《伤寒论》阳明、太阴病证与肠道微生态及人体反应性关系研究

【作者】 彭鑫；

【导师】 傅延龄；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2008， 博士

【摘要】 本研究在系统地整理古今文献的基础上,结合肠道微生态与中医学理论的关联性,从方证相应的基本观点切入,对《伤寒论》阳明、太阴病证应用中药干预后,肠道微生态所构成的中医“证”的变化进行了探索性研究。在研究结果的基础上,结合导师的学术观点,对人体反应性和医学现象学等学术观点进行了深入探讨。本论文由文献综述、实验研究和理论探讨三部分组成。第一部分为文献综述部分。第一篇综述对微生态学与现代医学的关系进行了研究。研究发现微生态学不仅深化和拓展了现代医学对发病学的认识;而且通过调控微生态菌群的方法治疗疾病,为现代医学拓展了治疗思路和方法,并在此基础上促进了预防和保健医学的发展。因此,微生态学对现代医学进一步认识人的生理、病理提供了新的理论和方法。第二篇综述对微生态学与中医学之间的关系进行了对比研究。论文首先对中医学的基本理论,如整体观、阴阳学说、藏象学说、以及中医病因病机、治则治法、预防保健等与微生态学理论进行对比发明后,发现二者之间有很多相似、相通之处;然后结合现代临床和实验研究,对中药对微生态的影响以及微生态对中药药效的作用进行了文献整理研究;最终研究结果认为该研究领域内存在菌种选择片面、药物选择单一、治疗方法局限、理论分析不足等四种问题,在未来研究中应发挥微生态学和中医学优势,二者应互相借鉴,共同提高。第三篇综述对中医“脾胃”学说与肠道微生态的关系进行了论述。研究发现中医的脾胃学说在理论构架上与新兴的微生态学说有着很多共通之处。脾胃功能和肠道微生态功能有密切对应关系,同时,二者在临床方面互相也有所借鉴。最终研究认为,用肠道微生态的观点可以理解脾胃学说,反过来用中医脾胃学说的理念也可以印证肠道微微生态表现,二者相得益彰,在该领域的未来研究中可以互相借鉴,共同提高。第二部分为实验部分。实验选取《伤寒论》中代表寒、热属性的中药黄连、干姜,观察其对肠道常见菌群体外培养的影响,以推测中医“证”变化所对应肠道微生态的变化规律。方法:将含有不同浓度的黄连、干姜、黄连干姜混合的中药培养基对肠道微生态四种代表菌群(大肠杆菌、粪肠球菌、双歧杆菌、乳酸杆菌)进行体外培养,与纯培养基培养对比。通过对比培养前后菌液分光光度值的变化(ΔOD值)的方法,观察中药对四种菌生长的影响。结果显示:1相同中药培养基、不同菌种的对比:干姜对大肠杆菌和粪肠球菌的影响以抑制为主,而对于双歧杆菌和乳酸杆菌则显示促进作用。黄连对前三种菌的影响以抑制为主,并随对浓度的不同而有所变化;而对于乳酸杆菌则显示低浓度促进和高浓度抑制作用。黄连干姜混合液对前三种菌的影响以抑制为主,而对于乳酸杆菌则显示低浓度促进和高浓度抑制作用。2相同菌种、不同中药培养基的对比:大肠杆菌经三种不同中药培养均呈抑制作用,且随浓度不同抑制程度有所变化。粪肠球菌经三种不同中药培养均呈抑制作用,且随浓度不同抑制程度有所变化。双歧杆菌经干姜和黄连干姜混合培养均呈促进作用;而经黄连培养则呈抑制作用。乳酸杆菌经干姜培养呈促进作用;经黄连和干姜黄连混合培养均呈低浓度促进和高浓度抑制作用。结论:相同寒热属性的中药对不同种类肠道菌所构成的影响不一定相同,可能促进也可能抑制;同种菌对不同寒热属性的药物的反应可能相同,也可能不同。中医“证”的变化所对应的是肠道微生态的整体变化,即肠道各种菌群的数量、分布、比例等的综合变化所组成的整体换位。第三部分为理论探讨。论文由实验而引出肠道微生态与中医“证”相关性,进一步深入探讨人体反应性、医学现象学这两个与本研究相关的学术观点。人体反应性是本论文专题论述的第一个学术观点。论文首先对其概念、种类和特点进行了说明。简而言之,人体反应性指生命个体的身心受到内、外环境的刺激后作出相应的反应,从刺激来源上来看其分类包括对物质和时间两种刺激的反应。人体反应性具有综合性、稳定性和变化性的特点。研究者可以通过直接观察和间接分析的方法辨识人体反应性,进而应用各种手段对其进行干预。论文进一步对人体反应性与中医学乃至整个医学的关系进行了论述,研究认为,中医学乃至整个医学都是围绕如何对人体反应性的辨识和干预而展开的,而中西医区别主要在于各自采集患者信息与治疗手段的对应关系的不同,但二者都是围绕人体反应性而进行。医学现象学是本论文专题论述的第二个学术观点。文章首先对医学现象学的概念、范围进行了说明;然后将医学现象与中医学理论及临床实践的关系进行了全面论述,认为中医学中取类比象的研究方法、藏象学说、气血津液、经络、病因病机、中药等理论的构建,以及中医诊断、治疗等临床实践无一不是建立在医学现象的基础之上;论文最终认为,医学现象是中医学乃至整个医学学科构建的重要依据和客观基础,整个医学实质就是对医学现象规律的总结。对这以上两个学术观点展开引申探讨,不仅有助于科学界清晰的理解中医辨证及中药作用,更为拓展中医科研思路与方法乃至中西医的互通和交融提供参考。更多还原

【Abstract】 According to the theory of TCM together with the theory of microecology,this paper study the change of interic bacterium which had been effect by the medicine in Taiyin,Yangming disease of ShangHanLun.The change could reflect the symptom complex of TCM. Furthermore, according to the result of this research together with Professor Fu’s academic study ,this paper makes a deep discussion on the point of the response of human body and medicinal phenomenology,so to explore the deep correlation between the symptom complex of TCM and the interic microorganism.This thesis involves in 3 parts:The first part involves 3 overviews of literature.The first overview summarize the concept, study field, history and present situation of microecology and the relationship between modern medicine and microecology. Not only dose microecology deepen the understanding of aetilogy but also expand the treatment, based on this, microecology promotes the development of sanipracitic.The second overview contrast microecology and TCM, discuss the entirety theory, yin-yang theory, manifestations of organs theory, principle of treatement, precaution and the theory of microecology to find out the resemblance between them. Then referenced by the research of clinic and experiment, the result of study shows it has four shortage in this research field: bacterium select unilateral, medicine select unilateral, treatment limited, short of academic analysis.In the future, the study should elaborate the advantage of microecology and TCM and improve them together. The third overview focus on the resemblance between interic microecology and spleen and stomach theory of TCM including the field of digestive system, immune system, metabolic system and circulatory system.In the opinion of microecology, the spleen and stomach theory of TCM can be understood deeply, vice versa,in the future,they should bring out the best in each other.The second part is experimental research. The course is in this way: first, let 4 different representative interic bacteria (Escherichia coli, Enterococcus, Bifidobacterium, Lactobacillus) cultured in the substrate which contain two different attribute medicine of TCM (Chinese goldthread, dried ginger) ,then observe the change of OD data of every bacteria after it has been cultured and then analyse the data to conjecture the change of the whole interic microorganism which corresponding the change of the cold and heart symptom complex of TCM. The result shows that the influence of same speciality Chinese Medicine to different speciality interic bacteria is not always same,perhaps promoting or restrain, the response of same speciality bacteria of different speciality Chinese Medicine perhaps is in the same or different. The third part is theoretical study. From the resemblance between microecology and the symptom complex of TCM, the thesis extends two academic point: the response of human body and medicinal phenomenology. At first, the thesis discuss the concept, class, feature of the response of human body, it is when the human body is stimulated by the environment, including physical and temporal stimulation,the response of the body. The response of human body has three character: compositive, stable and mutative etc.Investigator can identificate it by directly and indirectly method, farther more, intervene it by different means.TCM and even the whole medicine is expansion of how to identificate and intervene it, and based on this point of view, the differentiation in the field of life science between TCM and west medicine is the differention of the correspondence between the patient’s representation and treatment.The second academic point of this thesis is medicinal phenomenology. Fiest this thesis accounted for the concept and class of this academic point, then we discussed the relationship between this point and the theory of TCM, including method of analogy from presentation, manifestations of organs theory, qi blood and body fluids theory, meridian and collateral theory, disease cause and pathogenesis theory , Chinese medicine theory, diagnoses and therapy of TCM. We consider that all of these is based on the medicinal phenomenology.Then thesis bring forward that the medicinal phenomenology is the foundation of research of TCM and west medicine and the essence of the whole medicine is to find out the rule from the medicinal phenomenology. Therefore, the discussion of these two points not only is beneficial to other subjects to understand the TCM and Chinese medicine’s function clearly and deeply, but also made a contribution to the confluence between TCM and modern life science.更多还原