【作者】 徐征；

【导师】 吴承玉；

【作者基本信息】 南京中医药大学 ， 中医诊断学， 2011， 博士

【摘要】 中医学认为人体是以五脏为中心的有机整体,五官九窍、五体五志等皆可归入某脏而成一系统。肺系主要包括肺脏及与之相关联的大肠腑、卫表、鼻、咽喉、皮毛、手太阴经、手阳明经等。病位、病性是辨证的基本要素,基础证是由单一的病位与单一的病性构成的证。本论文通过文献研究、临床病案调查及专家问卷征询的方法,规范肺系病位特征及基础证。本研究通过查阅古今相关文献,明确肺系的概念、形态结构与生理功能、内在联系及与它脏的关系、病因病机及病理特点,对肺系各症状进行规范研究处理,总结肺系16个基础证,包括风淫卫表证、寒淫卫表证、热淫卫表证、湿淫卫表证、燥淫卫表证、风邪搏肺证、热邪壅肺证、痰邪阻肺证、饮邪停肺证、瘀血阻肺证、肺气虚证、肺阴虚证、寒凝大肠证、热壅大肠证、湿阻大肠证、大肠津亏证等。整理江苏省中医院病案室2002-2010年的存档病案、导师临床病案及杂志、医籍中的典型病案,共计2081份,对病案中各类证候的临床信息进行分析研究,采用SPSS统计软件,进行聚类分析处理,寻找与肺系病位及各证型相关系数较高的症状。同时征询全国范围内21位中医诊断学专家意见,请专家对肺系病位、病位特征、各基础证及证型中各症状作出重要性分级评价,对专家意见进行聚类分析和内容效度分析,概括最有意义的判断肺系病位的特征性症状,规范16个肺系基础证的概念、证候(包括病位特征与病性特征),明确主症(A)、次症(B)、舌脉表现(C)、现代检测指标(D)四类临床信息,并梳理历史源流脉络,综述现代研究进展。总结肺系常见的病性相兼证、病位相兼证,对少见证型也进行文献研究。肺系病位特征及基础证的确立符合临床证治规律,基础证有机组合后,能够涵盖临床各种错综复杂的证。辨证须注意原则性与灵活性的结合,重在把握具有病位与病性特征的表现,突出“从症辨证”灵活变通的思想。研究结论体现了辨证的系统性和发展性、证的稳定性和特异性,符合临床辨证思路,为构建五脏系统辨证体系中的肺系辨证体系作出探索性研究,对提高中医临床辨证论治水平具有重要指导意义。更多还原

【Abstract】 Human body is considered to be an organic whole centering on the five-zang organs in Traditional Chinese Medicine. Based on this, almost all the connected constituents can be classified into one system. The constituents contains nine orifices, five emotions, etc. And lung system mainly includes lung, large intestine, body surface, nose, throat, skin and hair, Taiyin Lung Meridian of Hand, Yangming Large Intestine Meridian of Hand. During the course of syndrome differentiation, disease-location and disease-character are the two basic elements. If a syndrome is composed of single disease-location and disease-character, it is called basic syndrome. Disease-location characteristics and basic syndromes of lung system are standardized by document survey, clinical case report and expert consulting in this essay.Through searching the relative literature in ancient and modern times, lung system’s concept, morphology and structure, physiological function, pathological character, etiology and pathogenesis are clarified, so is it with the relation between other organs and its inner. All the symptoms are standardization processed,16 basic syndromes are summarized, including the wind invading the surface syndrome, the cold invading the surface syndrome, the heat invading the surface syndrome, the dampness invading the surface syndrome, the dryness invading the surface syndrome, the wind invading the lung syndrome, the heat accumulating in the lung syndrome, the phlegm accumulating in the lung syndrome, the fluid accumulating in the lung syndrome, the blood stagnating in the lung syndrome, the lung-qi deficiency syndrome, the lung-yin deficiency syndrome, the cold coagulating the large intestine syndrome, the heat accumulating in the large intestine syndrome, the damp stagnating in the large intestine syndrome, and the fluid of the large intestine deficiency syndrome. By collecting medical records in 2002-2010 from Jiangsu Province Hospital of TCM, tutor’s clinical practice, medical magazine and books,2081 relative cases are selected. Then SPSS statistical software and clustering analysis are used to analyze clinical information of syndromes, so the high relative symptoms are expected to be found out. Meanwhile,21 TCM diagnosis experts throughout the country are consulted to show the importance evaluation on lung system’s disease-location, disease-location characteristics, basic syndromes and symptoms in each syndrome. After this procedure, the experts’ opinion are analyzed both from clustering and content validity. As a result, the most important symptoms in determining lung system’s disease-location and disease-character are summarized,16 basic syndromes in lung system are standardized from concept and symptoms (including the characteristics of disease-location and disease-character), and symptoms is clarified from main symptom (A), minor symptom (B), tongue and pulse expression (C), modern ancillary test (D), the historical origin and development are carded simultaneously, the modern researches are also summed up. Besides, the complicated syndromes of disease-location and disease-character of lung system are summarized, the uncommon syndrome are researched from document survey too.Establishment of disease-location characteristics and basic syndromes of lung system is accord with clinical treatment law. And the organic combination of basic syndromes can almost cover all the complicated ones. But what should be considered is the combination of principle and flexibility of syndrome differentiation, especially for expressions indicating disease-location and disease-character is due to be mastered, which emphasizes on differentiating syndrome from symptoms. The conclusion of the research is closed to clinical syndrome differentiation thinking, which doesn’t only embody integrity and development of syndrome differentiation, but also the stability and specificity of syndrome. Furthermore, exploratory research basis is made for the establishment of syndrome differentiation system of lung system by this research, also an important guiding function on improving TCM clinical syndrome differentiation.更多还原