【作者】 胡春雨；

【导师】 乔明琦；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2008， 博士

【摘要】 目的:针对目前因怒导致的情志病证远比其他情志刺激所致病证常见的临床现状,遵循量表编制的规范程序,尝试编制易怒体质量表,从体质角度研究因怒引发的不同情志病证的体质特点及其形成的基本机制,有针对性地制定出因怒致病的预防措施。方法:首先,以中医基础理论中的体质学、藏象学为基础,确立易怒体质的定义。第二,依据现存文献有关怒致病的论述,结合3家医院住院病历的回顾性调查,建立易怒体质量表的备选条目池,并采用频数法以P60为标准初选条目,参考、采纳专家的意见,建立初选条目池。第三,以济南市18～55岁人群为目标对象,采取多阶段分层整群抽样的方式抽取学生、工人、农民共520例,以初选量表为调查工具对其进行问卷调查,采用离散趋势法、区分度分析法、探索性因子分析法、Cronbach’sα系数法4种统计学方法筛选条目池,确立量表维度,保留条目最终形成初始易怒体质量表。第四,对初步确立的易怒体质量表进行可行性、信度及效度考评,所有统计方法的运算均采用SPSS13.0统计软件完成。结果:①确立了易怒体质的含义,论证出易怒体质形成的基本过程:机体气血潜在不畅→易怒→气机失调→肝疏泄太过或不及→脏腑组织功能失常→精、血、津液的运行代谢失调→易怒体质。②文献中共查找与怒相关的文献4 602篇,有效文献1 017篇;相关住院病历共54 703份,筛选出情志致病病历506例,其中因怒致病病历130例,从中筛选出高频数条目86条,经专家论证及小范围预试后最后保留56个条目。③通过流行病学调查及统计处理后,形成了包含37个条目4个维度的易怒体质量表,分别从形态结构特征、怒伤肝、机体功能下降、心理特征方面描述易怒体质。④量表可行性考评显示:量表回收率99.2 %,有效率96.3 %,被调查者10～15 min可完成量表的填写。信度考评显示:易怒体质量表的重测信度在0.707～0.799,分半信度为0.900,同质性信度的Cronbach’sα系数是0.921。效度考评显示:结构效度使用探索性因子分析法,显示该量表符合逻辑关系,方差累计贡献率为56.068%,每个条目在其对应的公因子上的负荷都大于0.4,最小值为0.432,最大值为0.784。内部相关系数研究表明量表总分与各维度之间的相关在0.632～0.881之间,各维度之间的相关在0.401～0.692之间。区分度显示该量表可以有效地判别特质怒与非特质怒人群的体质特征,除形态结构特征维度外,两组怒伤肝维度、机体功能下降维度、心理特征维度及量表总分比较,有极显著性差异(P<0.0001)。结论:易怒体质量表是灵敏、有效、可信的测量工具,能够较全面地反映易怒体质的特征,可以试用于人群的易怒体质评价。以此为依据可对易怒体质的形成环节实施有针对性地干预,修正体质偏颇,预防情志疾病的发生。更多还原

【Abstract】 Objectives: In the current clinical settings, the diseases caused by anger were more common compared to other emotion-related syndromes. The aim of this study was to construct an angry constitution scale according to the standard scale establishment procedure. The scale could be used as a tool to study the constitution characteristics and mechanisms in various emotional diseases triggered by anger and thus it might contribute to the prevention of anger-related emotional diseases.Methods: Firstly, defined the concept of angry constitution based on the Basic Theory of Traditional Chinese Medicine, specifically on its Constitution Theory and Zangxiang Theory. Secondly, all the possible candidates of the item pool were first listed by reviewing the literatures of angry related diseases and the retrospect studies of hospital records from three hospitals, and then the primary version of the scale was finalized by consulting the peers in this field, and by analyzing the item pool with frequency distribution and P60 standard. Thirdly, 520 people were sampled in the multistage stratified cluster sampling method and were tested by the primary scale of angry constitution, who lived in Jinan district with career variation of student, farmer and factory worker, aging from 18 to 55 years old. After further analysis of the survey data from valid 501 cases with four different statistic methods: tendency of dispersion method, distinction of analysis, exploratory factor analysis, Cronbach’sαcoefficient method, the item pool was filtered and the scale dimension was set up, and the prior test version of this scale was established. Fourthly, the feasibility, reliability and validity of the scale were tested. All statistic analysis was finished by SPSS13.0 if necessary.Results: 1. Definition of angry constitution was established. The process of formation of angry constitution was demonstrated as :potentially disorder of Qi and blood→angry→disturbance of movement of Qi→the live loss of control of the maintenance of normal flow of Qi→functional decline of viscera and organs→movement and metabolism disorder of essencial substances,blood and body fluid→angry constitution. 2. There were total 4 602 literatures related to angry, 1 017 of which were related to this studies; 54 703 hospital records were reviewed, of which 506 were emotional related disease and 130 cases were angry induced diseases. From the literature and hospital record study, 86 high frequency encountered items were pooled out and 56 items were kept after peer consultation and small range test. 3. After epidemic research and statistic analysis, the scale of angry constitution was established with 37 items distributed in four dimensions of morphological characteristics, angry impairing liver, decreased function of the body and psychological characteristics. 4. The feasibility of this scale: 99.2% feed back, of which effective rate 96.3%; the tester could finish the scale in 10 to 15 min. The reliability of the scale: test-retest reliability 0.707~0.799; split-half reliability: 0.900; Cronbach’sα= 0.921. The validity of the scale: exploratory factor analysis revealed that the structure validity had logic relation with the cumulative variance of 56.068%. The common charges on each item were all larger than 4.0 (with min 0.432 and max 0.784, respectively). The interior correlation coefficient between the total scale score and its subdivision dimension score were 0.632~0.881, among each dimension was 0.401~0.962. The validity of the scale of angry constitution could effectively distinguish trait angry and none-trait angry population. Except the morphological characteristics dimension, all other dimension scores were statistically different (P<0.001), including two groups of angry impairing liver dimension, decreased function of the body dimension, psychological characteristics dimension and between the total score of the scale.Conclusions: The scale establishment of angry constitution is a sensitive, effective and reliable test tool which can cover all the aspects of angry constitution and thus be used to evaluate the angry constitution of the population. It can also be used clinically as tool to adjust patient’s constitutional variation, thus it may have potential application in the prevention of emotion-related diseases.更多还原