| 摘要: | 中醫證型之確立是根據望、聞、問、切等四診蒐集病情資料，綜合分析而來，由於舌診、切脈等至今尚未一套客觀儀器做客觀的判定基準，所以中醫證型常被質疑。主流醫學藉著精密的科技儀器可以正確的判定病情，具有客觀性和再現性的科學精神。中醫典籍《醫宗金鑑》將腦中風分類為中絡、中經、中腑、中臟、中經絡兼中臟腑、中臟閉證、中臟脫證、中經絡閉證和中臟腑閉證等九種，堪稱對疾病分類最詳盡的典籍。因此，本研究目的是探討腦中風中醫證型分類之主流醫學觀點。我們蒐集260位第一次發病而且發病後七日內之腦中風患者，他們都經過神經科專科醫師和電腦斷層（CT）或磁振造影（MRI）檢查確定為腦中風，包括出血型和梗塞型。根據腦中風病患的臨床徵狀分類為中絡、中經、中腑、中臟、中經絡兼中臟腑、中臟閉證、中臟脫證、中經絡閉證和中臟腑閉證等九種，並標示出電腦斷層或磁振造影之病變部位及填寫腦中風臨床神經徵狀表。結果260人腦中風患者中有60位CT或MRI檢查沒有明確發現病變部位，中醫證型屬於中絡的有52人，其臨床神經徵狀分數為3.7±1.8；中經證型的有8人，其神經徵狀分數為9.4±3.1。200位CT或MRI有明顯病變區之腦中風患者，以臨床神經徵狀而言：1)中絡證型106位，其臨床神經徵狀分數為4.1±2.4 比非中絡中醫證型患者的臨床症狀分數的13.3±6.5小；2)中經證型62位其臨床症狀的分數為10.4±3.5比非中經證型患者的7.6±7.5大；3)中腑證型8人，臨床神經徵狀分數為12.5±6.7與非中腑證型患者的8.3±6.6相似；4)中臟證型3人， 臨床症分數為29.3±3.8比非中臟證型的8.1±6.2大；5)中經絡兼中臟腑證型21人，臨床神經分數為20.0±5.7比非中經證型的7.1±5.3大。以病變部位和病變區大小而言：1)中絡證型主要病變部位為基底核、視丘，屬於小病變區；2)中經主要病變部位為基底核、橋腦等；3)中腑證型主要病變部位為皮質下中大腦動脈區，屬於中等或大病變區；4)中臟證型主要病變部位為橋腦或皮質下，屬於中等到大病變區；5)中經絡兼中臟腑證型屬於大病變區之出血型腦中風。
以現代醫學而言，中絡證型是基底核或視丘小病變區輕度臨床神經徵狀之腦中風；中經證型是基底核、橋腦等輕度到中度臨床神經徵狀之腦中風；中腑證型是屬於中等到大病變區，皮質下中大腦動脈區域之中度臨床神經徵狀的腦中風；中臟是橋腦或中等到大病變區，皮質下之重度臨床神經徵狀的腦中風；中經絡兼中臟腑是大病變區，出血型之中度臨床臨床神經徵狀的腦中風。
The establishment of the Chinese Medicine pattern (CMP) is according to the data that was collected from four diagnostic methods including inspection, listening, smelling and palpitation, following these data was analyzed. Because the four diagnostic methods are no objective criteria by using a measuring apparatus until now, therefore CMP is still was suspicious. The main stream medicine may right to diagnosed disease by precision instrument, therefore, the collecting data is objective and may reappearance that is compatible with scientific. Chinese Medicine writings “I Tzung Chin Jiann” classify stroke divides into Chung-Lou (C-L), Chung-Chin (C-C), Chung-Fu (C-F), Chung-Tzang (C-T), Chung-Chin-Lou and Chung-Tzang-Fu (CCL & CTF), Chung-Tzang Bih pattern (C-T-B), Chung-Tzang Tou pattern (C-T-T), Chung-Chin-Lou Bih pattern and Chung-Tzang-Fu Bih pattern (CCL & CTF-B). The “I Tzung Chin Jiann” is the first detail and complete writings to the classification of stroke, therefore, the purpose of the present study was to investigate the view point of main stream medicine to CMP classification of stroke, we collected 260 stroke patients including hemorrhagic type and infarction type and according to their clinical manifestation divided into nine types of C-L, C-C, C-F, C-T, CCL & CTF, C-T-B, C-T-T, CCL & CTF-B and indicted the lesion of computer tomography or magnet resonance image and fill the form of clinical neurological sign and symptom (CNSS) Results: a total of 260 stroke patients were studied, and no lesion was found by computer tomography or magnet resonance image in 60 stroke patients. The C-L CMP was 52 patients and the CNSS score was 3.7±1.8; C-C CMP was 8 patinets and the CNSS score was 9.4±3.1. The lesion was found by computer tomography or magnet resonance image examination in the 200 strokes patients, and the CNSS score as follows: 1)C-L CMP was 106 patients and the CNSS score was 4.1±2.4 less than 13.3±6.5 in the non-C-L CMP; 2)C-C CMP was 62 patients and the CNSS score was 10.4±3.5 greater than 7.6±7.5 in the non-C-C CMP;3)C-F CMP was 8 patients and the CNSS score was 12.5±6.7 that is similar to 8.3±6.6 in the non-C-F CMP;4) C-T CMP was 3 patients and the CNSS score was 29.3±3.8 greater than 8.1±6.2 in the non-C-T CMP; 5) CCL & CTF CMP was 21 patients and the CNSS score was 20.0±5.7 greater than non-CCL & CTF CMP. In the lesion location and size: 1) the main lesion location was basal ganglion and thalamus in the C-L CMP, and the lesion size was small; 2)the main lesion was basal ganglion and pons etc. in the C-C CMP; 3)the main lesion location was subcortical area of middle cerebral artery, and the lesion size was moderate or large in the C-F CMP;4)the main lesion location was pons or subcortical area, and lesion size was moderate or large in the C-T CMP; 5) the lesion was large in the CCL & CTF CMP, and the most part was belong to hemorrhagic type.
The results according to the view point of main stream medicine, the C-L CMP was a small size lesion and mild CNSS stroke and that locates in the basal ganglion and thalamus; the C-C CMP was a mild or moderate CNSS stroke and locates in the basal ganglion and pons etc.; the C-F CMP was a moderate or large size lesion and moderate CNSS stroke and locates in the subcortical area of middle cerebral artery; the C-T CMP was a moderate or large size lesion and severe CNSS stroke and locates in the pons or subcortical area; the CCL & CTF CMP was a large lesion size stroke, and was a hemorrhagic type stroke with moderate CNSS stroke. |
