The Investigation Of Syndrome Differentiation In Stage For Pulmonary Tuberculosis During The Course Of The Intervention Of Chemotherapy

Object:At present, syndrome differentiation of pulmonary tuberculosis is mainly syndrome differentiation of typing, and this differentiation mode can't embody the evolution process of the disease, doesn't accord with the traditional thinking of syndrome differentiation. Ements of syndrome including the location and the nature of disease are based on the identification of the symptoms. The basic pathogenesis and minor pathogenesis are extracted by the ements of syndrome, which form the main patterns of syndrome and the minor patterns of syndrome. We try to set up a new differentiation system called syndrome differentiation in stage after the statistical analysis of symptoms, elements of syndrome, etiology and pathogenesis, and take elements of syndrome for its core.Method:We summarize more than 60 items of symptoms and signs of pulmonary tuberculosis including night sweating, hectic fever, cough, emaciation, poor appetite, insomnia, and vexation after reference to the concept of elements of syndrome put forward by professor Zhu Wenfeng and consulting literature. They are classified by yin deficiency, fire-host, qi deficiency, yang deficiency, pulmonary, spleen, kidney. Then we make it into survey questionnaire and collect materials of 300 patients,100 before chemical therapy,100 in chemical therapy,100 after chemical therapy. We statistic the expression frequency of the symptoms and signs separately. Then definite the location and the nature of disease which constitute elements of syndrome, so as to confirm patterns of syndrome of every stage of pulmonary tuberculosis. The central treatment and minor treatment are adopted according to the main clinical situation and pathogenesis and the minor clinical situation and pathogenesis.Results:(1) The main symptoms of patients before chemical therapy are emaciation (80%), cough (71%), expectoration (58%), hectic fever (56%), insomnia (51%), the minor symptoms are thirst (49%), poor appetite (48%), night sweating (44%); The main elements of syndrome before chemical therapy are pulmonary, fire-host, the minor elements of syndrome are pulmonary, yin deficiency, spleen,qi deficiency, kidney, yang deficiency, solidification of blood; The basic pathogenesis is that the lung is burned by the Pathogenic heat after the infection of TB bug. The minor pathogenesis are:①Illness of the child organ may involve the mother, spleen fails to transport and transform syndrome;②Innate deficiency of YANG in the body;③Eposition resistance of pulmonary because of burning of the lung by the pathogenic heat. The main patterns of syndrome is hyperactivity of fire due to yin deficiency, The minor patterns of syndrome are deficiency of qi of both lung and spleen, deficiency of kidney-yang and deposition resistance of pulmonary.(2) The primary symptoms of patients in chemical therapy are yellow urine (70%), emaciation (68%), cough (60%), dry mouth (57%), chest pain (54%), th roat itching (47%), thirst (44%), expectoration (42%), the minor symptoms are poor appetite (38%), loose stool (28%), abdominal distension (30%), insomnia (32%), exation (28%), irascibility (25%); The main elements of syndrome before chemical therapy are pulmonary, yin deficiency the minor elements of syndrome are fire-host, spleen, qi deficiency, yin deficiency, kidney, yang deficiency, solidification of blood; The basic pathogenesis is deficiency of lung-yin. The minor pathogenesis are:①the fire remained due to yin deficiency;②deficiency of qi of both spleen and stomach;③Innate deficiency of YANG in the body;④deposition resistance of pulmonary by the pathogenic heat. The main patterns of syndrome is deficiency of lung-yin, The minor patterns of syndrome are the fire remained due to yin deficiency, deficiency of qi of both spleen and stomach, deficiency of kidney-yang and deposition resistance of pulmonary.(3) The main symptoms of patients after chemical therapy are cough (59%), chest pain (55%), expectoration (44%), dry mouth (23%), thirst (32%); Elements of syndrome in chemical therapy are pulmonary (69%), yin deficiency (64%), spleen (32%); The main elements of syndrome are pulmonary, solidification of blood, yin deficiency, the minor elements of syndrome are spleen, qi deficiency, kidney, yang deficiency; The basic pathogenesis is deficiency of lung-yin, deposition resistance of pulmonary. The minor pathogenesis are:①the fire remained due to yin deficiency;②deficiency of qi of both spleen and stomach;③Innate deficiency of YANG in the body; The main patterns of syndrome is yin deficiency and solidification of blood, the minor patterns of syndrome are are the fire remained due to yin deficiency, deficiency of qi of both spleen and stomach, deficiency of kidney-yang.Conclusion:The intervention of chemotherapy is very important for the the evolution process of the patterns of syndrome of the untreated pulmonary tuberculosis. The the Pathogenesis and patterns of syndrome presant the variation of hyperactivity of fire due to yin deficiency→deficiency of lung-yin→yin deficiency and solidification of blood; The minor patterns of syndrome are the fire remained due to yin deficiency, deficiency of qi of both lung and spleen, deficiency of kidney-yang and deposition resistance of pulmonary, which provides theoretical basis for assitance treatment. Because of the lack of the number of cases, the scientific conclusion can only be determined after the research with multi-center and large sample of clinic epidemiology.