薄指数、胖瘦指数、腐腻指数,脉象参数中LPSR₁、LPSR₂、LCSR₃、LBF、RPSR₁、RPSR₂、RCSR₁、RCSR₂、RCSR₄、RBF、RCSOR、RLMP₃可作为慢性乙型肝炎中医辨证分型的参考指标。更多还原

【Abstract】 Objective:By the tongue and pulse condition characteristic and parametric change of tongue and pulse condition observing the chronic hepatitis B patients of traditional Chinese medicine syndrome types,discuss the chronic hepatitis B patients of traditional Chinese medicine syndrome types and parametric correlativity of tongue and pulse condition,expect to lead the tongue and pulse parameter into Chinese differentiation and make an effort for Objective,standard Chinese medicine differentiation of chronic hepatitis B.Method:394 chronic hepatitis B patients are divided into 5 common patterns in according to《guiding principles for clinical study of new Chinese medicine（try out）》2002:syndrome of hepatochlic hygropyrexia,syndrome of damp pathogen obstruction the spleen,syndrome of stagnation of liver qi with deficiency of the spleen,syndrome of liver qi stagnation and blood stasis,syndrome of hepatic and renal yin deficiency,we adopt tongue and pulse condition digitization analysator of traditional Chinese medicine of TP-1 type to determine tongue and pulse condition of these chronic hepatitis B patiens in the five groups,at the same time contrast with 142 normal person to analyze the parameter change and the characteristic of tongue and pulse’ parameters in every groups.Result:1.the chronic hepatitis B patient sees purple kind tongue and light red tongue much;tongue fur sees greasy white and grease of light yellow moss much.wiry kind pulse and smooth kind pulse are the fundamental pulse of the chronic hepatitis B.2.the chronic hepatitis B five syndromes’ tongue and pulse specificity target conclusion as following:（1）syndrome of hepatochlic hygropyrexia is mainly shown as red kind tongue, greasy of light yellow and greasy yellow moss to the tongue fur,wiry pulse to the pulse condition,smooth and rapid pulse.The parameter of tongue fur’s thickness is the highest,the parameters of moss color’s parameter,moisten and dry’s parameter obviously are the lowest;in the pulse parameters,LPSR₂,RPSR₂ are the highest, LCSR₃,RPSR₁,RCSR₄,RLMP₃ are the lowest.（2）syndrome of damp pathogen obstruction the spleen is mainly shown as white tongue,greasy white and greasy yellow moss to the tongue fur,wiry pulse,smooth and wiry pulse to the pulse condition.The parameters of tongue fur’s moss color’s parameter,moisten and dry’s parameter,fat and thin’s parameter,greasy and putrid’s parameter are the highest;in the pulse parameters,LCSR₃、RCSR₄、RCSOR are the highest,RCSR₁ is the lowest.（3）syndrome of stagnation of liver qi with deficiency of the spleen is mainly shown as white tongue and light red tongue,greasy white and greasy of light yellow moss to the tongue fur,wiry pulse and deep pulse to the pulse condition.The parameter of tongue color is the highest;in the pulse’s parameters,LPSR₁、RPSR₁、RCSR₂ is the highest,LCSR₃,RPSR₁,RCSR₄、LPSR₂,RPSR₂ is the lowest.（4）syndrome of liver qi stagnation and blood stasis is mainly shown as purple kind tongue,greasy white to the tongue fur,wiry pulse and deep pulse to the pulse condition.The parameter of tongue color is the highest;in the pulse’s parameters, LBF、RCSR₂、RBF is the lowest.（5）syndrome of hepatic and renal yin deficiency is mainly shown as red kind tongue and purple tongue,greasy white and greasy of light yellow moss to the tongue fur,wiry pulse,wiry and rapid pulse to the pulse condition.In the tongue’s parameters,the crack’s parameter is the highest,thickness’ parameter,greasy and putrid’s parameter are the lowest;in the pulse’s parameters,LBF、RCSR₁、RBF are the highest,LPSR₁、LCSR₃、RCSOR is the lowest.Conclusion:1.purple kind tongue,light red tongue,grease white and grease of light yellow moss are the common tongue demonstration,wiry kind and smooth kind pulse are the common pulse tracings to chronic hepatitis Ball these tongue and pulse conditions can provide chronic hepatitis B diagnosis with some assistant dependence.2.In the tongue’s parameters,tongue color’s parameter,moss color’s parameter, thickness’ parameter,fat and thin’s parameter,greasy and putrid’s parameter,and in the pulse’s parameters LPSR₁、LPSR₂、LCSR₃、LBF、RPSR₁、RPSR₂、RCSR₁、RCSR₂、RCSR₄、RBF、RCSOR、RLMP₃ may be used as one of the reference indexes for differentiation syndrome classification in chronic hepatitis B.更多还原