运用红外成像技术探索HIV/AIDS人群脏腑寒热虚实的研究
|
摘要
1研究目的
利用红外成像技术,获取平和质人群(A组)、HIV感染者(B组)和AIDS患者(C组)的脏腑能量数据(△T),在中医基础理论指导下,采用统计学方法,对上述三组人群的脏腑热值参数和热序列分别进行比较,推断HIV/AIDS人群脏腑的寒热虚实情况,探索用红外成像技术进行艾滋病辨证的方法和思路。
2研究：方-法
2.1方法
采用回顾性病例对照研究的方法,选择男女健康人群填写《中医体质调查表》和《知情同意书》,同时接受红外成像检测。根据《中医体质调查表》的结果,将体质判定为平和质的研究对象归为平和质组。接受红外成像检测的平和质人群和HIV/AIDS人群均采用统一的红外热像自动分析仪器采集腹背面两张红外热图,并且计算督、任脉、神阙、上中下三焦、五脏六腑(肺、心、肝、脾、肾、命门、胃、小肠、膀胱、大肠)的温度差值,比较平和质人群与HIV感染者和艾滋病病人的红外成像检测脏腑热态差异。
2.2检测仪器
本研究采用红外热像自动分析系统(红外成像检测)采集受试者的红外热图,其探测器为非制冷焦平面摄像头,像素为320*240,光谱范围为8-14μm,温度分辨率为0.08°C,软件设定可达0.05°C,空间分辨率<1mrad,测温精度为±1°C,聚焦范围为0.5-6m,测温范围：20-40°C。
2.3检测对象
平和质组红外数据全部采自北京地区,为西医诊断无疾病,中医体质评价为平和质的人群,共325例,平均年龄24.17±4.634岁。其中男性253人,女性72人。
HIV/AIDS人群红外资料采自北京,上海,柳州三地,其中北京地区181人,上海公共卫生中心27人,柳州疾病预防与控制中心65人,共计273例,其中,HIV感染者感染者165例,男性119例,女性46例,平均年龄35.47±10.169岁；AIDS期病人108例,男性83例,女性25例,平均年龄37.09±8.755岁。
2.4观察指标
运用红外热像技术设备采集HIV/AIDS人群躯干正面和背面两张红外热态图,运用中医红外检测软件(红外成像检测)系统自动定位定量人体上、中、下三焦,心、肝、脾、肺、肾、命门,胃、小肠、大肠、膀胱,任脉、督脉、神阙等体表投影区的相对温差(△T)。
2.5统计方法
运用SPSS13.0统计软件包进行统计学处理。计量资料采用(均数土标准差)进行描述；计量资料多组间比较采用协方差分析(analysis of covariance),以年龄作为协变量；单向有序资料的组间比较采用非参数检验的Kruskal-wallis秩和检验。
3研究结果
3.1三组人群脏腑热值参数比较
3.1.1三焦热值
与A组相比,B组和C组上焦呈热偏离态势,中焦和下焦呈凉偏离态势；B组与C组在上焦和下焦没有显著性差异,在中焦两组呈现显著性差异(P=0.035),C组的中焦热值明显低于B组,呈现中焦凉偏离。
A组呈上焦凉、中焦温、下焦热的热态特征与古人对三焦生理功能特点的描述一致。而B组和C组呈上焦热、中下焦凉的态势,说明其三焦正常生理活动受影响；C组中焦热值显著低于B组,说明艾滋病期病人中焦的气血化生功能进一步降低,呈中焦虚寒之象,而中焦是营卫的生发之地,故艾滋病期病人卫外功能更差,容易遭受各种外邪触犯。
3.1.2脏热值
与A组相比,B组和C组的心、肺呈热偏离态势,而肝、肾、命门呈凉偏离态势；B组与C组的热参数比较中,C组的肝、脾、肾、命门热值明显低于B组,四脏较B组更加呈凉偏离态势。
B组和C组肝、肾、命门的热值显著低于A组,而C组的脾、肝、肾、命门的热值又显著低于B组,说明了随病情进展,患者脏代谢机能逐渐减退,阳气衰弱,精元之气消耗,体质随之下降；
3.1.3腑热值
与A组相比,B组和C组的大肠、小肠、胃、膀胱热值均呈凉偏离态势；B组与C组只在胃上有显著性差异,P值为0.006,C组的胃热值呈现凉偏离态势明显低于B组。
B组和C组胃、小肠、膀胱、大肠的热值均明显低于A组,提示HIV/AIDS人群腑的受盛和传化水谷(包括水谷精微和糟粕)的功能降低；而且C组的胃热热值显著低于B组,说明艾滋病人元气虚损的根源是胃气的衰败。
3.1.4任督及神阙
与A组相比,B组的神阙呈凉偏离态势；C组的任督及神阙均较A组更凉；B组与C组在任、督脉上有显著性差异(P值均(0.01),C组的任、督脉热值明显低于B组,但神阙穴热值两组差异不明显。
C组的督、任脉热值均显著低于B组,在神阙穴上,A组显著高于B组和C组。督脉热值提示C组全身阳气温煦功能比B组低,任脉和神阙热值提示C组阴寒邪气较重。
3.2三组人群三焦脏腑热序列比较
3.2.1三焦热序列
A组呈现上焦→中焦→下焦依次变热的序列,B组和C组热序列倒置,呈现从上焦→中焦→下焦依次变凉的序列。
这说明HIV/AIDS人群正常的三焦热序列发生改变,下焦和中焦热值不足,上焦热值过亢,反映了脏腑内在关系的紊乱。可能是由于该组人群不同的感染途径(卖血、性乱、静脉吸毒等),导致气血、气阴、精血耗伤,正气受损,卫气失于防御而经常出现各种机会性感染。
3.2.2脏热序列
A组呈现心肺→肝脾→肾命门依次变热的序列,而B组和C组呈现心肺→肝脾→肾命门依次变凉的序列；B组与C组相比,C组肝、肾、命门的热秩低于B组(有统计学意义),说明艾滋病期病人病位更深、三脏虚损的程度更重。
3.2.3腑热序列
三组人群均未表现出明显的腑热序列高低关系,B组和C组的热秩低于A组,说明HIV/AIDS人群在食物、水液的受纳、消化、吸收和排泄上存在一定的代谢障碍。
4初步结论
根据脏腑热值的研究结果,HIV感染者和艾滋病病病人的上焦、心、肺热值高于正常对照组,中焦、下焦、肝、脾、肾、命门、大肠、小肠、胃、膀胱、神阙低于正常对照组,按照“知常达变”的原则,可以认为：HIV/AIDS人群上焦心肺邪热过亢,而中焦、下焦、肝、脾、肾、命门、大肠、小肠、胃、膀胱、神阙等脏腑则表现为不足的寒象；在HIV感染者与艾滋病病人的热值比较中,两组的上焦、心、肺热值无统计学差异,而艾滋病病人的中焦、肝、脾、肾、命门、胃、督脉、任脉热值低于HIV感染者,这一结果体现了处在不同病程阶段的病人脏腑热值的特点,说明艾滋病病人因其病程更长,其上述脏腑虚损程度更甚。
人体是一个由脏、腑、经、络以及筋肉骨骼组成的有机整体,因此,我们不仅要考察试验对象某一脏腑的寒热偏离情况,还应该考察脏腑之间的寒热关系和次序,因此本次研究做了脏腑热序列的探讨。
根据脏腑热序列研究结果,正常对照组为：上焦(心肺)最凉,中焦(肝脾)次之,下焦(肾命门)最热,而HIV感染者和艾滋病病人热次序颠倒,表现为：上焦(心肺)最热,中焦(肝脾)次之,下焦(肾命门)最凉,这一结果说明了HIV感染者和艾滋病病人脏器间正常的寒热关系出现紊乱。
红外成像技术仪器反应灵敏,并能及时显示温度分布的影像；测量精确度高,既可进行连续动态观察,也可将不同时间温度数据对比分析,并利用计算机和信息技术,图像处理功能强大,数据存储、复制方便；红外热像技术无辐射,不接触人体,对检查者没有任何副作用；红外热图反映的是机体能量代谢和基础代谢的改变,所以能更有效地反映机体的生理病理改变,根据本研究的研究成果,红外成像技术能接近表达人体表里寒热、正气盛衰等状况,为中医学全面、系统、动态地掌握脏腑的阶段性变化、发展趋势和预后,提供了一个客观的、科学的测量手段,有广泛的应用前景。
讨论
艾滋病(AIDS)是获得性免疫缺陷综合征的简称,它不是一种疾病,而是感染者在HIV病毒和CD4T淋巴细胞的斗争进退中所表现出来的一组疾病群。研究表明,艾滋病不仅有其特异性的病理改变,如原发病变、机会性感染、恶性肿瘤等,还有其他一些非特异性的病理改变,包括肺病变、心脏病变、相关性肠病、相关性肾病等等[1]；可见,艾滋病是一种累及人体多个系统和组织器官的广泛病变。红外成像技术是一种无创可视化的诊查手段,它既可以固定观察人体某一点、某个区域的温度特征,又可以整体观察全身的温度分布状态；既可以分析异常热源间的关系,又可以考察温度转移的轨迹；既可以获取人体某一时间点的温度信息,又可以实时动态观察人体温度演变。红外成像技术的这些特点能够很好地适应艾滋病研究的需求。其次,体温是人体的四大生命指证之一,是人体内绝大多数信息交换与生物能代谢的最终表现形式,它携带了人体丰富的生理病理信息,某脏器无论是功能性还是器质性病变都有可能通过某种特征性的温度改变加以提示；寒热是中医八纲辨证中重要的“两纲”,中医所讲的寒热应主要理解为“寒象”和“热象”,同时可以肯定它也包含了人体真实温度的寒热,如中医术语“体若燔炭”即是通过触诊感受人体真实温度；可见,人体温度的高低与中医的“寒热”概念有着天然的对应关系,这使红外成像技术解释中医病理成为可能；同时,在研究中如果恰当地设置对照组,那么中医的阴阳、虚实等概念也可通过红外温度参数得到说明。
本次研究中,正常对照组多是年龄在18岁至24岁之间的青少年人群,且男性占多数,与观察组多为中青年人群有较大差距,为使组间均衡我们以年龄为协变量,运用统计学的方法尽量弥补两组间因年龄差距所造成的偏倚,然而在今后的工作中还应尽量满足比较组间年龄的均衡,以及以年龄分层比较,将会得到更客观的研究结论；另外,本次研究是从总体的“寒热虚实”层次去把握HIV/AIDS人群的证候,没有细化到不同的具体证候下HIV/AIDS人群的红外热值特征,这与中医学证候难于统一证候诊断标准和试验对象样本量有限有关,今后随着样本量的丰富和艾滋病中医证候学研究的深入这一问题将逐步得到解答。
1 Objective
In the guidance of fundamental theory of TCM, through comparing zang fu's thermal parameters (△T) and heat sequence of HIV infected people, AIDS patients and healthy people presume the functions of zang fu of HIV/AIDS group and try to explore the methods of syndrome differentiation of AIDS in using of infrared imaging technology.
2 Methods
2.1 Methods
Design is retrospective case-control study. Selecting a number of people to fill in the physique questionnaire of Chinese medicine and informed consent form, and accept the infrared imaging test at the same time. According to results of the physique questionnaire of Chinese medicine, we determine those persons whose transformation scores are more than sixties and transformation scores of other eight physique less than thirties as healthy group.
All subjects that received infrared imaging detection use a unified automated analytical instruments, we collect two infrared images of ventral aspect and dorsal aspect, and relative temperature of triple energizer, heart, liver, spleen, lung, kidney, stomach, small intestine, large intestine, urinary bladder, the governor vessel, conception vessel and shen que will be automatically calculated by computer.
2.2 Instrument
Camera lens:pixel 320*240, spectrum 8～14μm, resolving power 0.08℃, precision±1℃, focal lenth 0.5-6m, testing extent 20～40℃
2.3 Subjects
All the healthy group come from Beijing area, total 325 cases, and 72 cases are female; average age 24.17±4.634, those are no disease and whose transformation scores are more than sixties and transformation scores of other eight physique less than thirties as healthy group.
HIV/AIDS people come from Beijing, Liuzhou and Shanghai, total of 273 cases, among them, HIV infected people are 165 cases with a average age of 35.47±10.169(119 males,46 females); AIDS patients are 108 cases with a average age of 37.09±8.755(83 males,25 females);
2.4 Observation target
We collect two infrared images of ventral aspect and dorsal aspect, and relative temperature of triple energizer, heart, liver, spleen, lung, kidney, stomach, small intestine, large intestine, urinary bladder, the governor vessel, conception vessel and shen que will be automatically calculated by computer.
2.5 Statistical method
All data import SPSS 13.0 statistical software package, measurement data are describe d with average±standard deviation; comparison of measurement data among groups use analysis of covariance, age as covariate; comparison of Count data among groups use Kruskal-wallis.
3 Results
3.1Comparison of Zang fu's metabolic heat within three group
3.1.1 Triple energizer
The triple energizer metabolic heat of HIV infected people and AIDS patients is different from healthy group, upper energizer metabolic heat of HIV infected people and AIDS patients is excesser than healthy group, In contrast, middle and lower energizer are lower than healthy group.Meanwhile, AIDS patients is markly lower than HIV infected people in middle energizer according to the results of Analysis of covariance.
The results of Comparison of Triple energizer's metabolic heat within three group show us that:Focus on the metabolism heat of AIDS patients was significantly lower than HIV infected people, the biological functions of middle energizer has been destroyed, while, because of qi and blood is produced by middle energizer, so we can infer that the function of defence of AIDS patients was even worse, vulnerable to committed by kinds of evils.
3.1.2 The Five Zang-Organs The Five Zang-Organs metabolic heat of HIV infected people and AIDS patients is different from healthy group, The heart and lung metabolic heat of HIV infected people and AIDS patients is excesser than healthy group, Other organs are lower than healthy group.
The results of Analysis of covariance show that:heart, liver, lung, kidney, life-gate of HIV infected people and AIDS patients are significantly different from helthy group(P<0.05), according to graph 2, metabolic heat of heart and lung of HIV infected people and AIDS patients show a ascending deviation, In contrast, liver, kidney, life-gate show a descending deviation.Meanwhile, in the comparison of HIV infected people and AIDS patients,there was significant difference in liver, spleen, kidney and life-gate, according to graph 2, the liver, spleen, kidney and life-gate of AIDS patients markly lower than HIV infected people.
The results of Comparison of Five Zang-organs's metabolic heat within three group show us that:the functions of liver, kidney, life-gate of HIV/AIDS are markly lower than healthy group, more over, the functions of spleen, liver, kidney, life-gate of AIDS patients was significantly lower than HIV infected people, this results directly proof that AIDS is a disease that gradually deplet the body vitality. On metabolic heat of heart and lung, HIV/AIDS people are markly escesser than healthy group, this results maybe induced by kinds of infections or pathological aversion of body energies.
3.1.3 The Six Fu-organs
The Six Fu-Organs metabolic heat of HIV infected people and AIDS patients is different from healthy group, The large intestine, small intestine, stomach, urinary bladder are markly lower than healthy group; stomach and nrinary bladder of AIDS patients are significant lower than HIV infected people.
According to graph 3. metabolic heat of The large intestine, small intestine, stomach, urinary bladder of HIV infected people and AIDS patients show a descending deviation, in the comparison of HIV infected people and AIDS patients,there was significant difference in stomach, according to graph 3, the stomach of AIDS patients markly lower than HIV infected people.
The results of Comparison of Six Fu-orangs's metabolic heat within three group show us that:the functions of stomach, small intestine, urinary bladder, large intestine of HIV/AIDS are markly lower than healthy group, showing that the decline of pepsic function.The results also tell us that protecting essential qi of the stomach is very important in treating AIDS.
3.1.4The governor vessel conception vessel shen que point
The healthy group is totally excesser than HIV infected people in governor vessel, conception vessel and shen que point, and HIV infected people is excesser than AIDS patients, there group shows no significant difference in governor vessel.
According to graph 4, metabolic heat of shen que point of HIV infected people shows a descending deviation in comparison to healthy group. there is a significant difference in governor vessel and conception vessel between HIV infected people and AIDS patients, According to graph 4, the governor vessel and conception vessel are markly lower than HIV infected people.
In addition, the thermal parameters of the governor vessel prompted to the decline of warm function, and the thermal parameters of Conception Vessel and Shenque point may be prompted to the heavier chill evil.
3.2Comparison of Zang fu's heat sequence within three group
3.2.1Triple energizer
Heat sequence of Triple energizer of HIV infected people and AIDS patients is different from healthy group, the healthy group gradually gose more hotter from upper energizer to lower energizer, in contrast, HIV/AIDS shows a inversion heat sequence in Triple energizer.
3.2.2The Five Zang-Organs
Heat sequence of The Five Zang-Organs of HIV infected people and AIDS patients is different from healthy group, the heat ranks of the heart and lung are the lowest in healthy group, and liver and spleen set in the second place, kidney and life-gate are the highest in The Five Zang-Organs'heat ranks. In contrast, HIV/AIDS shows a inversion heat sequence in The Five Zang-Organs'heat ranks.
3.2.3The Six Fu-Organs
Three groups showed no significant relationship in The Six Fu-Organs'heat ranks,while. the difference is the heat ranks of The Six Fu-Organs of HIV/AIDS are totally lower than the healthy group.
The results of Comparison of heat sequence within three group show us that: HIV/AIDS shows a inversion heat sequence in Triple energizer and Zang Fu.Organs, this is consistent with Transmission and clinical characteristics of AIDS, HIV/AIDS has a long history of selling blood, Sexual promiscuity and Intravenous drug, so it can directly damage qi and blood, qi and yin, essence and blood, which can induce asthenia of middle and lower energizer, injury of righteousness and kinds of Opportunistic infections. Heat ranks of The Six Fu-Organs of HIV/AIDS are totally lower than the healthy group showing that there is a serious metabolic disorder of HIV/AIDS group in digestion, absorption and excretion of foods and waters.
4 Conclusion
Infrared imaging technology have a responsive and precisive advantages, it can display temperature distribution timely, No matter continuous dynamic observation or different time temperature data can be analyzed; There is no radiation or exposure to the human body, and without any side effects on the examiner, Infrared heat map reflects the body's energy metabolism and basal metabolism changes, so it can better reflect the physiological and pathological changes of the body, According to the results of this study, the expression of infrared imaging technology close to the heat and cold, and also as the status of righteousness rise and fall of human body, It providing a comprehensive, systematic, and dynamic control instruments to measuring the phasic changes, trends and outcomes of human body for TCM Study,It has a wide applications in future Study of TCM.
5 Discussion
In this study, normal control group are mostly at the age of 18 to 24 years old, and mostly are male, which is different from testing group, In order to balance three groups, we adopted the statistical method of analysis of covariance, In future study, we will try to meet the age balance between groups, and we will gain more objective conclusions, if we compare by layer ages. In addition, we gain a general conclusion of syndrome differentiation of AIDS, that is cold and heat, asthenia and sthenia, The reason why we fail to gaining the distinctive Infrared caloric value of definite syndrome differentiation is relating to limited sample size and no unified diagnostic criteria of syndrome differentiation. This problem will be solvesd with sample size increasing and study of syndrome differentiation of AIDS deepening.
利用红外成像技术,获取平和质人群(A组)、HIV感染者(B组)和AIDS患者(C组)的脏腑能量数据(△T),在中医基础理论指导下,采用统计学方法,对上述三组人群的脏腑热值参数和热序列分别进行比较,推断HIV/AIDS人群脏腑的寒热虚实情况,探索用红外成像技术进行艾滋病辨证的方法和思路。
2研究：方-法
2.1方法
采用回顾性病例对照研究的方法,选择男女健康人群填写《中医体质调查表》和《知情同意书》,同时接受红外成像检测。根据《中医体质调查表》的结果,将体质判定为平和质的研究对象归为平和质组。接受红外成像检测的平和质人群和HIV/AIDS人群均采用统一的红外热像自动分析仪器采集腹背面两张红外热图,并且计算督、任脉、神阙、上中下三焦、五脏六腑(肺、心、肝、脾、肾、命门、胃、小肠、膀胱、大肠)的温度差值,比较平和质人群与HIV感染者和艾滋病病人的红外成像检测脏腑热态差异。
2.2检测仪器
本研究采用红外热像自动分析系统(红外成像检测)采集受试者的红外热图,其探测器为非制冷焦平面摄像头,像素为320*240,光谱范围为8-14μm,温度分辨率为0.08°C,软件设定可达0.05°C,空间分辨率<1mrad,测温精度为±1°C,聚焦范围为0.5-6m,测温范围：20-40°C。
2.3检测对象
平和质组红外数据全部采自北京地区,为西医诊断无疾病,中医体质评价为平和质的人群,共325例,平均年龄24.17±4.634岁。其中男性253人,女性72人。
HIV/AIDS人群红外资料采自北京,上海,柳州三地,其中北京地区181人,上海公共卫生中心27人,柳州疾病预防与控制中心65人,共计273例,其中,HIV感染者感染者165例,男性119例,女性46例,平均年龄35.47±10.169岁；AIDS期病人108例,男性83例,女性25例,平均年龄37.09±8.755岁。
2.4观察指标
运用红外热像技术设备采集HIV/AIDS人群躯干正面和背面两张红外热态图,运用中医红外检测软件(红外成像检测)系统自动定位定量人体上、中、下三焦,心、肝、脾、肺、肾、命门,胃、小肠、大肠、膀胱,任脉、督脉、神阙等体表投影区的相对温差(△T)。
2.5统计方法
运用SPSS13.0统计软件包进行统计学处理。计量资料采用(均数土标准差)进行描述；计量资料多组间比较采用协方差分析(analysis of covariance),以年龄作为协变量；单向有序资料的组间比较采用非参数检验的Kruskal-wallis秩和检验。
3研究结果
3.1三组人群脏腑热值参数比较
3.1.1三焦热值
与A组相比,B组和C组上焦呈热偏离态势,中焦和下焦呈凉偏离态势；B组与C组在上焦和下焦没有显著性差异,在中焦两组呈现显著性差异(P=0.035),C组的中焦热值明显低于B组,呈现中焦凉偏离。
A组呈上焦凉、中焦温、下焦热的热态特征与古人对三焦生理功能特点的描述一致。而B组和C组呈上焦热、中下焦凉的态势,说明其三焦正常生理活动受影响；C组中焦热值显著低于B组,说明艾滋病期病人中焦的气血化生功能进一步降低,呈中焦虚寒之象,而中焦是营卫的生发之地,故艾滋病期病人卫外功能更差,容易遭受各种外邪触犯。
3.1.2脏热值
与A组相比,B组和C组的心、肺呈热偏离态势,而肝、肾、命门呈凉偏离态势；B组与C组的热参数比较中,C组的肝、脾、肾、命门热值明显低于B组,四脏较B组更加呈凉偏离态势。
B组和C组肝、肾、命门的热值显著低于A组,而C组的脾、肝、肾、命门的热值又显著低于B组,说明了随病情进展,患者脏代谢机能逐渐减退,阳气衰弱,精元之气消耗,体质随之下降；
3.1.3腑热值
与A组相比,B组和C组的大肠、小肠、胃、膀胱热值均呈凉偏离态势；B组与C组只在胃上有显著性差异,P值为0.006,C组的胃热值呈现凉偏离态势明显低于B组。
B组和C组胃、小肠、膀胱、大肠的热值均明显低于A组,提示HIV/AIDS人群腑的受盛和传化水谷(包括水谷精微和糟粕)的功能降低；而且C组的胃热热值显著低于B组,说明艾滋病人元气虚损的根源是胃气的衰败。
3.1.4任督及神阙
与A组相比,B组的神阙呈凉偏离态势；C组的任督及神阙均较A组更凉；B组与C组在任、督脉上有显著性差异(P值均(0.01),C组的任、督脉热值明显低于B组,但神阙穴热值两组差异不明显。
C组的督、任脉热值均显著低于B组,在神阙穴上,A组显著高于B组和C组。督脉热值提示C组全身阳气温煦功能比B组低,任脉和神阙热值提示C组阴寒邪气较重。
3.2三组人群三焦脏腑热序列比较
3.2.1三焦热序列
A组呈现上焦→中焦→下焦依次变热的序列,B组和C组热序列倒置,呈现从上焦→中焦→下焦依次变凉的序列。
这说明HIV/AIDS人群正常的三焦热序列发生改变,下焦和中焦热值不足,上焦热值过亢,反映了脏腑内在关系的紊乱。可能是由于该组人群不同的感染途径(卖血、性乱、静脉吸毒等),导致气血、气阴、精血耗伤,正气受损,卫气失于防御而经常出现各种机会性感染。
3.2.2脏热序列
A组呈现心肺→肝脾→肾命门依次变热的序列,而B组和C组呈现心肺→肝脾→肾命门依次变凉的序列；B组与C组相比,C组肝、肾、命门的热秩低于B组(有统计学意义),说明艾滋病期病人病位更深、三脏虚损的程度更重。
3.2.3腑热序列
三组人群均未表现出明显的腑热序列高低关系,B组和C组的热秩低于A组,说明HIV/AIDS人群在食物、水液的受纳、消化、吸收和排泄上存在一定的代谢障碍。
4初步结论
根据脏腑热值的研究结果,HIV感染者和艾滋病病病人的上焦、心、肺热值高于正常对照组,中焦、下焦、肝、脾、肾、命门、大肠、小肠、胃、膀胱、神阙低于正常对照组,按照“知常达变”的原则,可以认为：HIV/AIDS人群上焦心肺邪热过亢,而中焦、下焦、肝、脾、肾、命门、大肠、小肠、胃、膀胱、神阙等脏腑则表现为不足的寒象；在HIV感染者与艾滋病病人的热值比较中,两组的上焦、心、肺热值无统计学差异,而艾滋病病人的中焦、肝、脾、肾、命门、胃、督脉、任脉热值低于HIV感染者,这一结果体现了处在不同病程阶段的病人脏腑热值的特点,说明艾滋病病人因其病程更长,其上述脏腑虚损程度更甚。
人体是一个由脏、腑、经、络以及筋肉骨骼组成的有机整体,因此,我们不仅要考察试验对象某一脏腑的寒热偏离情况,还应该考察脏腑之间的寒热关系和次序,因此本次研究做了脏腑热序列的探讨。
根据脏腑热序列研究结果,正常对照组为：上焦(心肺)最凉,中焦(肝脾)次之,下焦(肾命门)最热,而HIV感染者和艾滋病病人热次序颠倒,表现为：上焦(心肺)最热,中焦(肝脾)次之,下焦(肾命门)最凉,这一结果说明了HIV感染者和艾滋病病人脏器间正常的寒热关系出现紊乱。
红外成像技术仪器反应灵敏,并能及时显示温度分布的影像；测量精确度高,既可进行连续动态观察,也可将不同时间温度数据对比分析,并利用计算机和信息技术,图像处理功能强大,数据存储、复制方便；红外热像技术无辐射,不接触人体,对检查者没有任何副作用；红外热图反映的是机体能量代谢和基础代谢的改变,所以能更有效地反映机体的生理病理改变,根据本研究的研究成果,红外成像技术能接近表达人体表里寒热、正气盛衰等状况,为中医学全面、系统、动态地掌握脏腑的阶段性变化、发展趋势和预后,提供了一个客观的、科学的测量手段,有广泛的应用前景。
讨论
艾滋病(AIDS)是获得性免疫缺陷综合征的简称,它不是一种疾病,而是感染者在HIV病毒和CD4T淋巴细胞的斗争进退中所表现出来的一组疾病群。研究表明,艾滋病不仅有其特异性的病理改变,如原发病变、机会性感染、恶性肿瘤等,还有其他一些非特异性的病理改变,包括肺病变、心脏病变、相关性肠病、相关性肾病等等[1]；可见,艾滋病是一种累及人体多个系统和组织器官的广泛病变。红外成像技术是一种无创可视化的诊查手段,它既可以固定观察人体某一点、某个区域的温度特征,又可以整体观察全身的温度分布状态；既可以分析异常热源间的关系,又可以考察温度转移的轨迹；既可以获取人体某一时间点的温度信息,又可以实时动态观察人体温度演变。红外成像技术的这些特点能够很好地适应艾滋病研究的需求。其次,体温是人体的四大生命指证之一,是人体内绝大多数信息交换与生物能代谢的最终表现形式,它携带了人体丰富的生理病理信息,某脏器无论是功能性还是器质性病变都有可能通过某种特征性的温度改变加以提示；寒热是中医八纲辨证中重要的“两纲”,中医所讲的寒热应主要理解为“寒象”和“热象”,同时可以肯定它也包含了人体真实温度的寒热,如中医术语“体若燔炭”即是通过触诊感受人体真实温度；可见,人体温度的高低与中医的“寒热”概念有着天然的对应关系,这使红外成像技术解释中医病理成为可能；同时,在研究中如果恰当地设置对照组,那么中医的阴阳、虚实等概念也可通过红外温度参数得到说明。
本次研究中,正常对照组多是年龄在18岁至24岁之间的青少年人群,且男性占多数,与观察组多为中青年人群有较大差距,为使组间均衡我们以年龄为协变量,运用统计学的方法尽量弥补两组间因年龄差距所造成的偏倚,然而在今后的工作中还应尽量满足比较组间年龄的均衡,以及以年龄分层比较,将会得到更客观的研究结论；另外,本次研究是从总体的“寒热虚实”层次去把握HIV/AIDS人群的证候,没有细化到不同的具体证候下HIV/AIDS人群的红外热值特征,这与中医学证候难于统一证候诊断标准和试验对象样本量有限有关,今后随着样本量的丰富和艾滋病中医证候学研究的深入这一问题将逐步得到解答。
1 Objective
In the guidance of fundamental theory of TCM, through comparing zang fu's thermal parameters (△T) and heat sequence of HIV infected people, AIDS patients and healthy people presume the functions of zang fu of HIV/AIDS group and try to explore the methods of syndrome differentiation of AIDS in using of infrared imaging technology.
2 Methods
2.1 Methods
Design is retrospective case-control study. Selecting a number of people to fill in the physique questionnaire of Chinese medicine and informed consent form, and accept the infrared imaging test at the same time. According to results of the physique questionnaire of Chinese medicine, we determine those persons whose transformation scores are more than sixties and transformation scores of other eight physique less than thirties as healthy group.
All subjects that received infrared imaging detection use a unified automated analytical instruments, we collect two infrared images of ventral aspect and dorsal aspect, and relative temperature of triple energizer, heart, liver, spleen, lung, kidney, stomach, small intestine, large intestine, urinary bladder, the governor vessel, conception vessel and shen que will be automatically calculated by computer.
2.2 Instrument
Camera lens:pixel 320*240, spectrum 8～14μm, resolving power 0.08℃, precision±1℃, focal lenth 0.5-6m, testing extent 20～40℃
2.3 Subjects
All the healthy group come from Beijing area, total 325 cases, and 72 cases are female; average age 24.17±4.634, those are no disease and whose transformation scores are more than sixties and transformation scores of other eight physique less than thirties as healthy group.
HIV/AIDS people come from Beijing, Liuzhou and Shanghai, total of 273 cases, among them, HIV infected people are 165 cases with a average age of 35.47±10.169(119 males,46 females); AIDS patients are 108 cases with a average age of 37.09±8.755(83 males,25 females);
2.4 Observation target
We collect two infrared images of ventral aspect and dorsal aspect, and relative temperature of triple energizer, heart, liver, spleen, lung, kidney, stomach, small intestine, large intestine, urinary bladder, the governor vessel, conception vessel and shen que will be automatically calculated by computer.
2.5 Statistical method
All data import SPSS 13.0 statistical software package, measurement data are describe d with average±standard deviation; comparison of measurement data among groups use analysis of covariance, age as covariate; comparison of Count data among groups use Kruskal-wallis.
3 Results
3.1Comparison of Zang fu's metabolic heat within three group
3.1.1 Triple energizer
The triple energizer metabolic heat of HIV infected people and AIDS patients is different from healthy group, upper energizer metabolic heat of HIV infected people and AIDS patients is excesser than healthy group, In contrast, middle and lower energizer are lower than healthy group.Meanwhile, AIDS patients is markly lower than HIV infected people in middle energizer according to the results of Analysis of covariance.
The results of Comparison of Triple energizer's metabolic heat within three group show us that:Focus on the metabolism heat of AIDS patients was significantly lower than HIV infected people, the biological functions of middle energizer has been destroyed, while, because of qi and blood is produced by middle energizer, so we can infer that the function of defence of AIDS patients was even worse, vulnerable to committed by kinds of evils.
3.1.2 The Five Zang-Organs The Five Zang-Organs metabolic heat of HIV infected people and AIDS patients is different from healthy group, The heart and lung metabolic heat of HIV infected people and AIDS patients is excesser than healthy group, Other organs are lower than healthy group.
The results of Analysis of covariance show that:heart, liver, lung, kidney, life-gate of HIV infected people and AIDS patients are significantly different from helthy group(P<0.05), according to graph 2, metabolic heat of heart and lung of HIV infected people and AIDS patients show a ascending deviation, In contrast, liver, kidney, life-gate show a descending deviation.Meanwhile, in the comparison of HIV infected people and AIDS patients,there was significant difference in liver, spleen, kidney and life-gate, according to graph 2, the liver, spleen, kidney and life-gate of AIDS patients markly lower than HIV infected people.
The results of Comparison of Five Zang-organs's metabolic heat within three group show us that:the functions of liver, kidney, life-gate of HIV/AIDS are markly lower than healthy group, more over, the functions of spleen, liver, kidney, life-gate of AIDS patients was significantly lower than HIV infected people, this results directly proof that AIDS is a disease that gradually deplet the body vitality. On metabolic heat of heart and lung, HIV/AIDS people are markly escesser than healthy group, this results maybe induced by kinds of infections or pathological aversion of body energies.
3.1.3 The Six Fu-organs
The Six Fu-Organs metabolic heat of HIV infected people and AIDS patients is different from healthy group, The large intestine, small intestine, stomach, urinary bladder are markly lower than healthy group; stomach and nrinary bladder of AIDS patients are significant lower than HIV infected people.
According to graph 3. metabolic heat of The large intestine, small intestine, stomach, urinary bladder of HIV infected people and AIDS patients show a descending deviation, in the comparison of HIV infected people and AIDS patients,there was significant difference in stomach, according to graph 3, the stomach of AIDS patients markly lower than HIV infected people.
The results of Comparison of Six Fu-orangs's metabolic heat within three group show us that:the functions of stomach, small intestine, urinary bladder, large intestine of HIV/AIDS are markly lower than healthy group, showing that the decline of pepsic function.The results also tell us that protecting essential qi of the stomach is very important in treating AIDS.
3.1.4The governor vessel conception vessel shen que point
The healthy group is totally excesser than HIV infected people in governor vessel, conception vessel and shen que point, and HIV infected people is excesser than AIDS patients, there group shows no significant difference in governor vessel.
According to graph 4, metabolic heat of shen que point of HIV infected people shows a descending deviation in comparison to healthy group. there is a significant difference in governor vessel and conception vessel between HIV infected people and AIDS patients, According to graph 4, the governor vessel and conception vessel are markly lower than HIV infected people.
In addition, the thermal parameters of the governor vessel prompted to the decline of warm function, and the thermal parameters of Conception Vessel and Shenque point may be prompted to the heavier chill evil.
3.2Comparison of Zang fu's heat sequence within three group
3.2.1Triple energizer
Heat sequence of Triple energizer of HIV infected people and AIDS patients is different from healthy group, the healthy group gradually gose more hotter from upper energizer to lower energizer, in contrast, HIV/AIDS shows a inversion heat sequence in Triple energizer.
3.2.2The Five Zang-Organs
Heat sequence of The Five Zang-Organs of HIV infected people and AIDS patients is different from healthy group, the heat ranks of the heart and lung are the lowest in healthy group, and liver and spleen set in the second place, kidney and life-gate are the highest in The Five Zang-Organs'heat ranks. In contrast, HIV/AIDS shows a inversion heat sequence in The Five Zang-Organs'heat ranks.
3.2.3The Six Fu-Organs
Three groups showed no significant relationship in The Six Fu-Organs'heat ranks,while. the difference is the heat ranks of The Six Fu-Organs of HIV/AIDS are totally lower than the healthy group.
The results of Comparison of heat sequence within three group show us that: HIV/AIDS shows a inversion heat sequence in Triple energizer and Zang Fu.Organs, this is consistent with Transmission and clinical characteristics of AIDS, HIV/AIDS has a long history of selling blood, Sexual promiscuity and Intravenous drug, so it can directly damage qi and blood, qi and yin, essence and blood, which can induce asthenia of middle and lower energizer, injury of righteousness and kinds of Opportunistic infections. Heat ranks of The Six Fu-Organs of HIV/AIDS are totally lower than the healthy group showing that there is a serious metabolic disorder of HIV/AIDS group in digestion, absorption and excretion of foods and waters.
4 Conclusion
Infrared imaging technology have a responsive and precisive advantages, it can display temperature distribution timely, No matter continuous dynamic observation or different time temperature data can be analyzed; There is no radiation or exposure to the human body, and without any side effects on the examiner, Infrared heat map reflects the body's energy metabolism and basal metabolism changes, so it can better reflect the physiological and pathological changes of the body, According to the results of this study, the expression of infrared imaging technology close to the heat and cold, and also as the status of righteousness rise and fall of human body, It providing a comprehensive, systematic, and dynamic control instruments to measuring the phasic changes, trends and outcomes of human body for TCM Study,It has a wide applications in future Study of TCM.
5 Discussion
In this study, normal control group are mostly at the age of 18 to 24 years old, and mostly are male, which is different from testing group, In order to balance three groups, we adopted the statistical method of analysis of covariance, In future study, we will try to meet the age balance between groups, and we will gain more objective conclusions, if we compare by layer ages. In addition, we gain a general conclusion of syndrome differentiation of AIDS, that is cold and heat, asthenia and sthenia, The reason why we fail to gaining the distinctive Infrared caloric value of definite syndrome differentiation is relating to limited sample size and no unified diagnostic criteria of syndrome differentiation. This problem will be solvesd with sample size increasing and study of syndrome differentiation of AIDS deepening.
引文
[1]王健,李兴旺.艾滋病中西医结合临床科研实用教程[M].科学出版社,2010,37.[2]运用热态自动分析技术对冬泳、平和质、艾滋病3组人群热图的分析及其临床意义探讨[J].北京中医药大学学报,2010,33(2)：94-97.[3]陈振相,魏满良.对正常人面部红外线图的观察[J].中国医药学报,1991,6(4)：8-9.[4]吴敏,宓越.700名健康学龄期儿童红外热像谱特征及中医望诊关联研究[J].上海中医药杂志2002,3：34-36.[5]王鸿谟,张栋.中医色诊学定位与红外热象数字化研究[J].世界科学技术一中医药现代化
多学科研究与工程技术,2004,6(4)：26-32.[6]诸凯,魏璠,何坚.不同人群舌红外热像观察及动物舌血液灌注率测定[J].中医杂志,2004,45(1)：49-50.[7]章熙民,诸凯,李惟毅.应用红外热像技术测试舌面温度的研究[J].天津大学学报,1991,24(3)： 20-24.[8]张珊琴,肖沪生,盛瑜雯.正常与阴虚舌质热图的观察[J].中西医结合杂志,1990,10(12)：732-733.[9]姜智浩,诸凯.舌象特征的量化研究[J].天津中医药,2008(6)25：456-457.[10]刘黎青,周盛年,刘峰.老年不同辨证分型红外热象舌图特征[J]. Chinese Archives of Traditional Chinese Medicine,2002, (6) 20:738-739.[11]刘黎青,周盛年,张轶,薛一涛.糖尿病患者红外热象舌图及温度负荷变化的研究[J].山东生物医学工程,2001,3(20)：12-14.[12]许金森,汪培清,胡翔龙,吴宝华,张福强.红外辐射成像技术中等温显示与全温显示在中医经络研究中的应用[J].福建中医学院学报,2004,(2)14：20-22.[13]汪培清,胡翔龙,许金森,吴宝华,许小洋.人体体表十四经脉循行路线的红外热像显示[J].针刺研究2002,(4)27：260-161.[14]汪培清,胡翔龙,许金森,吴宝华.人体体表督脉与任脉的红外辐射轨迹显示的探讨[J].中国临床康复,2003,(9)7：1379-1380.[15]潘晓华,许金森,胡翔龙.人体命门穴红外辐射强度初探[J].辽宁中医杂志,2006,(10)33： 1338-1339.
[16]李伟,徐海燕,王芳.心气虚患者内关穴红外成像客观显示的研究[J].江苏中医药,2009,(2)41：27-28.
[17]张栋,高惠合,温宝珠等.“面口合谷收”的红外热像图的验证[J].中国医药学报,1989,4(1)：31-34.
[18]刘瑞庭,庄鼎,杨秀珍等.循经感传现象客观显示的研究[J].针刺研究,1990,15(3)：239-243.
[19]张栋.目与相关经脉特殊联系的热像图显示研究—针刺胆经络穴对目区温效应的观察[A].第六界全国经络研讨会论文汇编.长沙：1991.
[20]李洪娟,袁云娥.红外成像检测技术辅助中医辨证治疗高热1例[J].北京中医药大学学报,2008,15(4)：46.
[21]吴青.中医药结合红外热像仪治疗286例脑供血不足[J].上海医学影像,2004(3)13： 189-191.
[22]张耀如.乳腺增生病中医分型与近红外像关系临床观察[J].山西中医,2006,(2)22：20-21.
[23]罗华,罗宏明,古吉敏,贾钰铭.乳腺增生病红外线扫描图像与中医证型的关系探讨[J].山西中医学院学报,2000,(2)1：21.
[24]刘肖瑜,周肃陵,王正.红外热图技术与腰椎间盘突出症中医证型的相关性研究[J].中国中医骨伤科杂志,2008(5)16：10-12.
[25]谷华,孙丽斌,于畅,李海存.红外热图温度与肿瘤中医证型的关系[J].临床军医杂志,2009,(3)37：389-390.
[26]张世亮,张蕴慧,庄欣.红外成像技术对不同证型高血压患者面部温度的研究[J].山东中医药大学学报,(5)24：359-360.
[27]王伟钢,王微,符思.旭痹病变关节的红外线热图象改变[J].北京中医药大学学报,1997,(3)20：62-63.
[28]杜少辉,付友金,陈肖君,吕旭升,金梅.远红外线热层析系统对老年中医诊断的运用[J].中医药通报(4)7：26-28.
[29]杜昌华,王伏峰.红外热像技术在儿童哮喘分型中的应用[J].中国中西医结合杂志,1998,18(12)：755.
[30]陈振相.红外热象仪在中医学中的应用[J].上海医学影像,1994,24(3)：35-37.
[31]李小梅,李续娥等.采用红外热扫描成像系统进行复方寒凉中药热效应的研究[J].激光生物学报,2006,15(5)：516-519.
[32]李小梅,黄雪群等.采用红外热扫描成像系统研究归胃经寒性中药对胃热证大鼠的热效应[J].激光生物学报,2007,16(2)：180-185.
[33]朱明,李宇航.关于中药寒热药性试验的红外成像观测[J].中国体视学与图像分析,2007,12(1)：53-58.
[34]袁永明,陈晓等.寒证热证大鼠模型的红外热图研究[J].辽宁中医杂志,2008,35(5)：785-787.
[35]张栋,付卫星.动物实验中红外热成象方法的使用[J].红外技术,1997,19(1)：45-48.
[36]杨文涛,马学强.红外热像技术对中西医结合治疗大鼠肢体缺血模型疗效的观察[J].山东中医药大学学报,2000,24(3)：232-234.
[37]吕维柏.艾滋病中西医防治学[M].北京：人民卫生出版社,1994.144.
[38]苏诚练.中医试治艾滋病30例临床报告[J].中医药学报,1991,19(2)：31.
[39]王宝祥.中医药抗艾滋病的临床研究[J].空军军医高专学报,1998,20(1)：54-56.
[40]王振坤.艾滋病的中医辨证治疗[J].中医杂志,1995,36(4)：208.
[41]尤松鑫.艾滋病中医证治概述[J].江苏中医,1999,20(3)：4.
[42]杨凤珍.HIV/AIDS中医分期辨证治疗[J].中国医学报,2004,19(4)：240-242.
[43]谢世平,侯明杰.艾滋病中医基本证候专家问卷调查分析[J].中国中医基础医学杂志,2009,15(1)：56-58.
[44]黄剑雄,李峰,倪量.国内艾滋病中医文献的证候研究评价.辽宁中医杂志,2009,36(1)：1-3.
[45]谢世平,潘万旗,梁慕华.艾滋病中医基本证型的相关文献分析[J].河南中医学院学报,2006,22(1)：6.
[46]杨凤珍,王健等.72例HIV/AIDS患者中医证候与T淋巴细胞亚群和病毒载量相关性研究[J].中国医药学报,2004,19(12)：733-736.
[47]邱红,谢世平.HIV/AIDS患者274例中医证候流行病学分布[J].郑州大学学报(医学版),2007,42(2)：363-364.
[48]朱菲菲,符林春等.90例艾滋病发热患者温病学证候特点分析[J].广州中医药 大学学报,2008,25(2)：161-164.
[49]刘志斌,杨冀平等.210例HIV感染者/AIDS患者中医四诊信息分布特点[J].Chinese General Practice,2010,13(6):1810-1812.
[50]张国梁,徐经凤等.473例艾滋病毒感染者和艾滋病患者中医临床症状和证候分布规律初探[J].安徽中医学院学报,2009,28(5)：21-22.
[51]胡建华,李秀惠等.100例艾滋病患者中医辨证分型研究[J].北京中医,2007,26(2)：97-98.
[52]黄剑雄,李峰.170例静脉吸毒HIV感染者/AIDS患者中医证候研究[J].中国中医药信息杂志,2009,16(1)29-30.
[53]李洪娟,李峰等.158例HIV/AIDS感染者常见中医症状和证候分析[J].北京中医药大学学报,2005,28(1)：69-72.
[54]陈建设,谢世平,许前磊,等.艾滋病常见实证量化诊断的Logistic回归分析[J].中医杂志,2009,50(7)：632-645.
[55]谢世平,陈建设等.HIV/AIDS证候分型及量化诊断的结构方程模型分析[J].中国中医基础医学杂志,2010,16(7)：577-579.
[56]杨永利,施学忠等.因子分析在艾滋病中医证候研究中的应用[J].中国卫生统计,2007,24(5)：480-482.
[57]艾滋病和艾滋病病毒感染诊断标准及处理原则.卫生部,2008.
[58]中华中医药学会.中医体质分类与判定.中国中医药出版社.2008,1-7.
[59]杨凤珍,王健,烟建华.《难经》命门元气三焦理论在HIV/AIDS中应用初探[J].中国中医基础医学杂志,2003,9(8)：4-5.
[60]薛伯寿.从中医理论谈对艾滋病的认识[J].中医杂志,1991,32(1)：20.
多学科研究与工程技术,2004,6(4)：26-32.[6]诸凯,魏璠,何坚.不同人群舌红外热像观察及动物舌血液灌注率测定[J].中医杂志,2004,45(1)：49-50.[7]章熙民,诸凯,李惟毅.应用红外热像技术测试舌面温度的研究[J].天津大学学报,1991,24(3)： 20-24.[8]张珊琴,肖沪生,盛瑜雯.正常与阴虚舌质热图的观察[J].中西医结合杂志,1990,10(12)：732-733.[9]姜智浩,诸凯.舌象特征的量化研究[J].天津中医药,2008(6)25：456-457.[10]刘黎青,周盛年,刘峰.老年不同辨证分型红外热象舌图特征[J]. Chinese Archives of Traditional Chinese Medicine,2002, (6) 20:738-739.[11]刘黎青,周盛年,张轶,薛一涛.糖尿病患者红外热象舌图及温度负荷变化的研究[J].山东生物医学工程,2001,3(20)：12-14.[12]许金森,汪培清,胡翔龙,吴宝华,张福强.红外辐射成像技术中等温显示与全温显示在中医经络研究中的应用[J].福建中医学院学报,2004,(2)14：20-22.[13]汪培清,胡翔龙,许金森,吴宝华,许小洋.人体体表十四经脉循行路线的红外热像显示[J].针刺研究2002,(4)27：260-161.[14]汪培清,胡翔龙,许金森,吴宝华.人体体表督脉与任脉的红外辐射轨迹显示的探讨[J].中国临床康复,2003,(9)7：1379-1380.[15]潘晓华,许金森,胡翔龙.人体命门穴红外辐射强度初探[J].辽宁中医杂志,2006,(10)33： 1338-1339.
[16]李伟,徐海燕,王芳.心气虚患者内关穴红外成像客观显示的研究[J].江苏中医药,2009,(2)41：27-28.
[17]张栋,高惠合,温宝珠等.“面口合谷收”的红外热像图的验证[J].中国医药学报,1989,4(1)：31-34.
[18]刘瑞庭,庄鼎,杨秀珍等.循经感传现象客观显示的研究[J].针刺研究,1990,15(3)：239-243.
[19]张栋.目与相关经脉特殊联系的热像图显示研究—针刺胆经络穴对目区温效应的观察[A].第六界全国经络研讨会论文汇编.长沙：1991.
[20]李洪娟,袁云娥.红外成像检测技术辅助中医辨证治疗高热1例[J].北京中医药大学学报,2008,15(4)：46.
[21]吴青.中医药结合红外热像仪治疗286例脑供血不足[J].上海医学影像,2004(3)13： 189-191.
[22]张耀如.乳腺增生病中医分型与近红外像关系临床观察[J].山西中医,2006,(2)22：20-21.
[23]罗华,罗宏明,古吉敏,贾钰铭.乳腺增生病红外线扫描图像与中医证型的关系探讨[J].山西中医学院学报,2000,(2)1：21.
[24]刘肖瑜,周肃陵,王正.红外热图技术与腰椎间盘突出症中医证型的相关性研究[J].中国中医骨伤科杂志,2008(5)16：10-12.
[25]谷华,孙丽斌,于畅,李海存.红外热图温度与肿瘤中医证型的关系[J].临床军医杂志,2009,(3)37：389-390.
[26]张世亮,张蕴慧,庄欣.红外成像技术对不同证型高血压患者面部温度的研究[J].山东中医药大学学报,(5)24：359-360.
[27]王伟钢,王微,符思.旭痹病变关节的红外线热图象改变[J].北京中医药大学学报,1997,(3)20：62-63.
[28]杜少辉,付友金,陈肖君,吕旭升,金梅.远红外线热层析系统对老年中医诊断的运用[J].中医药通报(4)7：26-28.
[29]杜昌华,王伏峰.红外热像技术在儿童哮喘分型中的应用[J].中国中西医结合杂志,1998,18(12)：755.
[30]陈振相.红外热象仪在中医学中的应用[J].上海医学影像,1994,24(3)：35-37.
[31]李小梅,李续娥等.采用红外热扫描成像系统进行复方寒凉中药热效应的研究[J].激光生物学报,2006,15(5)：516-519.
[32]李小梅,黄雪群等.采用红外热扫描成像系统研究归胃经寒性中药对胃热证大鼠的热效应[J].激光生物学报,2007,16(2)：180-185.
[33]朱明,李宇航.关于中药寒热药性试验的红外成像观测[J].中国体视学与图像分析,2007,12(1)：53-58.
[34]袁永明,陈晓等.寒证热证大鼠模型的红外热图研究[J].辽宁中医杂志,2008,35(5)：785-787.
[35]张栋,付卫星.动物实验中红外热成象方法的使用[J].红外技术,1997,19(1)：45-48.
[36]杨文涛,马学强.红外热像技术对中西医结合治疗大鼠肢体缺血模型疗效的观察[J].山东中医药大学学报,2000,24(3)：232-234.
[37]吕维柏.艾滋病中西医防治学[M].北京：人民卫生出版社,1994.144.
[38]苏诚练.中医试治艾滋病30例临床报告[J].中医药学报,1991,19(2)：31.
[39]王宝祥.中医药抗艾滋病的临床研究[J].空军军医高专学报,1998,20(1)：54-56.
[40]王振坤.艾滋病的中医辨证治疗[J].中医杂志,1995,36(4)：208.
[41]尤松鑫.艾滋病中医证治概述[J].江苏中医,1999,20(3)：4.
[42]杨凤珍.HIV/AIDS中医分期辨证治疗[J].中国医学报,2004,19(4)：240-242.
[43]谢世平,侯明杰.艾滋病中医基本证候专家问卷调查分析[J].中国中医基础医学杂志,2009,15(1)：56-58.
[44]黄剑雄,李峰,倪量.国内艾滋病中医文献的证候研究评价.辽宁中医杂志,2009,36(1)：1-3.
[45]谢世平,潘万旗,梁慕华.艾滋病中医基本证型的相关文献分析[J].河南中医学院学报,2006,22(1)：6.
[46]杨凤珍,王健等.72例HIV/AIDS患者中医证候与T淋巴细胞亚群和病毒载量相关性研究[J].中国医药学报,2004,19(12)：733-736.
[47]邱红,谢世平.HIV/AIDS患者274例中医证候流行病学分布[J].郑州大学学报(医学版),2007,42(2)：363-364.
[48]朱菲菲,符林春等.90例艾滋病发热患者温病学证候特点分析[J].广州中医药 大学学报,2008,25(2)：161-164.
[49]刘志斌,杨冀平等.210例HIV感染者/AIDS患者中医四诊信息分布特点[J].Chinese General Practice,2010,13(6):1810-1812.
[50]张国梁,徐经凤等.473例艾滋病毒感染者和艾滋病患者中医临床症状和证候分布规律初探[J].安徽中医学院学报,2009,28(5)：21-22.
[51]胡建华,李秀惠等.100例艾滋病患者中医辨证分型研究[J].北京中医,2007,26(2)：97-98.
[52]黄剑雄,李峰.170例静脉吸毒HIV感染者/AIDS患者中医证候研究[J].中国中医药信息杂志,2009,16(1)29-30.
[53]李洪娟,李峰等.158例HIV/AIDS感染者常见中医症状和证候分析[J].北京中医药大学学报,2005,28(1)：69-72.
[54]陈建设,谢世平,许前磊,等.艾滋病常见实证量化诊断的Logistic回归分析[J].中医杂志,2009,50(7)：632-645.
[55]谢世平,陈建设等.HIV/AIDS证候分型及量化诊断的结构方程模型分析[J].中国中医基础医学杂志,2010,16(7)：577-579.
[56]杨永利,施学忠等.因子分析在艾滋病中医证候研究中的应用[J].中国卫生统计,2007,24(5)：480-482.
[57]艾滋病和艾滋病病毒感染诊断标准及处理原则.卫生部,2008.
[58]中华中医药学会.中医体质分类与判定.中国中医药出版社.2008,1-7.
[59]杨凤珍,王健,烟建华.《难经》命门元气三焦理论在HIV/AIDS中应用初探[J].中国中医基础医学杂志,2003,9(8)：4-5.
[60]薛伯寿.从中医理论谈对艾滋病的认识[J].中医杂志,1991,32(1)：20.