香港生态环境与港人外感湿证的相关性研究

【作者】 刘穗宁；

【导师】 烟建华；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2009， 博士

【摘要】 香港位于热带和亚热带的过渡区域,有自己的地理地貌特点,具有独特的自然生态环境;由于历史和地域原因,港人的社会生活、饮食习惯等又构成了独具特色的人文生态环境。自然与人文两类生态环境,造就了港人的体质偏颇,因而好发疾病的病种、证型以及治疗用药均有相应的特点。正是由于上述原因,香港湿病证候繁多,特别是外湿证,不仅使个人健康受损,生活质量降低,而且还影响香港的社会、经济活动,因此香港的湿病在中医界向来名有所闻,但历来鲜见专门研究者。有览于此,研究香港生态环境与港人外湿证特点就有较高的医学价值和社会意义。我们的工作采用了文献资料研究与流行病学调查相结合的方法。首先是对古今医家,特别是岭南医家对湿邪、湿证的研究作了文献综述。从文献可以看出,古今医家均重视湿邪致病与地理、气候环境及人群体质三者的相关性,并对湿邪的性质、特性、发病条件等进行论述,并对各种外湿证的辨证论治确立了基本原则和方法。岭南湿、温病医家对岭南湿病的地域性、人群体质和证治特点做了探讨,认为岭南炎热多湿的气候地理环境直接和间接地影响着人的体质,使其具有湿热型和气阴两虚型的体质倾向。其次,我们对香港的地理、气候资料进行了调研;对香港的社会、经济、文化以及饮食习俗等人文环境作了分析,并对以上自然与人文环境对港人体质的影响进行了研究。香港属于岭南气候,其气候炎热、潮湿、多雨、多风,地理环境山多楼高,空间少,屏风效应十分明显,从而为外湿证的形成提供良好的外在条件;同时,香港曾长期处于殖民统治,中外生活习惯交互影响,又为港人体质禀赋的形成和外湿证的发生奠定了内在条件。港人的饮食失时、爱好冷腻,休息不足、工作紧张,使之体质以脾虚、湿热或痰湿体质、气阴两虚体质为常见,成为港人外湿病发病的主要内因。我们对香港医师和药商的调查和统计分析表明,香港的湿病非常普遍,涉及病种很多。从外湿病结合证候分布情形看,除痹证和皮肤的证候外,香港外湿证以风热挟湿、湿遏卫阳、湿热证、湿热内蕴、暑兼寒湿、暑湿挟滞、风湿热证、风湿犯表、湿阻中焦、湿热弥漫三焦等证候为主;其病变多以脾胃为中心,病机重在三焦气化不利,时兼有表寒外束与气阴不足的特点。香港外湿证的诊断,需要结合香港的气候变化、人文环境、患者个人的体质倾向,并把握湿邪客伏的致病特性,结合四诊,审因辨机,重视舌诊,在临证变化中进行辨证。临床治疗要根据香港湿邪的特点、致病特性、人群体质特点和临床实际情况,以轻清、宣通、化湿、健脾为论治原则。研究显示,岭南医家的用药特点以甘凉甘寒为主、苦寒药次之,常伍苦温药;养阴护正药为始终用药。香港中医的用药,基本方法和与岭南医家相似,但香港中医更注重脾胃,健脾祛湿和益气养阴的药用得更多。香港中医用药特色是甘凉甘寒清热、芳香理气化湿、健脾益气护阴,善用本地或岭南一带本土草药。对于香港外湿证的预防,根据研究成果结合香港气候环境、港人的体质特点、人文习惯,提出了改善家居环境,提倡有氧运动锻炼,保持好的心境,学会收心养性,养成良好的生活习惯及调节饮食等一系列的策略和措施。并设计一些迎合香港人饮食习惯口味的防湿健脾汤水药膳,从而达致预防湿病的目的。更多还原

【Abstract】 Hong Kong is situated between the tropical and sub-tropical regions of Asia.Together with its geographical characteristics,it creates a unique socio-ecological environment.It is such an environment that shapes the physical characteristics of Hong Kong people and the common diseases they are partial to.As such,the type of disease,its symptoms and the use of herbs will be distinguishingly different.This study would discuss on the characteristics of the dampness syndrome in Hong Kong,its diagnosis and treatment.This would be done by reviewing past literatures and utilizing epidemic disease research methodologies,systematic analysis of data related to climate and diseases,past,modern and Lingnan region practitioners’ research in the formation,factors and use of medicine.In addition,surveys would be done on Hong Kong Chinese medicine practitioners and Chinese medicine wholesalers,and interviews would be done with some of the medical practitioners.Statistical analysis will also be done on Hong Kong people’s physical characteristics,symptoms of dampness syndrome,factors of the disease,the tendency of herbs used and its correlation with climate change.Reviews of literature have shown that past and present practitioners agreed on that pathogenic dampness is correlated to the changes in climate and the physical characteristics of the patient under environmental factors.Also,the occurrence of exogenous dampness and its pathological changes were shown to correlate with environmental factors and physical characteristics.Characteristics,nature and conditions for the disease to occur were given, and standards in identifying,treatment and herbal use in exogenous dampness were set.In the surveys for Chinese medicine practitioners and wholesalers in Hong Kong,it was found after analysis that the mountainous,gutful,rainy environment gave ideal external conditions for the formation of exogenous dampness.In addition,the formation of exogenous dampness was shown to have relationship with Hong Kong’s socio-ecological environment.All these factors gave rise to the large number of exogenous dampness diagnosed,from it can be concluded that dampness syndrome in Hong Kong is mainly due to damp-heat.From the analysis of the distribution of symptoms in exogenous dampness,it was observed that other than the damp arthralgia syndrome and skin related syndromes, symptoms of exogenous dampness is mainly based on wind-heat mixed with dampness、syndrome of weiyang due to blockage of dampness、damp-heat syndrome、retention of damp-heat、summer disease with pathogenic damp-cold、summer-heat-damp mixed with stasis、wind-damp-heat syndrome、attack of wind-damp on the surface、dampness blocked in the middle heater、damp-heat spread all over the tri-warmer.Other symptoms were formed during the development of the disease or due to varying physical characteristics between patients.Pathological changes in cases of exogenous dampness in Hong Kong were mainly focused in the spleen and stomach,with its pathology is mainly hypo function of triple energizer.And the property of pathology is showed the attack of damp-cold on the body surface,or the deficiency of both qi and yin.Therefore,the diagnosis of exogenous dampness should be based according to the environment,climate changes,the vulnerability to pathogenic factors of Hong Kong people, the ability of the disease to lie dormant in the body,physical characteristics and individuality; Success of diagnosis would only be through combining the four diagnosis methods, examination of the etiologic factor and differentiation of the pathogenesis,attaching great importance to inspection of the tongue and discriminating pathological changes.Clinical treatment of exogenous dampness should be based on the properties of pathogenic dampness in Hong Kong,the people’s physical characteristics and the actual situation during diagnosis;with attention to regulating qi activity and expelling the evil of factor with mild diaphoretics medicines,facilitating the flow of lung-qi,eliminating damp,invigorating the spleen,as the principles of treatment.Research in the use of herbs for Lingnan practitioners have shown that medicines used were cold and cool in property while sweet in flavour,or cold in property and bitter in flavour, used together with bitter and warm-natured drugs;used the drugs of nourishing yin and supporting healthy-qi as the whole treatment.Better the use of resolving heat with drugs sweet in flavour and cold nature、eliminating pathogenic damp with drugs of fragrant flavour、invigorating qi and nourishing yin.While practitioners in Hong Kong generally used the same herbs and methods,they tend to focus on the spleen and stomach;herbs that invigorate the spleen to remove dampness and supplementing qi and reinforcing yin were used more frequently.Evidence of this can be seen in the common use of Atract ylodes、Poria、Altsmatis、Semencoicis、Heterophylly falsetarwort、Pilose asiabell、Common yam and etc;while also showing the common physical characteristics of Hong Kong people are weak in the spleen, excess in damp-heat and retention of phlegm-dampness and weak in both the qi and yin. Hong Kong practitioners were influenced deeply by Lingnan practitioners in their use of local and Lingnan herbs.The study will also give recommendations to the prevention of exogenous dampness in Hong Kong,based on the actual climate,physical characteristics and social habits.This include improving the home environment,participating in aerobic exercises,maintaining a healthy state of mind,developing healthy eating,drinking and living habits and etc.Ideas of health food that suit the taste of Hong Kong people and able to prevent dampness while invigorating the spleen will be given as well,so as to achieve the purpose of prevention of the dampness syndrome.更多还原