【作者】 刘向哲；

【导师】 王永炎； 王新志；

【作者基本信息】 中国中医科学院 ， 中医内科学， 2008， 博士

【摘要】 做系统整理。总结禀赋在中医生理、病理、诊断、治疗、养生和预防中的具体应用内容。结合现代遗传学、心理学等多学科理论知识,揭示中医禀赋概念中所包含的形、神两方面的重要内容和意义。2.2应用研究中,采用临床流行病学病例对照研究的方法,分别运用中医《五态性格测验表》和《一级亲属中风史调查表》,从禀赋的后天表现和先天实质两个层面,探讨禀赋与中风的关系。两个步骤同时进行。《五态性格测验表》的理论基础即是《黄帝内经》五态阴阳理论,并参照了现代人的实际特征。测验表制订了全国总体常模,具有较高的信度和效度。该表把人的性格分为:太阳、少阳、太阴、少阴、阴阳和平五种类型。测试员使用该量表对研究对象进行测试,测试员由研究者统一培训。研究对象不识字或有视觉障碍者,可由测试员读题。自行设计的、统一的《一级亲属中风史调查表》,则以直接询问的方式对全部研究对象进行问卷调查,内容包括年龄、性别、民族、职业及家族中脑梗死的发病情况等方面,其中家系调查范围主要包括一级亲属(父亲、母亲、同胞、子女)和配偶,内容涉及其中风病史、患病年龄及中风人数等。在五态性格与中风发病关系研究中,对照为全国总体常模。在一级亲属中风史调查中,对照组为同期就诊于同一医院泌尿内科的肾炎患者。然后依据获得的数据,分析易患中风个体的禀赋特征(即五态性格类型)。采用Li-Mantel-Gart法计算中风的分离比,用Falconer法计算其遗传度。并计算一级亲属中风史与脑梗死的关联程度(odds ratio,OR值)。进而从五态性格特征和遗传两个方面探讨禀赋与中风发病的相关性。3结果3.1脑梗死患者一级亲属及不同性别患病率与对照组比较:脑梗死先证者一级亲属患病率为6.58%,与对照组的1.74%相比,差异有显著性(χ~2=28.664,F=0.000)。有一级亲属中风史者患脑梗死的危险是没有一级亲属中风史者的3.97倍(OR=3.97,95%CI:2.38-6.61)。在100对先证者配偶的调查中发现:病例组配偶患病率为4%(4/100),对照组配偶脑梗死患病率为2%(2/100),病例组高于对照组,但二者之间差异无显著性(χ~2=0.687,P=0.407)。3.2脑梗死的分离比估算:100例先证者的同胞(包括先证者)脑梗死的患病情况显示,本次调查估算得到脑梗死的分离比:P=0.1398,分离比方差:Sp~2=0.00029,标准误:SE(P)=0.01702,95%CI:0.1064-0.1732。3.3脑梗死遗传度的估算:脑梗死患者一级亲属遗传度为47.34%±4.46%。考虑到性别因素可能对脑梗死发病的影响,将其一级亲属按性别进行分层分析,结果一级亲属表现出男性高于女性的趋势。以上结果提示,在脑梗死的发病过程中,遗传因素发挥着一定的作用,尤其对男性作用可能较为明显。3.4脑梗死组与对照组(全国常模)五态性格得分比较:病例组与对照组比较,太阳人格维度得分与少阳人格维度得分,病例组明显低于对照组(P＜(0.01)。阴阳和平人格维度得分,病例组明显低于对照组(P＜0.05)。少阴人格维度得分,病例组明显高于对照组(P＜0.05)。太阴人格维度得分,病例组明显高于对照组(P＜0.01)。4结论4.1禀赋是个体在先天遗传的基础上及胎孕期间内外环境的影响下,所表现出的形态结构、生理功能、心理状态和代谢方面综合的、相对稳定的特征。其形成于出生之前,但受后天环境影响。4.2从现代生物学和遗传学的角度来认识,中医禀赋的概念当有狭义和广义之分,狭义的禀赋即遗传信息,广义的禀赋则指所有从先天获得的信息,包括遗传信息和胎传信息。在中医学中,应用更多的是禀赋的广义概念。4.3禀赋的先天实质包含遗传信息和胎传信息,禀赋的后天表现则体现在体质、心理两方面,其先天实质决定后天表现。4.4禀赋具有先天性、个体性、地域性、种族性和可调性,先天性是其最根本的特性。禀赋特征都是遗传和环境条件互相作用的最后产物。遗传和环境条件任何一方面发生变化都可能导致某种禀赋特征的变异,这也为禀赋调控提供了可能。4.5一级亲属中风史与脑梗死的发病具有相关性。4.6按照《灵枢·通天》篇“五态人”分类,脑梗死患者的性格特征趋向于阴阳两极型,即以太阴、太阳型性格为主要外显模式;太阳分偏低而太阴分偏高是脑梗死病人的主要危险因素。说明五态性格与脑梗死发病具有明显相关性。4.7先天禀赋与中风发病具有相关性。更多还原

【Abstract】 Innateness(禀赋) is a special concept of Traditional Chinese Medicine(TCM),which relative content runs through many taches of theory and practise,with important academic significance and practice value. However,the concept and reliable definition of Innateness could not be reported till now.Along with the era of life science century,modern medical pattern is changing from biomedicine to society-biology-psychology medical pattern,the research on individual of human being is facing a new times.The connotation of Innateness concept is abundant and its extension is comprehensive.Today,when outer factors such as environment and life style are attached importance increasingly, the theory of Innateness has a predominance not edged out by the concept of heredity and constitution,which may be a new interject point of life research.So whole connotation of the concept of Innateness,lucubration the relation among health and disease and the physiology,pathology, diagnosis,prevention and treatment on Innateness would have a important signification on construction of frame of Innateness theory,promotion of innovation of basical theory of TCM,exploring arcanum of anthropic life,direction of clinical practice.Stroke is a clinically familiar,acute and severe disease,threatening on human health with the characteristics of high incidence,high deformity, high rate of death and high rate of recrudesce burdening much on society and family.TCM has special superiority on prevention and treatment of Stroke,then if theory of TCM Innateness is used in the research of Stroke, it will help to development of Stroke etiology,deepeness of understanding Stroke syndrome,leading to the individualization of Stroke’ s diagnosis, treatment and prevention.1.Aim1.1 By theoretical research,we will annotate wholely TCM concept of Innateness,definitude its characteristic,effective factor and regulator, and so on.,elucidate the applied value of Innateness in clinical practice of TCM.In the same time,we will definitude relation and difference among Innateness and habitus,Innateness and heredity.Then we will get mostly integrity and precise TCM concept of Innateness.1.2 In application research,we took stroke as a model,definitude the relation between accidence and Stroke patients’ five-state character characteristic and heredity factor,explore the relation between Innateness and stroke,then put forward the basic thought of Stroke’ s prevention and treatment in the point of view of Innateness,which will base scientific evidence on "Prevention of disease" and individualization therapy of Stroke.1.3 Summarization above result of research makes basement for the research of individual Innateness characteristic in the point of view of psychology, eugenics,molecular heredity,and further research of the relation between Innateness and human body from the lays of physiology,pathology, diagnosis,prevention and treatment on Innateness.2.Methods2.1 Theoretic research methodsBy theoretical research,we use TCM philology research method,and systemitically clear up the content about Innateness in TCM conference of past dynasties.We summarized up the detail about Innateness including the physiology,pathology,diagnosis,prevention and treatment in TCM. Linked with theoretical knowledgement such as modern heredity,psychology, some important content and signification of shape and spirit in TCM concept of Innateness will be revealed.2.2 Application research methodsIn application research,we used the clinical epidemiological methods of case control research by Test table of five-state character in TCM and Questionary of the history of stroke of the first-degree relatives, explore the relation between Innateness and Stroke,in the two layers of born manifestation and innate essential of Innateness.The two steps will take up in the same time.The test table of five-state character is based abstractly on inner Canon of Yellow Emperor theory of five-state Yin & Yang,and consults true characteristic of modern person.The table maps out national whole model,with high reliability and validity.The table divids human’ s character into Taiyang,Shaoyang,Taiyin,Shaoyin, balanced Yin & Yang.On this table,testers trained by researcher measure every object.If research object can not know word or see clearly,this table may be read for him/her.The self-designed,uniform Questionary of the history of stroke of the first-degree relatives is questionnaired direct question on all research objetct,which include age,sex, nationality,professional,family occurring of cerebral infarction and so on.In the questionary,genealogy investigation including mainly the first-degree relatives and spouse involves age,age of accidence,history of cerebral infarction and so on.In the research of the relation between five-state character and accidence of Stroke,the control group is general national normal model.In the research of the history of stroke of the first-degree relatives,control group are the patients of nephritis in the corresponding period in urologic medicine ward in the same hospital. According to the obtained data,we analysis the Innateness characteristic, ie.five-state character of Stroke patients.We calculate segregation ratio of Stroke by the method of Li-Mantel-Gart and its heredity degree by the method of Falconer.We also calculate the correlation degree(odds ratio,OR) of the history of stroke of the first-degree relatives and the cerebral infarction.Then in the five-state character characteristic and heredity,we explore the relation between Innateness and stroke.3.Results3.1 The comparison of accident rate of cerebral infarction patients’ the first-degree relatives and different sex with that of control group:The accident rate of cerebral infarction proband in the first-degree relatives is 6.58%,comparing with that of control group(1.74%), significantly difference(χ~2=28.664,P=0.000).The risk of stroke of person who has the history of stroke of the first-degree relatives is 3.97 times of the person who has no the history of stroke of the first-degree relatives.In the investigation on 100 pairs proband spouse,we find that accident rate of case group spouse is 4%(4/100),and that of control group is 2%(2/100),which that of case group is higher than that of control group,without significant difference(χ~2=0.687,P=0.407)。3.2 Segregation ratio of cerebral infarction:The accident research on 100 cases of probands’ fellowmen(inciuding the proband) on cerebral infarction shows that segregation ratio of cerebral infarction P=0.1398, segregation ratio Variance:Sp~2=0.00029,Standard error:SE(P)=0.01702, 95%CI:0.1064-0.1732。3.3 Heredity ratio of cerebral infarction:Heredity ratio of cerebral infarction patients’ first-degree relatives is 47.34%±4.46%.With a view to the effect factor of accidence of cerebral infarction by sex,we analysis the first-degree relatives in delamination of sex,then that of male among the first-degree relatives show higher than that of female. Above all,in the period of accident of cerebral infarction,heredity factor takes a certain action,especially more marked correlation in male.3.4 Comparison of five-state character score between cerebral infarction group and control group(national nomal model):Comparing with control group,Taiyang personality dimensionality score and Shaoyang personality dimensionality score of case group is lower markedly than that of control group(P＜0.01).The score of personality dimensionality in balanced Yin & Yang in case group is markedly lower than control group (P＜0.05).Dimensionality score of Shaoyin personality in case group is markedly higher than control group(P＜0.05).The score of Taiyin personality dimensionality in case group is markedly higher than that of control group(P＜0.01)。4.Conclusions4.1 Innateness is a individual’ s compositive and rather steady characteristic in configuration,physical function,psychological status and metabolism based on innate heredity and iner and outer enviroment’ s effect.It come out before bore and is effected by inner and outer environment in the period of fetus or pregnancy.4.2 On point of view of modern biology and heredity,the concept of TCM Innateness have the difference of narrow sense and broad sense,which narrow sense is heredity information,and broad one is all unborn information including heredity and embryogenesis information.For TCM, broad sense of Innateness takes more.4.3 Innate substance of Innateness includes heredity and embryogenesis information,and the born manifestation of Innateness includes constitution,psychology,which the innate essential determines the born manifestation.4.4 Innateness has congenital,individual,regional,ethnical and adjustable characteristic.The congenital one is the most basic characteristic.The characteristic of Innateness is the ultimate products of interaction between heredity and the environmental condition.Any changes in these two conditions can result in change in some characteristics of Innateness,which may lead to regulation of Innateness. 4.5 The history of stroke of the first-degree relatives has dependablity with the onset of cerebral infarction.4.6 According to the classification of five-state person in book of Lingshu Tongtian,character characteristic of cerebral infarction patient are more incline to the type of extreme Yin & Yang,namely character of Taiyin,Taiyang are the main outer display model:The score of Taiyang is fewer and that of Taiyin is more,which is main hazard factor of cerebral infarction patients.It manifests that five-state character and cerebral infarction onset has marked dependablity.4.7 Innate Innateness has dependablity with stroke onset.更多还原