Wu Jian, Wang Xin-Yue, Sun Hui-Yi
Department of Digestive Diseases, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2012 Apr;32(4):445-9.
To observe the distribution features of Chinese medicine syndrome (CMS) in 137 patients with active ulcerative colitis (AUC), and to analyze the correlation between the intestinal mucosal manifestations and CMS.
Totally 137 AUC patients were syndrome typed. The intestinal mucosal manifestations were observed under endoscope, thus analyzing the correlation between the intestinal mucosal manifestations and CMS.
In the distribution of main syndromes, the case numbers were sequenced as the damp heat of Dachang syndrome > the yang deficiency of Pi-Shen syndrome > the Gan-depression and Pi-deficiency syndrome > the deficiency of Pi-qi syndrome > the blood stasis of the intestine meridian syndrome > the deficiency of blood and yin syndrome. The frequency of intestinal mucosal manifestations more than 50% covered mucosal damage, abnormal mucosa membrane color, congestion, edema, erosion, ulcer, pus tongue fur, and obscure or disappeared blood vessels. The edema, erosion, and ulcer occurred more in the damp-heat of Dachang syndrome, followed by the yang deficiency of Pi-Shen syndrome and the Gan-depression and Pi-deficiency syndrome (P < 0.05, P < 0.01). Polypi, abnormal enterokinesia, grainy occurred more in the damp-heat of Dachang syndrome and the Gan-depression and Pi-deficiency syndrome (P = 0.010). Shallower plica or disappeared sacculations of colon occurred more in the yang deficiency of Pi-Shen syndrome and the damp-heat of Dachang syndrome (P = 0.002). The mucosa bridge occurred more in the yang deficiency of Pi-Shen syndrome and Gan-depression and Pi-deficiency syndrome (P = 0.280). Fragility or contact bleeding occurred more in the damp-heat of Dachang syndrome, the deficiency of Pi-qi syndrome, and Gan-depression and Pi-deficiency syndrome (P = 0. 045). Pale blood of the intestinal hemorrhage occurred more in the deficiency of Pi-qi syndrome while dark blood occurred more in the damp-heat of Dachang syndrome (P = 0.017). Pus tongue fur occurred more in the damp-heat of Dachang syndrome, the yang deficiency of Pi-Shen syndrome, and the Gan-depression and Pi-deficiency syndrome. White pus tongue fur occurred more in the yang deficiency of Pi-Shen syndrome while yellow pus tongue fur occurred more in the damp-heat of Dachang syndrome (P < 0.001). Mucus occurred more in the yang deficiency of Pi-Shen syndrome, the Gan-depression and Pi-deficiency syndrome, and the deficiency of Pi-qi syndrome (P = 0.012). Narrow enteric cavity or intestinal canal fibrosis, lead pipe like manifestations occurred more in the blood stasis of the intestine meridian syndrome (P = 0.001). Atrophic mucosa occurred more in the blood stasis of the intestine meridian syndrome and the deficiency of blood and yin syndrome (P < 0.001).
The intestinal mucosal manifestations of AUC showed certain laws in CMS. The microscopic differences could verify macroscopic CMS to some extent.
观察137例活动期溃疡性结肠炎(AUC)患者的中医证候分布特征,分析肠道黏膜表现与中医证候的相关性。
对137例AUC患者进行中医证候分型,在内镜下观察肠道黏膜表现,分析肠道黏膜表现与中医证候的相关性。
在主要证候分布中,病例数排序为大肠湿热证>脾肾阳虚证>肝郁脾虚证>脾气虚证>肠络瘀血证>气血两虚证。肠道黏膜表现出现频率超过50%的有黏膜损害、黏膜色泽异常、充血、水肿、糜烂、溃疡、脓苔、血管模糊或消失。水肿、糜烂及溃疡在大肠湿热证中出现较多,其次为脾肾阳虚证、肝郁脾虚证(P<0.05,P<0.01)。息肉、肠运动异常、颗粒样改变在大肠湿热证及肝郁脾虚证中出现较多(P = 0.010)。结肠黏膜皱襞变浅或袋囊消失在脾肾阳虚证及大肠湿热证中出现较多(P = 0.002)。黏膜桥在脾肾阳虚证及肝郁脾虚证中出现较多(P = 0.280)。黏膜脆性增加或接触性出血在大肠湿热证、脾气虚证及肝郁脾虚证中出现较多(P = 0.045)。肠道出血血色淡在脾气虚证中出现较多,血色暗红在大肠湿热证中出现较多(P = 0.017)。脓苔在大肠湿热证、脾肾阳虚证及肝郁脾虚证中出现较多。白脓苔在脾肾阳虚证中出现较多,黄脓苔在大肠湿热证中出现较多(P<0.001)。黏液在脾肾阳虚证、肝郁脾虚证及脾气虚证中出现较多(P = 0.012)。肠腔狭窄或肠道纤维化、铅管样表现在肠络瘀血证中出现较多(P = 0.001)。黏膜萎缩在肠络瘀血证及气血两虚证中出现较多(P<0.001)。
AUC的肠道黏膜表现在中医证候方面呈现一定规律,微观差异在一定程度上可验证宏观的中医证候。