【作者】 欧杰；

【导师】 王兴华；

【作者基本信息】 南京中医药大学 ， 中医临床基础， 2012， 博士

【摘要】 论文以江苏省中医院2008-2010年间共1539例死亡患者的临床资料为原始素材,从公历月份、季度、上中下旬、昼夜时间、季节、农历月内三三个时间段、月相、口干、时干、日支、时支、干支的阴阳五行属性、伤寒六经欲解时等多个角度,探索胰腺癌、结直肠癌、原发性肺癌、乳腺癌、原发性肝癌、胃癌、食管癌、恶性血液病、慢性肾功能不全、急性出血性中风、急性缺血性中风、急性心肌梗死共12个主要病种和全体恶性肿瘤患者、全体患者两大类病人死亡时间的规律。并联系中医经典中的原文进行讨论。同时在不同病种间,从上述各个层面对比了死亡时间存在的差异。论文第一部分从古代中医文献和当代临床报道的角度,综述了目前关于患者死亡时间与疾病关系等方面的研究进展。论文第二部分探讨了主要病种患者死亡时间的规律,比较了两性患者的平均年龄、末次住院天数,发现各病种都存在一定的节律性。由此提出：(1)胰腺癌终末期与《内经》“心病”密切相关,与《伤寒论》“太阴病”存在一定的联系。(2)结直肠癌终末期患者病情的恶化与阳气升发、外散,且男性患者病情与《内经》“脾病”关系密切。(3)终末期原发性肺癌与《内经》“肺病”有密切的联系。气温对其病情存在影响。(4)乳腺癌终末期病情与《内经》“肝病”关系密切,与《伤寒论》“阳明病”存在一定的关联。(5)原发性肝癌终末期与《伤寒论》“阳明病”存在密切联系。(6)胃癌终末期男性患者的病情与《金匮要略》“虚劳病”和《内经》“肝病”均存在一定关联。(7)恶性血液病终末期男性患者病情与《内经》“肺病”存在一定联系。(8)女性患者病情的恶化更容易受到气温影响。(9)节气转换对终末期患者的病情存在不利的影响。论文第三部分从多个角度对比了各病种间死亡时间存在的差异,发现这种差异普遍存在,说明单一病种单独分析未表现出节律,但在不同病种间比较时却有显著差别。由此论证了不同病种间在时间医学的层面上存在明显区别。论文第四部分论述了中医与时间医学的关系,简要分析了当前中医时间医学发展缓慢的主要原因,阐明了课题的创新性和可行性,从季节、月相、干支及其阴阳五行属性、伤寒六经欲解时等角度总结全文,最后提出结论：现代医学定义下的疾病,其节律性仍普遍存在,不能完全被现代医学的不断进步所掩盖。这些节律的某些部分与《内经》、《伤寒论》的记载吻合且与临床相符,说明相关记载有其合理性,也说明现代医学定义下的疾病在某些阶段与《内经》、《伤寒论》的“病证”存在一定的趋向性。更多还原

【Abstract】 This research explores the law of death time of1539patients of Pancreatic Carcinoma, Colorectal Carcinoma, Primary Lung Carcinoma, Breast Carcinoma, Primary Hepatocarcinoma, Primary Gastric Cancer, Esophageal Cancer, Hematological Malignancy, Chronic Renal Failure, Acute Hemorrhagic Stroke, Acute Ischemic Stroke and Aute Myocardial Infarction, who died in Jiangsu Province Hospital of Traditional Chinese Medicine (TCM) from2008to2010, in view of month,quarter,tendays,time of day and night,season,ten days of lunar calendar,lunar phase,the heavenly stems of day and hour,earthly branches of day and hour and their yin-yang attribute, recovery of disease from six pairs of channels. This research discuss problems with original text of ancient Huangdi Neijing, Shanghan, Jinguiyaolue and contrast difference of death time between different diseases.In the chapter one, research advancement is summarized in the point of ancient TCM literature and clinical cases.In the chapter two, the law of death time of patients is discussed. The avarage age of male and female and last hospital days are compared. It is show that every disease has some rhythms. Some view points are introduced:(1)Pancreatic Carcinoma has relationship with heart disease of Neijing in close and disease of taiyin meridians in Shanghan in some extent.(2)Aggravation of Colorectal Carcinoma is relate to ascending of yangqi. Male patient’s condition has close relationship with spleen disease of Neijing.(3) Primary Lung Carcinoma has close relationship with lung disease of Neijing and temperature can affect the condition of illness.(4)Breast Carcinoma has relationship with liver disease of Neijing in close and yangming disease in Shanghan in some extent.(5)Primary Hepatocarcinoma has close relationship with yangming disease of Shanghan.(6)Primary Gastric Cancer has close relationship with consumptive disease in Jinguiyaolue and liver disease in Neijing.(7)The state of Male patients of Hematological Malignancy has some relationship with lung disease of Neijing.(8)Aggravation of condition caused by temperature of female patients is easier than male patients.(9)Solar term change has negative effect on the condition of patients. In the chapter three, the differences of each disease are contrasted from different points of view. Significant deviations are found anywhere that prove differences in chronomedicine between diseases exist.In the charpter four, the relation between TCM and chronomedicine is discussed. The major reason of slow development of TCM chronomedicine is analysed concisely. The innovation and feasibility of this research topic is clarified.In conclusion, diseases defined by modern medicine has rhythms which can not be covered up with development of modern medical science. Some part of this rhythms consist with the records of Shanghan, Neijing and clinic cases. It is proved that the records in ancient TCM is rational in some extent and illustrate disease defined by modern medicine has tropism in some stage to disease in Neijing or shanghan. liturature is rational, and diseases defined by modern medicine has some tropism with diseases recorded in Neijing or Shanghan in some stage.更多还原