【作者】 祝玉慧；

【导师】 乔明琦；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2009， 博士

【摘要】 目的:针对当今社会环境下多种情志交织共同致病更为多见,而相关研究多采用单一情绪量表测量患者情绪,忽视情志间的协同致病及相互影响,情志伤脏规律尚无定论的现状。用严格科研设计下的流行病学调查方法研究在当今医院门诊患者的情志特点、证候特点和伤脏定位特点,探讨并揭示情志致病多种情志交织组合特点和伤脏规律。为情志致病方式与伤脏规律提供新证据和新认识,丰富发展情志学说,为临床准确辨治情志病证提供新依据。方法:在济南市三家三级甲等省级中西医院神经内科、妇科、消化、内分泌、心内科5个科室同时期展开现况调查,采用自行设计的“门诊患者情志病证候与伤脏现况调查表”收集情志病证患者证候与伤脏信息,“负性情绪形容词检表”收集患者情志状况;采用探索性因子分析探索情志致病多情交织规律,应用logistic回归、卡方检验、方差分析探索多情交织特点与情志病、证、症状、体征的相互关联与影响;采用描述性统计分析情志致病伤脏规律及患者的性别、年龄等社会人口学特征。结果:①共检出情志病证病例553例,其中女性410例,占情志病例总数的74.1%,男性143例,占25.9%;文化程度初中125例,占22.6%,高中132例,占23.9%,大学108例,占19.5%;年龄20-30岁146例,占26.4%,30-40岁138例,占24.95%,40-50岁117例,占21.57%。②单一情绪致病61例,占全部病例的11.03%,两种或两种以上负性情绪共同致病492例,占全部病例的88.97%。在情志病例中分析出4类情绪因子,其中“焦虑类情绪因子”包括忧郁、思虑、悲伤、紧张、痛苦、担忧、焦虑7种情绪,焦虑因子负荷最高;“嫉妒类情绪因子”包括厌恶、悔恨、嫉妒、敌意、羞耻5种情绪,嫉妒因子负荷最高;“惊吓类情绪因子”包括恐惧、惊吓2种情绪,惊吓因子负荷最高;“愤怒类情绪因子”包括愤怒、郁怒2种情绪,愤怒因子负荷最高。③在情志病例中“愤怒类情绪因子”分值最高,其次是“焦虑类情绪因子”,“嫉妒、惊吓类情绪因子”分值较低;肝阳上亢、肝火上炎、肝胆湿热证患者焦虑类情绪较显著,肝气郁、肝阳上亢证患者愤怒类情绪较显著。④情志疾病共出现95种,其中排在前10位的是胃炎、甲亢、月经不调、失眠、糖尿病、胆囊炎、冠心病、高血压、抑郁症、消化性溃疡;情志证候共出现23种,出现10次以上的有8种,其中肝系证候出现频率为91.5%,肝郁脾虚144例,频率26.04%,肝气郁143例,频率25.86%,肝气逆132例,频率23.87%;情志病证脏腑定位涉及13个脏腑,其中伤肝者占520例,频率94%,伤心者85例,频率15%,伤脾者175例,频率31.6%,伤胃者151例,频率27.3%,伤胆者56例,频率10.1%。结论:①情志病患者女性多见,年龄以中青年为多;情志致病涉及胃炎、甲亢、糖尿病、失眠等95种疾病;肝郁脾虚、肝气逆、肝气郁等23种证候;伤及肝、脾、心、肾、胆、胃等13个脏腑。提示情志致病具有广泛性、多样性。②负性情绪致病方式多为多情交织共同致病,以“焦虑类情绪”、“嫉妒类情绪”、“惊吓类情绪”、“愤怒类情绪”四种组合规律出现。“焦虑类情绪”在一定程度上体现了气机不畅的病机特点;“嫉妒类情绪”主要表现出心理失衡的特征;“惊吓类情绪”产生的内在因素主要为脏腑气血不足;引发“愤怒类情绪”为个体愿望受阻和气血上逆不畅,病机为肝疏泄失常。③在情志病例中“愤怒类情绪因子”、“焦虑类情绪因子”分值较高,提示愤怒类情绪与焦虑类情绪更易导致情志病证。④在情志病例中伤肝者有520例,提示情志伤脏以肝为主。本研究修正了传统的“五志伤五脏”的理论模式,深化了原有的多情交织共同致病的认识,为情志致病机理研究增添了新的内容,验证了“多情交织共同致病首先伤肝”假说,为临床准确辨治情志病证,提供了理论及实践依据更多还原

【Abstract】 Destination: According to the present situation that the interlace of moods inducing diseases is more common, but the related research mostly using signal moods rating scale to test the moods of the patient, but the cooperative relation and interaction between the moods are neglected, and there is no verdict for the law of viscera injury has been achieved yet. This paper researches the moods features, syndrome characteristics and visceral injury location characteristics which using the epidemiology investigation method under the strict scientific research design among the outpatients, studies and reveals the moods combination feature of moods inducing diseases and law of viscera injury. This paper provides new evidence and new knowledge for the pathogenetic pattern of emotional diseases and law of viscera injury, enriches and develops the theory of emotional factors, provides new foundation for the accurately discrimination and treatment of emotional disease.Method: This paper does the cross-sectional study in department of neurology, department of gynecology, department of gastroenterology, department of endocrinology and department of cardiology in three provincial grade iii-a hospitals in Jinan, collects the information of syndromes and visceral injury for emotional disease patients using the self-designed questionnaire of emotional disease syndromes and visceral injury present situation, and collects the patients moods situation using the moods objective table, studies the law for interlace of moods inducing emotional disease by the analysis method of exploratory factor, explores the relationship and effect for the several moods interlaced characters and the emotional disease, degradation, symptoms and signs using methods of logistic regression method, chi-square test and variance analysis, analyses the law of emotional disease visceral injury and the character of social demography of the patients, such as gender, age, and so on.Results:①Totally detected 553 emotional disease patients, in which 410 are female which account for 74.1% and 143 are male which account for 25.9%. Comparing from education level, 125 are junior middle educations which account for 22.6%, 132 are seior middle education which account for 23.9%, and 108 are university education which account for 19.5%. The ages from 20 to 30 are 146 peoples which account for 26.4%, ages from 30 to 40are 138 peoples which account for 24.95%, ages from 40 to 50 are 117 peoples which account for 21.57%. All the emotional disease patients involve 95 categories.②The number of diseases which caused by single mood is 61, which account for 11.03%, there are 492 disease which caused by two or more than two negative diseases, which account for 88.97%. The anxiety, melancholy, thoughtfulness, sadness, stress, misery, misgivings are the moods factors of anxiety, and anxiety is the main pathogenic emotion. The aversion, regret, jealousy, hostility, and shame are the moods factors of jealousy, and jealousy is the main pathogenic mood. The fear and terror are the moods factors of terror, and terror is the main pathogenic mood. The anger and suppressed anger are the moods factors of anger, and anger is the main pathogenic mood.③In the case of emotional diseases, the mood factors of anger has the most highest score, and then is the mood factors of anxiety, jealousy, and the mood factors of terror has the lowest score. Mood factors of anxiety have obviously relationship with liver-yang hyperactivity, liver-fire flaming-up, hepatobiliary damp-heat, and mood factors of anger have obviously relationship with liver-qi depression and liver-yang hyperactivity.④There are 23 emotional syndromes, and 8 of them appears more than 10 times. Liver syndromes account for 91.5% of all the emotional syndromes. In all emotional disease, liver depression and spleen deficiency happens 144 and the frequency is 26.04%, liver-qi depression happens 143 and the frequency is 25.86%, and liver-qi invasion happens 132 and the frequency is 23.87%. Emotional syndromes impairment of liver are 520 and the frequency is 94%, impairment of heart is 85 and the frequency is 15%, impairment of spleen is 175 and the frequency is 31.6%, impairment of stomach is 151 and the frequency is 27.3% and impairment of biliary is 56 and the frequency is 10.1%.Conclusion:①Among all emotional disease patients, the number of female is bigger than the number of male, the age distribution is mainly in young and middle patients. Moods inducing diseases involves 95 diseases such as gastritis, hyperthyroidism, diabetes mellitus, insomnia, it also involves 23 syndromes such as liver depression and spleen deficiency, liver-qi invasion, liver-qi depression and so on. And the moods inducing diseases do harm to 13 visceras such as liver, spleen, heart, renal, biliary, gastric and so on, and the fact shows that the emotional diseases has the characters of universality and diversity.②The pathogenic pattern of negative moods is interlace of moods inducing emotional disease, and appears in four combination patterns among moods of anxiety, jealousy, terror and anger. Moods of anxiety reflects the character that qi movement is accumulation together, moods of jealous mainly reflects the character of psychological imbalance, the main causing reason for moods of terror is insufficiency of qi and blood of viscera. The causing reason for moods of anger is personal wishes blocking and personal adverse rising of qi and blood, and the pathogenesis is maladjustments of liver conveyance and dispersion.③In the emotional diseases cases, moods factors of anxiety and anger have the higher score, and this shows that moods of anger and anxiety are easy to cause emotional disease syndrome.④In the emotional diseases patients, there are 520 persons are liver injury, this shows that moods inducing diseases and viscera injury is mainly in liver. This paper corrects the traditional theory pattern of five moods injury five viscera, further understand the interlace of moods inducing diseases, adds new contents for study of emotional diseases pathogenesis, proves the hypothesis that the interlace of moods inducing emotional disease is most harmful to liver than others. The study provides the theoretical and practical basis for the discrimination and treatment of emotional disease.更多还原