本文選題：血脂異常 + 證候�。� 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:探討血脂異常的中醫(yī)證候及證候要素組合規(guī)律,并初步建立證候診斷標準。方法:多中心收集1019例血脂異�；颊�,采用聚類分析和對應分析對其四診信息進行中醫(yī)證候及證候要素的非線性降維和相關(guān)性研究。結(jié)果:①在1019例血脂異�；颊咧�,排名前10的臨床癥狀、體征分別是胸悶584例(占57.3%)、眩暈476例(占46.7%)、失眠432例(占42.4%)、倦怠乏力391例(占38.4%)、心悸 378 例(占 37.1%)、口干 331 例(占 32.5%)、咳嗽 319 例(占 31.3%)、喘憋304例(占29.8%)、咳痰272例(占26.7%)、胸前區(qū)脹痛268例(占26.3%)。排名前3的舌象是舌質(zhì)紫暗590例(57.9%)、苔白497例(48.8%)、苔膩453例(44.5%),排名前三的脈象是脈弦531例(52.1%)、脈滑375例(36.8%)、脈細334例(32.8%)。②基于聚類分析發(fā)現(xiàn),血脂異常的中醫(yī)證候可分為6類:氣滯證、痰瘀互阻證、痰濁阻滯證、脾腎陽虛證、脾氣虛證、腎陽虛衰證。③并且初步建立了血脂異�；咀C候(氣滯證、痰瘀互阻證、痰濁阻滯證、脾腎陽虛證、脾氣虛證、腎陽虛衰證)的診斷標準:一是氣滯證,主要癥狀是口干(0.5229)、口苦(0.4011)、急躁易怒(0.1525),次要癥狀為耳鳴(0.0983)、腹?jié)M(0.0804)、胸前區(qū)脹痛(0.0359)、善太息(0.0568)、舌瘀斑瘀點(0.0555)、健忘(0.0500);二是痰瘀互阻證,主要癥狀是脈滑(0.4641)、脈弦(0.3485)、脈沉(0.1750)、苔膩(0.2033)、舌紫暗(0.0661),次要癥狀為痛有定處(0.0127)、嘔吐痰涎(0.0044)、肥胖(0.0027)、肢體困重(0.0025);三是痰濁阻滯證,主要癥狀是咳嗽(0.7320)、咳痰(0.7256)、喘憋(0.2432),次要癥狀為胸悶(0.0968)、氣短(0.0731)、頭-重如裹(0.0165);四是脾腎陽虛證,主要癥狀是苔白(0.6284)、畏寒肢冷(0.2343)、舌淡(0.2489),次要癥狀為齒痕舌(0.1243)、走竄疼痛(0.0355)、舌胖(0.0190)、肢體麻木(0.0112);五是脾氣虛證,主要癥狀是納差(0.2863)、脘腹脹悶(0.2582),次要癥狀為呃逆(0.1457)、嘔惡(0.1373)、反酸燒心(0.1437)、便秘(0.1543)、腹痛(0.1850)、失眠(0.1702)、眩暈(0.1800);六是腎陽虛衰證,主要癥狀是尿頻(0.4877)、尿急(0.6120)、尿痛(0.2989),次要癥狀為面肢浮腫(0.0454)。并發(fā)現(xiàn)血脂異常的氣滯證與脾氣虛證的關(guān)系最為密切(相關(guān)距離0.23415)。④基于對應分析發(fā)現(xiàn),關(guān)系最密切的證候要素是氣虛和血瘀(直線距離為0.060066796),脾虛和血瘀(直線距離為0.060372262),脾虛和氣滯(直線距離為0.068734416),痰濁和氣滯(直線距離為0.074379097)。血脂異常的核心證候要素是氣滯(直線距離為0.028738824)、津虧(直線距離為0.073979795)、痰濁(直線距離為0.085363283)、脾虛(直線距離為0.083952010)。結(jié)論:血脂異�？煞譃闅鉁C、痰瘀互阻證、痰濁阻滯證、脾腎陽虛證、脾氣虛證、腎陽虛衰證6個基本證候,且常見的證候要素組合為氣虛和血瘀,脾虛和血瘀,脾虛和氣滯,痰濁和氣滯,治療上當用運脾化濁法(包括運脾理氣、運脾益氣、活血和化痰),同時還提示聚類分析和對應分析能夠幫助進行中醫(yī)證候的分類及證候要素組合規(guī)律的研究。
[Abstract]:Objective: to explore the rule of syndromes and syndromes combination of dyslipidemia, and to establish the diagnostic criteria of syndromes. Methods: 1019 patients with dyslipidemia were collected from 1019 patients with hyperlipidemia. Cluster analysis and correspondence analysis were used to study the nonlinear reduction and correlation of TCM syndromes and syndromes. Results among 1019 patients with dyslipidemia, the first 10 clinical symptoms, The signs were chest tightness in 584 cases (57.3%), vertigo in 476 cases (46.7%), insomnia in 432 cases (42.4%), fatigue in 391 cases (38.4%), palpitation in 378 cases (37.1%), dry mouth in 331 cases (32.5%), cough in 319 cases (31.3%), dyspnea in 304 cases (29.8%). 272 cases (26.7%) were phlegm, 268 cases (26.3%) were pain in chest area. In the top 3 cases, 590 cases (57.9%) of purple dark tongue, 497 cases (48.8%) of white fur, 453 cases (44.5%) of greasy fur, 531 cases (52.1%) of pulse string, 375 cases (36.8%) of silky veins, 334 cases (32.8%) of fine veins were found to have six types of TCM syndromes of dyslipidemia based on cluster analysis. Syndrome of phlegm and blood stasis, stagnation of phlegm and turbidity, syndrome of deficiency of spleen and kidney yang, syndrome of deficiency of spleen qi, syndrome of deficiency of kidney yang, and establishment of basic syndromes of abnormal blood lipids (Qi stagnation, phlegm and blood stasis mutual obstruction, phlegm and turbid block, spleen and kidney yang deficiency, spleen qi deficiency), The diagnostic criteria of kidney yang deficiency and failure syndrome are as follows: one is Qi stagnation, the main symptoms are dry mouth (0.5229), bitter mouth (0.4011), irritability and irritability (0.1525), secondary symptoms are tinnitus (0.0983), abdominal fullness (0.0804), distending pain (0.0359) in anterior chest area, good breath (0.0568), stasis spot in tongue (0.0555), forgetfulness (0.0500), and phlegm and stasis obstruction syndrome (0.0500). The main symptoms were pulse slip (0.4641), pulse string (0.3485), pulse sink (0.1750), greasy fur (0.2033), tongue purple dark (0.0661). The secondary symptoms were pain, sputum (0.0127), vomiting sputum (0.0044), obesity (0.0027), and limb distress (0.0025). The main symptoms were cough (0.7320), expectoration (0.7256), dyspnea (0.2432), secondary symptoms were chest tightness (0.0968), shortness of breath (0.0731), head-heavy as wrapped (0.0165), fourth, deficiency of spleen and kidney yang, The main symptoms were white fur (0.6284), chills of cold limbs (0.2343), thin tongue (0.2489), secondary symptoms of tooth mark tongue (0.1243), walking pain (0.0355), fat tongue (0.0190), limb numbness (0.0112), and syndrome of deficiency of spleen qi. The main symptoms were anorexia (0.2863), abdominal distention (0.2582), hiccup (0.1457), nausea (0.1373), acid resuscitation (0.1437), constipation (0.1543), abdominal pain (0.1850), insomnia (0.1702), vertigo (0.1800); It was also found that the relationship between qi stagnation syndrome with abnormal blood lipid and spleen qi deficiency syndrome was the most close (correlation distance 0.23415). 4. 4 based on corresponding analysis. The most closely related syndromes are qi deficiency and blood stasis (linear distance is 0.060066796), spleen deficiency and blood stasis (straight line distance is 0.060372262), spleen deficiency and qi stagnation (linear distance is 0.068734416), phlegm turbidity and qi stagnation (straight line distance is 0.074379097). The key syndromes of dyslipidemia were Qi stagnation (linear distance was 0.028738824), deficiency of Jin (linear distance was 0.073979795), phlegm turbidity (linear distance was 0.085363283), spleen deficiency (linear distance was 0.083952010). Conclusion: the abnormal blood lipid can be divided into six basic syndromes: Qi stagnation syndrome, phlegm and blood stasis mutual obstruction syndrome, phlegm turbid block syndrome, spleen and kidney yang deficiency syndrome, spleen qi deficiency syndrome and kidney yang deficiency failure syndrome, and the common syndromes are qi deficiency and blood stasis, spleen deficiency and blood stasis, and the common syndromes are qi deficiency and blood stasis, spleen deficiency and blood stasis. Spleen deficiency and qi stagnation, phlegm turbidity and qi stagnation, the treatment was done with the method of transferring spleen to remove turbidity (including the transfer of spleen to regulate qi, to transfer spleen to replenish qi, to transfer spleen to invigorate qi, At the same time, cluster analysis and correspondence analysis can help to study the classification of TCM syndromes and the combination of syndromes.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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