【作者】 仲伟梁；

【导师】 马健；

【作者基本信息】 南京中医药大学 ， 中医临床基础， 2010， 博士

【摘要】 湿热证是指由湿热病邪引起的诸多病证的总称,在外感疾病和内伤杂病,均可见之。随着全球气候的暖化,以及食品工业化后产生的大量高脂、高糖、高盐食品,据资料表明,湿热证有上升的趋势。新加坡的湿热证十分常见。我们应该加大对新加坡湿热证的进一步研究,从防治常见病、多发病的角度促进新加坡卫生保健事业的进步与发展。有鉴于此,研究新加坡湿热病证的特点有较高的医学价值和社会学意义。本课题采用了文献学研究和流行病学调查相结合的方法,首先对对湿热证的理论渊源做了历史性的回顾。古代中医文献对湿热证的病因、症候、治疗、禁忌等都有着详尽的论述,湿热证理论的形成发展是在长期的医疗实践过程中,经过无数医家的著书立说而形成。先秦、汉晋、隋唐时期是其理论的萌芽时期,宋元时期是其理论的奠基时期,至明清后,湿热理论的逐步形成并系统化,日臻完善,蔚为大观。近代以来的医家对此又有进一步的研究和发展。这些湿热证的理论很大程度上促进了温病学理论的发展。通过对湿热证古代文献的研究,可以明确湿热证的理论渊源和证候特点,为进一步研究湿热证打下坚实的理论基础。其次对近十年来湿热证的现代研究进展作了文献综述。从这些文献资料可以看出,近年来不少专家学者对湿热证方面亦做了大量的研究,从其现象到本质、从宏观到微观等各方面都进行了很多有益的探索。进一步深入开展湿热证研究,探讨其作用机制及配伍规律；探讨与湿热相关的疑难疾病的中医病因与致病环节,对中医证的本质研究和中医临床水平的提高无疑是很有益的。为了更好地了解新加坡湿热证,首先对新加坡的地理环境、气候特点及新加人群的饮食习惯进行了简单的概述,认为新加坡湿热证多见的原因与新加坡独特的地理气候密切相关。首先,新加坡位于东南亚,地处热带,属于热带海洋性气候。全年炎热潮湿,四季气温无明显变化,空气湿度高,气候温暖而潮湿,是易感湿热证最重要的外部因素。其次,新加坡人的饮食丰富,贪凉饮冷,嗜食肥甘厚味之品,脾阳容易失去健运而化生痰湿,是易感湿热证的内在基础。再次,新加坡这种特殊的气候与地理环境直接或间接地影响着当地人的体质,使其形成具有湿热类型及气虚、阴虚或气阴两虚类型的体质特点,这种体质特点决定了临床疾病中湿热证的易感性和倾向性。在研究调查方面,为了更好地分析、研究新加坡人的体质,在2008年10月一2009年8月期间借用群体体质的调研方法,对新加坡当地华人的体质采用问卷调查,发现新加坡当地华人的体质偏于气虚、阴虚及湿热体质,这与新加坡炎热多湿的环境密切相关。另外在2008年9月1日一2009年8月31日收集了新加坡221份外感热病的病例,判断湿热证在其中所占的比例及统计出湿热证常见的症状。初步得出的结论为：新加坡炎热多湿、四时气候不明显的特殊气候环境,使得风温、暑温、湿温及暑湿一年四季中均可以发生,并不拘于一般理论所论。而且在这两种主要温病类型中,以湿热类温病所占的比例偏高(59.7%),说明了新加坡外感热病中,湿热类温病较温热类温病更为常见,间接证明湿热病邪在新加坡炎热潮湿环境中成为主要病邪,易造成湿热证形成。根据对其的症状频数统计,认为湿热证常见的症状为发热(一般不超过40度,多见于午后或入夜体温增高)；口干或渴；脾胃系统症状包括纳差、胸脘痞胀等；头痛或头晕沉重；汗出；烦热面赤；身痛；舌红,苔黄,脉滑数等。新加坡医家从中国中医学的理论出发,在中国清代医家以及岭南医家研究的基础上,结合当地环境气候、体质特点等实际因素,对湿热证的辨证论治规律做了不少的整理和探索工作。我们详细阐述了一些较有代表性且对此有一定研究心得的新加坡医家,他们从刚开始的不识湿热证,到现在的重视、精研湿热证,并有一定的诊治心得,他们的研究在逐渐丰富和发展着新加坡湿热病证理论和辨证论治,在辨证、诊病、用药方面都有独到的心得,反映了新加坡医家的学术特色。因为新加坡与岭南地区气候相似,中国岭南地区湿热病证亦十分常见,历代以来的不少名家对湿热证的研究很具有岭南特色,对临床很有指导意义,对新加坡的医家防治湿热证亦有很大的影响。故在附篇中总结归纳了一部分中国岭南地区名家对湿热证的研究心得,以供新加坡的中医师借鉴和学习。更多还原

【Abstract】 Damp-heat Syndrome refers to a kind of syndrome that caused by the hot and dampness evils, which can be visible in epidemic febrile diseases and internal injuried diseases. Damp-heat Syndrome is very common in Singapore. To study its characteristics has a high medical value and sociological significance.Our study would be done by reviewing past literatures and utilizing epidemic disease research methodologies. First,we make an overall review of theoretical origin of Damp-heat Syndrome. We can find that there are many representations on its etiology, symptoms, treatment, taboos and so on in ancient Chinese literature. The formation and development of Damp-heat Theory had been based on long-term medical practices of numerous physician. These theories promote the development of the theory of Febrile Diseases to a large extent. Through the study of ancient literature, we can lay a solid theoretical basis for the further study.Second, we make a literature review of modern research in Damp-heat Syndrome in recent ten years. From these literature we can see that many experts and scholars have done a considerable amount of research on Damp-heat Syndrome from all sorts of aspects. They have made a lot of useful explorations and achievements from its phenomenon to its nature, from the macro to the micro.The reason for Damp-heat Syndrome’s universality in Singapore is closely related to its unique geographical environment, climate characteristics and the local people’s eating habits. First of all, Singapore is located in Southeast Asia and belongs to a tropical maritime climate. It is almost hot and humid throughout the year, the weather is always warm and humid, which is the most important external factors that the local people are susceptible to get Damp-heat Syndrome. Secondly, rich diet and cold drinking in Singapore make the local people’s body more easily to produce phlegm and endogenous dampness due to the failure of the spleen’s transporting function. Once again, Singapore’s particular geographical environment directly or indirectly affect the local people’s constitution that producing the physical characteristics of damp-heat type and deficiency of qi or yin type. This characteristics make Damp-heat Syndrome more susceptible in clinical diseases.In research part, we use a questionnaire survey to study the local Chinese people’s physical constitution during October 2008 to August 2009, and find that damp-heat type and deficiency of qi or yin type are the most common constitution in Singapore. In another research of 221 cases of Febrile Diseases in Singapore, we make a conclusion that Damp-heat Syndrome is more likely to get in Singapore, which takes a part of 59.7%in Febrile Diseases. Its common symptom are fever(usually not more than 40 degrees, much worse in the afternoon or at night or elevated temperature);dry mouth or thirst; stomach system symptoms include anorexia, chest expansion,abdominal distension,ect; headache or dizziness; sweating; restless and flushed face; body pain; redded tongue with yellow coating; slippery and rapid pluse.ect.The doctors in Singapore have done a lot of collective and exploratory work in the differentiation and treatment of Damp-heat Syndrome combined with its local environment, climate, physical characteristics and other practical factors on the basis of ancient Chinese literature. Their studies are gradually enriching and developing Singapore’s Samp-heat Theory,which reflect the academic characteristics of doctors there.Because the climate of Singapore is much similar to LingNan region of China, where Damp-heat Syndrome is also very common. So in the attached part of article, we have summed up some representative doctors’study of Damp-heat Syndrome in LingNan for doctors’reference and learning in Singapore.更多还原