Abstract:

Objective: To investigate the clinical symptoms, signs, and distribution patterns of syndrome elements in patients with severe pulmonary tuberculosis (PTB), providing references for developing precise Traditional Chinese Medicine (TCM) syndrome differentiation, as well as diagnostic and treatment strategies. Methods: Clinical data were collected from patients with severe PTB admitted to the Department of Tuberculosis at Shanghai Public Health Clinical Center between January 2020 and January 2025. Symptoms, signs, tongue coating, pulse manifestations, and current symptoms were recorded. Association rule analysis and cluster analysis were used to summarize syndrome elements, characterize syndrome patterns, identify major TCM syndrome types, and preliminarily explore corresponding diagnostic and treatment protocols. Results: A total of 619 patients with severe PTB were enrolled, including 488 males and 131 females, with a male-to-female ratio of 3.73∶1. The age ranged from 18 to 95 years, with a median (quartile) age of 76 (71,81) years; 88.69% (549/619) were over 60 years old. Among them, 520 cases (84.01%) had comorbidities, mainly type 2 diabetes mellitus (412 cases, 66.56%), hypertension (368 cases, 59.45%), and coronary heart disease (230 cases, 37.16%). The main clinical symptoms were sputum production (583 cases, 94.18%), poor appetite (567 cases, 91.60%), weight loss (480 cases, 77.54%), fatigue (423 cases, 68.34%), cough (376 cases, 60.74%), shortness of breath (354 cases, 57.19%), altered consciousness (355 cases, 57.35%), and fever (322 cases, 52.02%). Association analysis of syndrome elements revealed that the lung-qi deficiency association was the strongest (51.53%, with a confidence level of 100.00%). Cluster analysis showed that syndrome elements mainly clustered into two categories as lung-spleen qi deficiency, and phlegm-fire (heat) yin deficiency. While seven independent syndrome elements were identified, including cold, blood stasis, dampness, qi blockage, blood stirring, yang deficiency and heart. The dominant TCM syndrome types were lung-spleen qi deficiency syndrome (56.70%, 351/619) and phlegm-heat yin deficiency syndrome (39.74%, 246/619). Conclusion: Patients with severe PTB present with complex clinical manifestations and multiple comorbidities. Clinical diagnosis and treatment should break through TCM classification frameworks, adhere to the principle of “simultaneous regulation of multiple organs and addressing both root and branch”, with emphasis on the interactions among phlegm, stasis, and deficiency, which can provide evidence for developing precise TCM intervention protocols.

Key words: Medicine, Chinese traditional, Tuberculosis, pulmonary, Disease attributes