Study On TCM Syndrome Differentiation Of Pulmonary Tuberculosis Combined With Endobronchial Tuberculosis

Pulmonary tuberculosis is a chronic infectious disease to human health which result from mycobacterium tuberculosis and invade many organs, mostly mianly in the lung. Bronchus tuberculosis, which is also called endobronchial tuberculosis, is the tuberculosis pathological change in the trachea, tunica mucosa bronchiorum and submucosa.China is a high-burdened country in the pulmonary tuberculosis and it is reported that there are4.5million patients of pulmonary tuberculosis, among which over2million patients of pulmonary tuberculosis are infectious.Syndrome differentiation of pulmonary tuberculosis is mainly syndrome differentiation of typing, and this differentiation mode can’t embody the evolution process of the disease of pulmonary tuberculosis associated endobronchial tuberculosis,doesn’t accord with the traditional thinking of syndrome differentiation. In the research, transverse section research and perspective research were made through investigation and collection of symptom, signs, tongue diagnosis and relative clinical detection indexes from the200patients of pulmonary tuberculosis associated endobronchial tuberculosis gathered in the309Hospital of PLA from February2011to April2013. Through the above mentioned research, multivariate statistical analysis such as cluster analysis and treatment based on syndrome differentiation were used to try to set up a new differentiation system and diagnosis criterion of pulmonary tuberculosis associated endobronchial tuberculosis after the statistical analysis of symptoms, elements, of syndrome, etiology and pathogenesis.In the research, about94.50%(189) patients of pulmonary tuberculosis associated endobronchial tuberculosis got the syndrome of cough, most mainly were serious and middle. In the189cases with cough, about57.67%patients were serious in the morning and night, and only about8.47%patients were serious in the daytime, about62.96%patients were dry cough, and about56.09%patients can result in chest pain in coughing.122patients of pulmonary tuberculosis associated endobronchial tuberculosis got the syndrome of phlegm, which indicate that the patients of pulmonary tuberculosis associated endobronchial tuberculosis were mainly manifested the syndrome of no phlegm or a little phlegm. In the122cases with phlegm, about65.57%patients were difficult to cough up phlegm, about34.43%patients were easy to cough up phlegm, about86.07%patients cough up sticky phlegm, about79.50%patients were without wheeze or a few wheeze. And the122cases were mostly mainly white sputum and few yellow sputum and blooding sputum.About87.50%patients of pulmonary tuberculosis associated endobronchial tuberculosis got the syndrome of fever, and about68.00%patients were mostly manifested as low fever (<38℃), which indicate the depletion of Lung Yin and asthenia in origin and asthenia in superficiality.In the constitutional symptoms, most mainly were weakness and night sweat,84.50%and69.00%separately, which were manifested as light and middle condition, and hectic fever, dysphoria in chest palms-soles and insomnia were less,13.00%、31.50%and37.50%separately.Of all the symptoms included (except tongue diagnosis) in the research, the symptoms of frequency of occurrence over50%successively were:cough, fever, chest suppression, weakness, emaciation, short breath, night sweat, difficult phlegm, chest pain and phlegm. the symptoms in the tongue diagnosis of frequency of occurrence over50%successively were:greasy fur, white sputum, rapid pulse and yellow sputum.Referring to TCM syndrome types, deficiency syndrome is more than excess syndrome and intermingled deficiency and excess is the least.This is mainly because pulmonary tuberculosis associated endobronchial tuberculosis is a chroninc disease and mainly manifested as deficiency syndrome.According on the results of cluster analysis, the disease of pulmonary tuberculosis associated endobronchial tuberculosis could be divided into seven types as a sequence in the following:deficiency of both vital energy and yin(33.00%)> phlegm-heat obstructing lung (19.50%)>lung yin deficiency(15.50%)>fire excess from yin deficiency(12.50%)>Qi-stagnation and blood stasis(11.50%)>yin-yang deficiency(4.50%)>qi deficiency of lung and kidney (4.50%).Compared with the types of pulmonary tuberculosis, phlegm-heat obstructing lung and Qi-stagnation and blood stasis are added.pulmonary tuberculosis associated endobronchial tuberculosis is manifested as deficiency syndrome,then fire excess from yin deficiency,or deficiency of both vital energy and yin, then yin deficiency affecting yang, and eventually yin-yang deficiency. The results indicate that in the treatment of pulmonary tuberculosis associated endobronchial tuberculosis, nourishing the Yin and promoting glandular secretion should be combined with the herbs of tonifying qi and reducing phlegm in accordance with the different differentiation of pulmonary tuberculosis associated endobronchial tuberculosis.