【作者】 耿元卿；

【导师】 王旭东；

【作者基本信息】 南京中医药大学 ， 中医康复学， 2013， 博士

【摘要】 亚健康状态是人在生理、心理及社会适应能力等方面处于健康与疾病之间低水平的功能状态。心理亚健康是亚健康状态的一个亚型,介于心理健康与精神疾病之间的中间状态,如不引起重视可能发展为躯体疾病和精神疾病。目前现代医学对亚健康状态的发生原因及发生机制尚未阐明,干预方法较少,且缺乏针对性。亚健康的表现多为人体功能上的异常,属于中医“证”的范畴。中医药在调节机体功能方面具有独特的优势,使用中医养生方法调节人体的身心状态能达到有效防治亚健康的目的。[目的]本论文通过文献综述,系统地回顾亚健康的现代医学研究概况,掌握中医学对亚健康的认识和防治现状,并提出中医干预亚健康的理论依据和有效的干预方法；通过中医养生方法干预心理亚健康的实验研究,观察不同养生方法对心理亚健康状态的效果,探讨其作用机理,为亚健康状态的防治提供新的研究思路和值得推广应用的干预方法。[方法]本研究分为两个部分：第一部分是文献综述和理论探讨。通过文献综述,系统地回顾亚健康的现代医学研究概况,掌握中医学对亚健康的认识和防治现状。在此基础上,总结中医学干预亚健康状态的理论依据,即“形神合一”观是中医防治亚健康的重要理论,亚健康状态是一种神伤及形、形损及神,形神俱疲的功能失调状态；形神共养是防治亚健康的重要法则,应从养形和调神两方面干预亚健康,以达到形神合一的健康状态。第二部分是实验研究。以本校医学专业二年级学生为心理亚健康的筛查对象,经过初筛和复筛,得到心理亚健康状态的实验对象,随机分为4组,即八段锦干预组、中医五行音乐干预组、八段锦+五行音乐综合干预组和空白对照组。干预时间是4周。使用90项症状自评量表作为干预前后判断效果的评定方法,进行干预前总均分和各因子得分的组间比较、干预后总均分和各因子得分的组间比较、某因子内各项症状分值的组间比较,以及同组干预前后总均分和各因子得分的比较。[结果]组内比较：八段锦组和五行音乐组干预后除人际关系敏感因子得分外,总均分和其他因子得分均较干预前减低。综合干预组干预后的总均分和所有因子得分均较干预前减低,其中,躯体化、焦虑、抑郁、强迫症状、消化不良和睡眠障碍得分较干预前显著性下降。组间比较：八段锦组总均分和所有因子分都比空白对照组低,尤其是躯体化、焦虑、抑郁这三个因子分较对照组有显著性差异,P<0.001；八段锦组的躯体化因子分比五行音乐组低,P<0.05。五行音乐组总均分和所有因子分都较空白对照组显著减低,尤其是焦虑、抑郁这两个因子分较对照组有显著性差异,P<0.001；焦虑、抑郁、强迫因子分较八段锦组减低,P<0.05。综合干预组总均分和所有因子分都比空白对照组低,改善焦虑、抑郁、精神病性、消化和睡眠的程度优于八段锦组,改善躯体化、精神病性、消化和睡眠的程度优于五行音乐组。因子内主要症状的组间比较：八段锦组对因子内主要症状较对照组有明显改善。八段锦能减轻躯体症状,其中对腰痛和手脚发沉的康复效果优于五行音乐组,还能减轻焦虑和抑郁的程度,对消化不良和睡眠障碍都有明显的改善作用。五行音乐对腰痛、四肢酸痛的躯体症状,焦虑、抑郁、敌对和强迫因子内症状,以及消化不良和睡眠障碍较对照组有明显改善；较八段锦组能更好地改善容易哭泣、感到苦闷、过分担忧、易激动的情绪控制不良的症状。综合干预组的躯体化、焦虑、抑郁、敌对和强迫、消化功能不良、睡眠障碍因子的所有症状较对照组均有明显改善,对躯体化症状康复效果优于五行音乐组；对心理精神症状康复效果优于八段锦组。上述研究结果表明：八段锦干预法、五行音乐疗法以及八段锦+五行音乐综合干预法对改善心理亚健康状态的整体效果都很明显,证实了从形体和精神两方面调节亚健康状态的有效性。其中八段锦干预法、八段锦+五行音乐综合干预法对躯体症状较五行音乐疗法有更好的康复作用；五行音乐疗法、八段锦+五行音乐综合干预法对抑郁和焦虑不良情绪的改善优于八段锦干预法；三种康复方法在改善心理亚健康症状程度方面均优于自然转归。[结论]形神统一观是中医防治亚健康的重要理论基础。亚健康状态是一种神伤及形、形损及神,形神俱疲的功能失调状态。形神共养是防治亚健康的重要法则,应从养形和调神两方面干预,以达到形神合一的健康水平。养生必须充分重视“神”的调养。基于“五脏主情志”理论,八段锦不仅能减轻亚健康的躯体症状,还能通过强健五脏达到调节心理亚健康状态的作用,是机体全面调养的健身功法。中医五行音乐基于中医五音疗法,通过调节五脏功能来改善不良的心理状态和异常的行为,达到了调神的作用,对心理亚健康状态的精神症状有良好的康复效果,尤其能放松精神,改善抑郁和焦虑等不良情绪。八段锦+五行音乐综合干预法的疗效优于单一方法,具有同时改善躯体亚健康和心理亚健康的作用,这体现了“杂合以治”的养生思想和中医养生法综合调理亚健康的有效性。八段锦和五行音乐疗法都属于中医非药物疗法,安全而无毒副作用。本研究观察并评价这两种疗法和两种疗法组合对心理亚健康状态的康复效果,为亚健康的防治提供新的研究思路和值得推广应用的干预方法。更多还原

【Abstract】 Sub-health is the lower functional state between health and illness, which covers the aspect of personal mental, psychology and social adaption ability. As a subtype of sub-health, mental sub-health is the middle state between mental health and psychological disease, which can potentially lead to body illness and mental disorders. At present, modern medicine has not illustrated the root cause and the development of sub-health state. There are a few intervention methods with particular pertinence. Traditional Chinese medicine focuses on the prevention of disease. The behavior of sub-health usually indicates the abnormal of the personal body functions that belongs to the "pattern" in Chinese medicine. It has special advantages to use the Chinese medicine for adjustment of the body functions. It is highly expected to effectively intervene sub-health by using Chinese medicine methods in order to adjust the physical and metal states.ObjectiveThe literature research of the article is to systematically review the current research situation on sub-health by modern medicine and to master the understanding of sub-health by Chinese medicine.The article is to put forward the theoretical basis and effective methods by using of Chinese medicine to intervene sub-health. The effects of the different preserving health options on the undergraduates’psychological sub-health state were observed and its mechanism was studied through the experimental research on Chinese preserving health methods to intervene the mental sub-health state. Thus, the study point has been proofed to be effective and the research methods are provided to preventively treat sub-health.MethodsThe study is divided into two sections:the first one is literature research and theoretical discussion.It systematically reviewed the current research situation on sub-health by modern medicine and understanding of sub-health by Chinese medicine;and it mastered the research progress on the sub-health.Based on the theoretical research,the article puts forward the academic point "unification of body and mind" that is the vital instructional theory on preventively treatment of sub-health by Chinese medicine.The sub-health state is defined as dysfunctional state in which the disorder of mind affects the body, the discomfort of body damages the mind and finally the body and mind is thoroughly tired. First of all, the emotion and sentiment has to be adjusted to change the sub-health and then the body and mind will be unified to reach the expected healthy level. Adjustment of sub-health state is the vital prerequisite to ensure the fitness by building fitness and regulating the mind in order to keep the state of unification of body and mind.The second part is the experimental research. The subject was the second-year medical school undergraduates.After initial screening and the second screening,the experimental subjects were randomly divided into four groups, that is, the Baduanjin intervention group, Five Notes Music intervention group, the Baduanjin and Five Notes Music intervention group and the control group. During the intervention period of four weeks, the effects of before and after intervention were comprehensively evaluated by use of Symptom Checklist90(SCL-90). The total mean score of SCL-90and each factor score were observed and statistically compared among groups and within groups before the experiment and after the experiment. Besides,the score of each symptom in some factors was compared in the experiment.ResultsComparison in the group:except for sensitivity of interpersonal relationship,the total mean score of SCL-90and the scores of all factors were significantly reduced in the group of the Baduanjin and Five Notes Music intervention group.The total mean score of SCL-90and the scores of all factors were significantly reduced in the group of combined intervention,especially in the factors of somatization,depression, anxiety,obsession, digestion and sleep disorders.Comparison among groups:The total mean score of SCL-90and the scores of all factors were reduced in Baduanjin Group in comparison with the scores of the control group,especially in the factors of somatization,depression and anxiety(P<0.001).The score of somatization is lower than Five Notes Music group(P<0.05).The total mean score of SCL-90and the scores of all factors were significantly reduced in Five Notes Music Group in comparison with the scores of the control group,significantly in the factors of anxiety and depression (P<0.001).The scores of anxiety, depression and obsessive-compulsive were reduced in comparison with the score of Baduanjin group(P<0.05).The total mean score of SCL-90and the scores of all factors were reduced in the group of combined intervention in comparison with the scores of the control group.For anxiety,depression,symptom,psychoticism,digestion and sleep disorders, the Combination Group had better improvement degree than Baduanjin Group;at the mean while, for somatization,psychoticism,dyspepsia and sleep disorders,the Combination Group had better improvement degree than and Five Notes Music Group.Comparison of each symptom score of some factors among groups:the main symptoms of Baduanjin Group had significant improvement degree.The scores of some somatization symptoms were reduced than Five Notes Music group,such as low back pain and the heavy feeling of hands and feet;at the mean while,the degree of anxiety,depression,digestion and sleep disorders had significant improvement.For Five Notes Music Group,there are more significant improvement in low back pain,limbs ache,anxiety, depression, hostility, obsessive-compulsive, digestion and sleep disorders than the control group.In Five Notes Music Group,dysthymia symptoms such as easy to cry,excessive worry and feeling of depression and irritation were greatly improved than Baduanjin Group.There are more obvious improvement in symptoms of somatization, anxiety, depression,hostility,obsessive-compulsive,dyspepsia and sleep disorders than the control group.For somatization,the Combination Group had better improvement than Five Notes Music Group;for dysthymia symptoms,the Combination Group had better improvement than Baduanjin Group.The study results indicate:it is obvious that Baduanjin Group, Five Notes Music Group and Combination Group have overall great effects on improving mental sub-health.From what has mentioned above,there are significant improvement to sub-mental health for Baduanjin Group, Five Notes Music Group and Combination Group.It is confirmed that adjusting sub-health from body and mind is firmly valid and effective.Compared with Five Notes Music Group, Baduanjin Group and Combination Group have better rehabilitation effects on the somatization symptom.Five Notes Music Group and Combination Group have advantages over Baduanjin Group on treating depression and anxiety mood.The three intervention options are better than natural rehabilitation in the respect of treating mental sub-health.ConclusionThe combination of body and mind is the important theoretical foundation for Chinese medicine to preventively treat sub-health. Being the dysfunctional state, sub-health is the disorder of mind affecting the body, the discomfort of body damaging the mind and tiredness of body and mind. In order to achieve the healthy state of unifying body and mind, the alteration of sub-health state should firstly focus on optimizing the adjustment of emotion and sentiment. The critical premise to ensure health is to actively and timely adjust the sub-health state.Based on "five organs predominating emotion"theory, Baduanjin not only relieves somatization symptoms,but also adjusts mental sub-health through enhancing the five organs and improving functions. Consequently, Baduanjin is a complete adjustment for body building method. Based on the therapy of Five Notes of Chinese medicine,Five Notes Music adjusts adverse psychological state and abnormal behavior through adjusting the five organs and improving functions.Five Notes Music has the optimal regulating functions for mental sub-health via the adjustment of mental and psychology,especially relaxing and relieving depression and anxiety.Compared with the signal method,the combination of Baduanjin and Five Notes Music can better simultaneously optimize sub-health and mental sub-health states.The combination method demonstrates the point of "combination and comprehension as treatment" and the rehabilitation idea of comprehensive adjustment and treatment.The therapies of Baduanjin and Five Notes Music that are safe and non-toxic side effects belong to the non-drug therapy of Chinese medicine.The effects of the two therapies and the combination therapy on the sub-mental state were observed and its mechanism was studied.Its point has been proofed to be effective and the research way is steered into the practically preventive treatment for sub-health.更多还原