腦中風中西醫診斷類型之相關性研究－－八十五例分析

COMPARISONS OF TRADITIONAL CHINESE AND WESTERN DIAGNOSES FOR STROKE: ANALYSES OF 85 CASES

中醫將中風依有無意識障礙分中藏府和中經絡，依輕重淺深程度可再細分為中絡、中經、中府、中藏。我們經由中醫師和神經內科專科醫師同時診查腦中風病人，得到中西醫不同的診斷類型，再加以比較作卡方檢定分析。根據統計結果，中經絡或中藏府和中風類型為缺血或出血無顯著相關。天幕下病灶比天幕上病灶較多產生中藏。腦中風預後由好到差依序為中絡、中經、中府、中藏。針對本研究的八十五例中風病患而言，可將中經絡藏府的診斷指標配合西醫神經學檢查修訂如下。中絡：面神經麻痺或感覺異常。中經：運動性無力或失用症。中府：意識障礙或大便超過三日以上未自解或是小便瀦留難解。中藏：失語症或昏迷指數中的V 1 ～2 分。意識障礙的病人再區分閉證或脫證。閉證：肢體對刺激仍有反應，昏迷指數中的M 2 ～6 分；伴隨有或沒有肌張力強直。脫證：肢體對刺激沒有反應，昏迷指數中的M 1 分；伴隨肌張力弛緩。In traditional Chinese medicine, whose approach is usually more holistic, stroke patients are grouped into four categories according to the nature and severity of the conditions. These are respectively apoplexy involving the collaterals, meridians, fu organs and viscera. Our clinical observations in 85 cases indicated such classification bore little correlation with the etiologically oriented but simplistic Western classification of ischemic or hemorrhagic strokes. Those with infratentorial lesions are more likely than those with supratentorial lesions in developing apoplexy involving the viscera. The prognoses of apoplexy involving the collaterals and meridians are better than those involving the fu organs and viscera. We suggest the diagnostic criteria of apoplexy involving the collaterals, meridians, fu organs and viscera to be as follows: Apoplexy involving the collaterals: facial palsy or sensory impairment. Apoplexy involving the meridians: motor weakness or apraxia. Apoplexy involving the fu organs: consciousness impairment, or retention of stool or urine. Apoplexy involving the viscera: dysphasia, or verbal response scores of 1-2 on the Glasgow coma scale. Stroke patients with conscious impairment can be further divided into the emphraxis and depletion syndromes as follows: Emphraxis syndrome: motor response scores of 2-6 on the Glasgow coma scale with or without spastic muscle tone. Depletion syndrome: motor response score of 1 on the Glasgow coma scale with flaccid muscle tone.