【作者】 丁以艳；

【导师】 吴承玉；

【作者基本信息】 南京中医药大学 ， 中医诊断学， 2012， 博士

【摘要】 中医学认为人体是以五脏为中心的有机整体,可分为心、肺、肝、脾、肾五个系统。心系主要包括心脏及与之相关联的小肠、脑、心包、舌、脉、面等。辨证是中医学的核心及精华,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,规范并确立心系病位特征及基础证。本研究通过查阅古今相关文献,梳理中医心系理论,明确心系的概念、形态结构、生理功能及特性、内在联系及与它脏的关系、病因病机及病理特点等。对心系各症状进行规范研究处理,确立心系8个基础证,包括心气虚证、心血虚证、心阴虚证、心阳虚证、心血瘀阻证、心火亢盛证、痰蒙心神证、瘀阻脑络证。收集整理江苏省中医院病案室2000-2010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1741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。同时征询全国行业内21位中医诊断学专家意见,请专家对心系病位、病位特征、各基础证及证型中各症状作出重要性分级评价,对专家意见进行内容效度分析。在两项研究中,寻找出与心系病位及各证型相关系数较高的症状,结合中医理论,概括最有意义的判断心系病位的特征性症状,规范8个心系基础证的概念、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。心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。辨证注重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的重要组成部分之一,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. The constituents contains heart, lung, liver, spleen and kidney system. And heart system mainly includes heart, small intestine, pericardium, brain, tongue, vessels and face. 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 heart 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, heart 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,8basic syndromes are summarized, including asthenia of heart qi syndrome, heart blood asthenia syndrome, heart yin asthenia syndrome, heart yang asthenia syndrome, heart vessels obstruction syndrome, exuberance of heart fire syndrome, mind confusion by phlegm, brain vessels obstruction syndrome. By collecting medical records in2000-2010from Jiangsu Province Hospital of TCM, tutor’s clinical practice, medical magazine and books,1741relative cases are selected. Then SPSS statistical software and clustering analysis are used to analyze clinical information of syndromes. Meanwhile,21TCM diagnosis experts throughout the country are consulted to show the importance evaluation on heart 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 high relative symptoms are expected to be found out, the most important symptoms in determining heart system’s disease-location and disease-character are summarized,8basic syndromes in heart 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.Establishment of disease-location characteristics and basic syndromes of heart 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 heart system by this research, also an important guiding function on improving TCM clinical syndrome differentiation.更多还原