【作者】 张维骏；

【导师】 陶功定；

【作者基本信息】 湖北中医药大学 ， 中医基础理论， 2011， 博士

【摘要】 生态危机与疾病的关系已愈发密不可分,原有医学形式面临严峻考验,探寻更完善的认识疾病的途径,成为本课题的宗旨。主要通过文献研究的方法,从不同层面对中西医病因学进行了比较。生态环境问题日益尖锐,生态学发展方兴未艾,并与各学科进行了不同程度的交叉融合,生态医学成为了其中一个重要的分支。生态医学的创立和发展秉承了和谐的生态文化和天人一体、物我一如的生态哲学。生态医学的研究要素是生物性和非生物性生态致病因子。大生态医学理论从全新的角度阐释了人的疾病与健康同自然环境及社会环境之间的关系。中西医病因认识早期都有鬼神文化的印记,随着文化的发展,中医的天人合一思想彰显出和谐文化的本质,西医的对抗思维体现出征服文化的特点。中医病因认识根植于整体论观点及整体直觉领悟法,西医病因认识立足于还原论观点及微观逻辑实证法,在生态哲学系统观总体指导下,以中医整体论思维宏观把握,西医还原论思维微观深入,升华原有的理论体系,形成一种全新的认知方式,这一天终将到来。生态因子是生物生存所不可缺少的环境条件,也可认为是环境因子中对生物起作用的因子。在大生态的范畴里,凡是能引起疾病的因素都可归于致病性生态因子。在生态医学中,致病性生态因子包括生物性的和非生物性的。生物性的致病因子诸如：细菌、病毒等病原微生物以及寄生虫等,非生物性的致病因子诸如：日月星辰、四季气候、地域环境、昼夜寒温等,往往大的生态因子中又包含若干小的因子。无论中医还是西医病因,都可以归属到不同类别的生态因子中,在更广阔的大生态背景下,消除偏见,发现二者理论体系的差异性,寻求双方共同发展的融合点。前期研究中发现,从相似的疾病背景出发,中医有关非生物性生态因子的六淫理论和西医有关生物性生态因子的病原微生物理论之间存在较大的差异性和可比性。本课题将重点在这二者之间进行比较。中医强调非生物性生态因子致病,六淫致病理论反映了中国传统哲学“取象比类”的意象思维,以六种气候征象比附疾病原因,从其表现形式和应用范围上看,属生态学的非生物生态因子范畴。疾病在时空关系上密不可分,不同时间对应不同地区,时空不同自然患病各异,这是中医学自古以来认识疾病的方法。六淫致病理论的本质就是五运六气学说,创造性地解释了疾病的时空规律。在生理上,《素问·阴阳应象大论》从生态巨系统的角度阐述了五方所对应的复杂联系。在病理上,《素问·异法方宜论》专就五方地域特点与发病的联系进行了细致分析。《素问·气交变大论》、《素问·五常政大论》、《素问·六元正纪大论》中某岁灾某宫之说更是指出疾病的九宫分野。对于五运六气学说,我们首先要注意克服其局限性,发扬其合理性,既不能机械推算,也不可主观臆断；既不能盲目夸大其预测作用,也不能一概否定其科学内涵。《内经》虽然没有明确提出“伏气”一词,但却明确地说明了四时所感风寒暑湿之邪可潜伏于体内,不即刻发病,过一季后方发病。后世发展的许多伏气理论都以此为据,伏气温病从病因特点上符合事物发展的客观规律,揭示了“正虚邪微”的发病规律。中医认识疫病的最大优势就是：不仅仅局限在病原微生物(鬼毒),更重要的是放眼环境气候变化(六气),结合人体自身状况(正气),从多方面综合考虑其生态关系。西医注重生物性生态因子致病,揭示了病原微生物致病的一般规律。生物性生态因子致病主要指微生物感染,其对人类最重要的影响之一是导致传染病的流行。病原微生物理论使人类认识与治疗疾病的方法发生了深刻的变化,在相当长的历史时期里,西医学以对微生物致病的精确诊断和可靠疗效而备受推崇。对待单一病因的病原微生物,西医采用的多是攻击性或排除性的策略,多强调单一活性化合物对单一靶点的作用。这对于多由单一病原微生物所致的传染病,在疗效上无疑是具有特异性的。各种疫苗的广泛接种,已成为当今人类对付许多传染病的最有效和最经济的手段。虽然西医学在病原微生物领域及控制传染病方面已取得巨大成就,但至今仍有一些传染病的病原体尚未完全认识,某些疾病还缺乏有效的防治方法。原因在于西医病原微生物理论存在发展瓶颈：指导思想“只见树木不见森林”；对治策略“以不变焉能应万变”；认识病毒“雾里看花终隔一层”从中西医病因认识的早期发展轨迹来看,二者曾有过相互重合的萌芽,这也为未来中西医病因研究交汇于对生态因子致病的认识提供了可能性。如果把西医微观研究的精细与中医宏观认知的模糊有机结合将是生态医学所倡导的优化医学形式。WTO提倡的“个体化医疗”使体质对发病的影响逐渐得到重视。生态医学已认识到人的健康、疾病、寿夭都与其生存环境的变化影响紧密相连。相对于西医体质学说发展的范围局限和整体滞后,源于天人合一思想的中医体质学说可谓丰富系统、观念超前,提出体质发病倾向与五运六气学说关系密切,是中医体质学说的一大亮点。和谐是生态思想的灵魂,整合是中西医学发展的归宿。通过生态医学思想背景下的中西病因比较,对构建生态病因学理论框架进行了初步探索。生态病因学认为：人体发病的本因是人体与生态环境的关系失和、调控失谐。要从广义和狭义两方面理解生态病因学的内涵,提出了三个发展方向,即：从六淫的时空之象分别对应的病原微生物致病,以及胎孕期五运与体质发病倾向相关性对应不同基因类型表现出的疾病易感性。更多还原

【Abstract】 Eco-environmental problems are increasingly acute. Ecology has been developing, and had varying degrees of integration with various subjects, then ecological medicine has become an important branch of it. Establishment and development of ecological medicine takes the ecological culture of harmony and ecological philosophy of harmonization between man and nature. Study essentials of ecological medicine are pathogenic factors of biological and abiotic ecology. Theory of macro-ecological medicine from a new perspective illustrates the relationship between man’s disease-healthy and the natural-social environment.In the early stage, the etiological recognition of Chinese and Western medicine had cultural imprints of ghosts and gods, with the development of culture, the ideology of harmony between the heaven and human showed the essence of harmonious culture in Chinese medicine, the confrontational thought reflected the conquering culture in Western medicine.Chinese medical eitology reflects the holism and macro-intuitive realization, and Western medical etiology reductionism and micro-logic substantiation. Under the guidence of systematic perspective of ecological philosophy, with macroscopic grasp of Chinese medicine and micro-reductionism thinking of Western medicine, this day will come, in which the original system sublimates and a new cognitive style forms. Ecological factors are indispensable for living conditions, and can also be considered as environmental factors on organisms at work. In macro-ecological areas, all factors that can cause diseases can be attributed to the ecological factors of pathogenicity. Ecological pathogenic factors includes the biological and non biological in ecological medicine. Biological pathogenic factors—pathogenic microorganisms contain bacteria, viruses and parasites, etc. Non-biological pathogenic factors contain sun and moon, seasons and climates, geographical environment, day and night, temperature changes, etc. Often large ecological factors contain several smaller factors.No matter Chinese or Western medicine causes, can be attributed to the different types of ecological factors, in the broader context of macro-ecology, to eliminate prejudices, and to find the differences between the two theoretical systems and to seek the integrating point of common development. Preliminary study found that there is large differences between six evils theory of Chinese medicine about abiotically ecological factors and pathogenic microorganism theory of Western medicine about biologically ecological factors. This project will focus on comparison between the above two.Chinese medicine emphasizes pathopoiesia of abiotically ecological factors, Six evils pathogenic theory reflects the imaginery thinking of Analogism in traditional Chinese philosophy, analogizes disease causes with six climatic changes, and belongs to the category of abiotic ecological factors from the form of expression and scope of application.Diseases in spatial and temporal relations are inseparable, which were important methodology of Chinese medicine since ancient times, and which different time corresponds to different areas, and different diseases, different time and space. The essence of six evils theory is the theory of Five Yun and Six Qi, which creatively had interpreted the spatio-temporal pattern of diseases. Physiologically, From the ecological system point of view, Plain conversation-Major discussion on the theory of Yin and Yang and the corresponding relationships among all the things in nature illustrates the complex linkages corresponding to five orientations. Pathologically, Plain conversation-Discussion on different therapeutic methods for different diseases carefully analyzed the relations between five regional characteristics and the onset of illness. Further, in Plain conversation-Major discussion on the changes of Qi -convergence, Plain conversation-Major discussion on the administration of five-motions, Plain conversation-Major discussion on the progress of the six climatic changes, the statement of calamities befalling some region in some year, points out dividing lines of nine regions concerned about diseases. For the theory of Five Yun and Six Qi, first of all, we should pay attention to overcoming its limitations, and carrying forward their rationality, and neither mechanically reckoning nor subjectively assuming; and neither blindly exaggerating its forecasting application nor totally negating its scientific connotation.Although Nei jing did not clearly come up with the term "incubative pathogen", but definitely stated exogenous evils at four seasons could be latent in the body, are not immediate onset, but incidence after this season.Later developed theory were on the basis of this, epidemic febrile disease occurring after incubation accorded with the objective law of things development from the etiological characteristics, which revealed the pathogenic law of deficient Zheng Qi and weak evils.The biggest advantage of Chinese medicine understanding infectious diseases is not only limited to pathogenic microorganisms (ghost poison), more importantly, but also took a broad view of environmental and climatic changes (Six Qi), and combined with the body’s own position (Zheng Qi), considered their ecological relationships by the various aspects. Western medicine lays stress on pathopoiesia of bio-ecological factors, which had revealed the general law of pathogenic micro-organisms. The pathopoiesia of biologically ecological factors mainly refers to microbial infections, it is one of the most important influences that cause the prevalence of infectious diseases. Pathogenic microbiology made the methods of mankind knowing and treating diseases occur profound changes. In a long historical period, Western medicine was rewarded and respected owing to the exact diagnosis and the reliable effect for the pathopoiesia of microorganisms.Towards a single cause of pathogenic microorganisms, Western medicine emphasizes a single active compound on the role of a single target, using mostly offensive or exclusive strategy. There is no doubt about the specificity in the curative effect for the infectious diseases caused by single pathogenic microorganisms. Wide variety of vaccine inoculation has become the most effective and economical means for modern people to deal with many infectious diseases.Although Western medicine has made great achievements in the field of pathogenic microorganisms and the control of infectious diseases, A number of infectious pathogens has not been fully recognized, and certain diseases are lack of effective preventive and curative methods. The reason is the bottleneck in the theory of pathogenic microorganism:the guiding ideology can’t see the wood for the trees; the strategy can not adapt the various changes; knowing viruses is like looking at flower in fog.From the early development of understanding causes of Chinese and Western medicine, the two had germination of mutual coincidence, which provided the possibility for etiological study of Chinese and Western medicine converging to the cognition of the ecologically pathogenic factors. If the fuzzyness in the macroscopic study of Chinese medicine is integrated with the accurateness in the microscopic study of Western medicine, this will be the optimizing model advocated by ecological medicine."Individual medicine"promoted by WTO has made the constitutional impact on pathogenesis become more and more important. Ecological medicine has been recognized that human health, diseases, life and death are closely linked to its environmental changes. Relative to the limited range and overall lag of constitutional theory of Western medicine, constitutional theory of Chinese medicine derived from ideology of harmony between the heaven and human has been abundant, systematic, and fruitful, constitutional predisposition has close relations with the theory of Five Yun and Six Qi, which has been considered by Chinese medicine.Through the etiological comparison between Chinese and Western medicine under the background of ecological medicine, establishing the theoretical framework of ecological etiology has been explored. Harmony is the soul of ecological thinking, integration a home to return to of Chinese and Western medical deveplopment. Ecological etiology believes that fundamental causes of diseases are unharmonious in the relations and disarranged in the regulation and control between the human body and the environment.The connotation of ecological etiology has been explainned from broad and narrow sense, and been put forward three development directions, namely:the symbol of time and space of six evils corresponding to pathogenicity of pathogenic microorganisms respectively, and correlation between Five Yun during pregnant time and constitutional predisposition corresponding to susceptibility of diseases showed by different genetic types更多还原