干支运气与疾病中医证型的关联性研究

【作者】 汤巧玲；

【导师】 贺娟；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2014， 博士

【摘要】 运气学说是我国古代探讨天时、气象运动变化规律,及其对人体生理和发病影响的一门学科。两千年来,运气学说一直以其独特的视角,应用于分析疾病的病因病机和指导临床辨证论治。《黄帝内经》“运气七篇”大论中用大量的篇幅论述了五运的太过不及、六气司天在泉,与疾病罹患的种类、脏腑系统以及中医证候之间的关系,认为不同的干支年份,临床发病的脏腑、病证亦有不同,临证分析病机、处方用药等均应结合运气特点。历代医家大量的医理论述及医案记载,也均体现了运气与疾病及其证型的密切关系。因此,五运六气与人体疾病发生的关联性是五运六气的核心内容,不仅其客观性、科学性有待验证,而且其内涵的挖掘与揭示,对于发展中医理论,指导中医临床辨证,提高临床疗效均有重要意义。1研究目的根据北京中医药大学东直门医院2000-2011年内科住院病历的疾病证型数据以及同期气象数据,探索干支运气与疾病中医证型之间的关联性,为干支运气在中医临床诊疗中的应用提供参考。具体包括：(1)探讨内科疾病六气、五脏相关证型的分布与干支运气(五运、六气、运气相合)所推演的疾病趋势之间是否存在关联性,评价干支运气对中医证型的影响程度；(2)从现代气象学角度,探讨自然界气象因子(温度、降水量、风速、相对湿度、水汽压)与中医的六气(风、寒、暑、湿、燥、火热)相关证型之间的关联性。2资料与方法资料来源：病历资料来源于北京中医药大学东直门医院2000-2011年12年间所有内科住院病历；气象资料来源于北京市观象台提供的同期12年的逐日平均气温、逐日平均降水量、逐日平均水汽压、逐日平均相对湿度、逐日平均风速。资料的归类：提取、录入12年间所有记录完整且符合纳入标准的住院病历的基本信息(包括疾病、证型、入院时间等),按疾病的入院中医证型中所涉及的“六气”及“五脏”进行逐一归类。将气象资料按一年六段气进行划分。五运与证型的相关性研究：按12年岁运的阴阳属性,比较太过组(阳千年)与不及组(阴干年)的证型分布差异；根据岁运的五行属性,比较木、火、土、金、水五组的差异；根据《内经》对五运的认识,比较岁运理论高发年与岁运理论低发年两组的差异。六气与证型的相关性研究：按12年证型在全年、上半年、下半年的分布,进行曲线拟合度检验,比较司天与在泉对全年的影响程度；根据每年的司天之气,比较太阳司天、厥阴司天、少阴司天、太阴司天、少阳司天和阳明司天六组的差异；根据《内经》对六气的认识,比较司天理论高发年与司天理论低发年两组的差异；根据证型在六主气以及六客气各组间的平均比值,比较组间差异。运气同化与证型的相关性研究：分析运气同化年(主要包括寒化年和火化年)的六气及五脏证型的分布特点,并对运气同化年与运气非同化年两组各证型进行独立样本的非参数检验,观察各证型在运气同化年与运气非同化年的分布差异。六气证型与气象因子的相关性研究：将12年证型相关病例数自立春始,按六步气(每一步气为四节气)分为72段,并计算出各时段的病例数均值,分别与温度、风速、降水量、相对湿度、水汽压气象因子相应时段的均值进行偏相关分析,气象因子共包括360段值,观察其关联性。统计学方法：应用Microsoft excel2010软件进行数据的描述性统计,应用SPSS17.0软件进行t检验、方差分析、卡方检验、相关分析、拟合度检验和非参数检验等。3结果五运与证型：各证型的分布在岁运(天干)的阴阳(阴干岁运不及,阳干岁运太过)、五行(木年、火年、土年、金年和水年)属性无明显的相关性。单纯从岁运角度推演所得出的某一疾病证型高发或者低发,难以反映临床的实际证型情况。六气与证型:证型在司天(上半年)和在泉之气(下半年)的分布具有一定规律,在客气中,司天之气较在泉之气对全年病证特征的影响可能更大。从六气、五脏各相关证型的分布来看,受上半年影响大的有“寒”、“暑”、“燥”、“火”、“心”、“脾”、“肾”相关的证型；证型在主气的分布,“暑”证发病主要集中在四之气、“心”证发病主要集中在初之气,其他证型主要集中在五之气,与相同性质的主气未表现出一一对应的关系。运气同化与证型：运气寒化年,当年“风”、“寒”、“湿”等属阴邪的证型发病略高于运气非寒化年,“肝”相关的证型发病明显高于运气非寒化年；“燥”、“火”、“热”等属阳邪的证型发病略低于运气非寒化年,“肺”相关的证型发病明显低于运气非寒化年,其余无差异；运气火化年,当年“热”相关的证型的发病明显高于运气非火化年,“寒”相关的证型的发病明显低于运气非火化年,其余无差异。六气证型与气象因子：部分六气证型与特定气象因子呈一一对应的直接关系。如“暑”相关的证型与四之气的温度、“火”相关的证型与五之气的温度、“热”相关的证型与二之气的温度等,均为正相关,且具有统计学意义；部分六气证型与特定气象因子间接相关,如“寒”相关的证型与终之气的降水量正相关；“湿”相关的证型与初之气的风速负相关；其他证型与气象因子的关系,未能发现或无法计算。4结论干支运气与疾病的中医证型具有一定的关联性,干支运气的不同要素对不同类型的证型影响程度差异很大。六气证型与干支运气的关联度高于五脏证型与其的关联度。五运、六气以及运气相合对疾病证型的影响不一,运气同化对疾病的影响最大,其次是六气,影响最弱的是五运。中医“风”、“寒”、“暑”、“湿”、“燥”、“火”、“热”等证型与自然界的温度、降雨量、风速、相对湿度、水汽压等气象因子的变化具有一定的关联性。对于五运六气我们要以辩证的态度灵活运用,在掌握干支运气的一般规律和运气推演方法的基础上,应因时、因地、因人制宜,客观分析运气在疾病发病中的作用。建议今后开展多中心、前瞻性的研究,增加样本量,适当延长观察周期,选择与自然界气候变化具有密切关系的病种,从岁运、主气、客气(司天、在泉之气)、运气相合等多个角度分别或综合分析证型与干支运气的相关性,以期研究结果能更好地指导运气学说在临床疾病诊疗中的应用。更多还原

【Abstract】 Yunqi theory is a subject which is used to explore the rule of nature and climates changes and its influence on the physiology and pathogenesis of human. For two thousand years, yunqi theory has been applied to analyze the etiology and pathogenesis of disease and provide reference for clinical practice based on pattern differentiation. Huang Di Nei Jing(黄帝内经)was rich of etiology and pathogenesis theory, which guided the traditional Chinese medicine (TCM) doctor to recognize the pathogenesis and syndrome characteristic of diseases, and then mastered the rule of treating diseases. According to large amounts of medical theory records and case reports from ancient TCM physicians’books, there is a close relationship between gan zhi yun qi(干支运气)and the TCM pattern of diseases.1ObjectiveInternal medical records and the meteorological data from corresponding period were used to explore the correlation between gan zhi yun qi and the disease pattern, aiming to provide reference for the application of gan zhi yun qi in TCM clinical practice. The details includes:(1)To explore the correlation among distribution of six qi (六气) pattern and five organs(五脏) pattern of diseases and gan zhi yun qi, check whether the correlation is exist and how it should be.(2)To explore the correlation between climate factors (including temperature, precipitation, wind speed, relative humidity, and vapor pressure) and six qi patterns (wind, cold, heat, wet, dryness and hot).2Materials and MethodsData sources:Internal medical record data range from2000to2011was provided by Dongzhimen Hospital of Beijing University of Chinese Medicine. Meteorological data was provided by Beijing Observatory, including the daily average data of temperature, precipitation, vapor pressure, relative humidity and wind speed.Extraction of data:Basic information including the diagnosis, pattern and treatment time was extracted from internal disease data of medical records which met the inclusion criteria of the research. Diseases data which contained the patterns of six qi or five organs would be classified and calculated respectively, the meteorological data was classified by the six stages of one year.Correlation analysis of five yun and TCM pattern:Firstly,12years were divided into yin-gan (阴干) group and yang-gan (阴干) group according to their yin-yang belongings, and then the difference of pattern distribution was compared between the two groups. Secondly, 12years were divided into wood-yun, fre-yun, earth-yun, gold-yun and water-yun group according to their five elements belongings, and then the difference of pattern distribution was compared among the five groups. Thirdly,12years were divided into high and low incidence of patterns year group according to the five-yun theory of Huang Di Nei Jing, and then the difference of pattern distribution was compared between the two groups.Correlation analysis of six qi and TCM pattern:Firstly, we compared the distribution of pattern in the first half(qi of si tian,司天之气)and second half(qi of zai quan,在泉之气)of a year, and find which was the domain to the whole year, so as to evaluate the influence of si tian and zai quan on diseases and their patterns. Secondly,12years were divided into Taiyang, Jueyin, Shaoyin, Taiyin, Shaoyang and Yangming group according to kinds of qi of si tian, and then the difference of pattern distribution was compared between the six groups. Thirdly,12years were divided into high and low incidence of patterns according to the six qi theory of Huang Di Nei Jing, and then the difference of pattern distribution was compared between the two groups. Lastly, we also divide12years into six groups according to six host qi(主气)or guest qi(客气),and then the difference of pattern distribution was compared between the six groups respectively.Correlation analysis of cooperative yun-qi (运气同化) and TCM pattern:We explored the distribution characteristic of six qi and five organs patterns in cooperative yun-qi year (including cold and fire), and compared the difference of patterns between the cooperative yun-qi year group and non-cooperative yun-qi year group.Correlation analysis of six qi pattern and meteorological factors:Every year was divided into six stages (one stage was further divided into four solar terms) according to twenty-four solar terms in China, so we get72results of pattern distribution. Correspondingly, the average of temperature, wind speed, precipitation, relative humidity and vapor pressure in each stage were calculated, so we get360results of meteorological factors. Then we analyze the relationship among the patterns and meteorological factors by partial correlation.Statistical methods:Microsoft Excel2010was used to conduct the descriptive statistics, and SPSS17.0was used to conduct t-test, analysis of variance, chi-square test, correlation analysis, goodness of fit test and non-parametric tests.3ResultsCorrelation of five yun and TCM pattern:There is no significant statistical difference in distribution of TCM pattern of yin-gan and yang-gan group, nor five elements group (wood yun, fire yun, earth yun, golden yun and water yun). It is difficult to predict the clinical TCM patterns changes by using the five yun theory alone to deduce incidence of diseases’pattern. Correlation of six qi and TCM pattern:The distribution of TCM patterns showed regularity to a certain extent according to si tian and zai quan. Si tian had a greater impact to the whole year’s pattern distribution than zai quan. The distribution of patterns including cold, summer-heat, dryness, fire, heart, spleen and kidney might be affected by si tian of the host climatic qi in the first half of a year. The incidence of summer-heat pattern concentrated in the fourth stage of a year, and heart pattern concentrated in the first stage; other patterns concentrated in fifth stage, showed no corresponding relationship with host qi with the same belongings.Correlation of cooperative yun-qi year and TCM pattern:In the cooperative yun-qi cold year, the incidence of wind, cold and damp pattern and liver pattern was higher than non-cooperative cold year, the incidence of dryness, fire and heat pattern and lung pattern was lower than in non-cooperative cold year. In the cooperative yun-qi fire year, the incidence of heat pattern was higher than in non-cooperative fire year, and the cold pattern was lower than in non-cooperative fire year.Correlation of six qi pattern and meteorological factors:Some patterns showed close relationship with corresponding climate factors, such as summer-heat pattern with the fourth stage’s temperature, fire pattern with the fifth stage’s temperature, and heat pattern with the second stage’s temperature. The above correlations were positive with statistical significance. Some patterns showed close relationship with indirect climate factors, like cold pattern with the last stage’s precipitation, damp pattern with the first stage’s wind speed, were negative correlation with statistical significance. Others didn’t found any correlation.4ConclusionThe incidence of pattern of diseases has a certain correlation with gan zhi yun qi, and different parts of gan zhi yun qi have different influence on patterns. The correlation of six qi pattern with gan zhi yun qi is closer than five organs pattern with gan zhi yun qi. The influence on the pattern of diseases varies widely in five yun, six qi and cooperative yun-qi: cooperative Yun-qi is the most important influencing factor of diseases and their patterns, the second is six qi, and the last is five yun. TCM’s six qi pattern like wind, cold, summer-heat, damp, dryness, fire and hot, has a certain correlation with meteorological factors like temperature, precipitation, wind speed, relative humidity and vapor pressure.As for the value ofyunqi theory, we should hold a dialectical attitude. On the premise of the commanding of common rule and calculation method of yunqi theory, we should analyze the effect of yunqi theory on disease varies from circumstances, local conditions and individuals. We suggest that, multi-center and prospective study with larger sample size and longer observation period should be conducted in future, and the targeting disease should be relevant with climate change. From the perspective of five yun, host qi, guest qi (si tian and zai quan) and cooperative yun-qi, to analyze the correlation of gan zhi yun qi and TCM patterns individually or overall, so as to provide reference for the application of yunqi theory in TCM’s clinical practice.更多还原