情志致病方式与伤脏规律研究
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摘要
目的:已有的情志病因研究提示情志致病常由一定的始发因素所引起;情志致病方式有单一情志致病和多情交织之不同;不同的情志与不同的病证相关;气血潜在不畅、个性特征与情志表达方式是情志致病的影响因素;情志伤脏以肝为主,肝气逆、肝气郁为肝失疏泄的始发证候。胃脘痛是典型情志病证之一,情志伤肝,肝失疏泄,胃失和降而致胃脘痛,是情志与胃脘痛发病的已有认识。选择胃脘痛为切入点,对胃脘痛患者的情志病因的构成和相关的生活事件、症状表现、证候分布等进行分析,并进一步分析胃脘痛患者的怒特质及怒表达、调节方式,以期揭示情志与胃脘痛的更深层次的关系,丰富胃脘痛的病因研究和情志病因学说的内容,进一步探求情志致病规律,丰富情志学说,最终为情志病证的临床防治、心理干预提供理论指导。
方法:采用文献分析法与流行病学调查法。流行病学调查使用自编情志病因调查表与引进并经过初步修订的STAXI-2为调查与分析工具,采用横断面流行病学调查方法,对来自山东省中医院消化内科门诊的107例有明显情志诱因的胃脘痛患者进行问卷调查,主要调查内容包括一般情况、情志病因、相兼病因、社会事件、主要症状、中医诊断、损伤脏腑、西医诊断,并将相关数据进行频数分析、因子分析和聚类分析。为了解情志特质、表达方式与胃脘痛发病的关系,使用STAXI-2对107例胃脘痛患者和选取的107例正常人进行怒状态(state-anger)、易怒特质(trait-anger)、怒表达方式(anger-in/out;anger-expression/contrul)的判别,所得数据采用方差分析,同时比较不同证型之间的差异。
结果:女性,中老年人,脑力劳动者,受教育程度高者更容易因情志因素而引发胃脘痛;家庭关系失和、人际关系不和是胃脘痛发病的主要始发因素;与胃脘痛发病有关的单一情志以怒、思、忧等负性情志为主,怒是最主要的单一致病情志,且有发泄(愤怒)与抑制(郁怒)的不同,因子分析显示多种情志交织组合规律为思虑与恐惧交织、忧郁与悲伤交织,愤怒与郁怒相斥;情志因素可单独为病,也常与劳倦、饮食等致病因素相兼为病;情志病因不仅与功能性胃肠病的发病有关,与器质性胃肠病的发病也不容忽视;除胃脘痛外,其主要伴随症状为腹胀,嗳气,反酸,纳呆,烧心等局部症状,同时也伴有胁痛,头痛等肝经循行所过部位症状,对主要症状分别进行变量聚类和样本聚类进行证候分析,结果显示,两种聚类结果均可聚为两类,且症状显示的证候特点具有一致性,结合中医基础理论分别为肝气犯胃和肝胃气滞两种证候,分别与肝气逆和肝气郁相对应;脏腑损伤规律则显示肝为除胃外最主要损伤脏腑;胃脘痛患者在易怒特质和怒表达方式方面与正常人存在明显差异(P<0.01);而不同证型在怒特质、怒状态和表达方式方面存在一定的差异,呈现不同的特点。
结论:(1)性别、年龄、职业、受教育程度均为情志病因的影响因素,女性、中老年人、脑力劳动者、受教育程度高的人更容易因情志因素而引发胃脘痛。
(2)与胃脘痛发病有关的单一情志以怒、思、忧等负性情志为主,怒是最主要的单一致病情志,且有发泄(愤怒)与抑制(郁怒)的不同,多种情志交织致病时,呈现一定的规律性;情志因素可单独为病,也常与劳倦、饮食等致病因素相兼为病。
(3)情志伤肝,肝失疏泄,肝疏泄太过,出现肝气逆证,胃脘痛则表现为肝气犯胃;疏泄不及出现肝气郁证,胃脘痛则表现为肝胃气滞。为从肝论治胃脘痛的治疗原则提供了依据,并提示对于情志伤肝所致胃脘痛应区分肝气犯胃与肝胃气滞的不同而分别采用敛肝与疏肝之法分而治之。
(4)家庭关系失和、人际关系不和是胃脘痛发病的主要始发因素;胃脘痛患者具有高易怒特质的个性特征和压抑的怒表达方式。从而为胃脘痛的心理干预和治疗的具体环节提供了方向和依据。
(5)情志致病具有共同的规律。即肝是调节情志活动的核心,也是情志首伤之脏;情志伤肝,肝失疏泄,产生疏泄太过与疏泄不及两种始发证候,是情志病证诸证的基础;生活事件是情志致病的始发因素,而气血潜在不畅是情志致病的内在条件,个性特征是情志致病的重要影响因素。
Objective :It has been recognized that epigastralgiais caused by the liver injuried by emotions,the liver failing to maintain the normal flow of qi,stomach-qi being anable to descend normally.But pathogenic manners which are closely related to epigastralgia, and the pathogenic manners’origin, and their internal psychological mechanism are still unclear. The liver failing to maintain the normal flow of qi is divided into hyperactivity of liver-qi and deficency of liver-qi. The relevance of hyperactivity of liver-qi and deficency of liver-qi with specific syndrome of epigastralgia has not been systematically studied yet. Based on self-questionnaire of emotional etiology and Speilberger’s state-trait anger expression inventory 2 (STAXI-2)which was translated and revised preliminary, the emotional etiology, pathogenesis ,state-trait and expression of epigastralgia were systematically studied here in order to effectively prevent and treatepigastralgia.
Methods: Using questionnaire of emotional etiology and STAXI-2,107 cases of epigastralgiainduced by emotional factors were investigate in the Division of Gastroenterology, Internal Medicine Department of Shandong Province Hospital of Traditional Chinese Medicine, by cross-sectional epidemiological investigation methods. The main investigation included: the general situations, the cause of emotion, complicated causes, social events, the main symptoms, TCM diagnosis, viscera injury, Western diagnosis, ect. The data were analyzed by frequency analysis, factor analysis and cluster analysis. In order to make it clear of the relationship of emotional state expression and epigastralgia, 107 cases of normal people were selected to fill in STAXI-2, and their state-anger, trait-anger, anger expression (anger-in/out; anger-expression/contrul) were compared with 107 epigastralgia patients. The data from these two groups were analyzed by variance analysis. At the same time, the type differences were also compared.
Result : People in the classes of high level of education, mental work, middle-aged and elderly old, women were more attacked by emotional factors and led to epigastralgia than other classes. Estranged family relationships and estranged interpersonal relationships were the main origin factors ofepigastralgia. The related negative emotions, such as anger, too much thinking, worry, were main emotional causes of epigastralgia. epigastralgia could be induced by either single or intertwined emotional disorder. Factor analysis showed that the most frequent combinations of the emotional disorder include thought with fear, depression with sadness , anger-out and anger-in. Emotional disorder could induce disease by its own or combine with other factors, such as eating disorder, excess work, et al. Emotional disorders could cause both functional gastrointestinal disease and organic gastrointestinal diseases. The main symptoms were stomach pain, abdominal distention,eructation,acid regurgitation,loss of appetite and pyrosis. Other accompanied symptoms includes side chest pain, headache where the liver meridian runs by. When the main symptoms were analyzed by variable clustering and sample clustering, two categories of clustering results were revealed. Based on basic theory of traditional Chinese medicine, the symptoms were divided into liver-qi invasion and liver-qi depression, and the mostly involved organ injury is liver followed by stomach.
There were significant differences of angry trait and anger expression between epigastralgia patients and normal persons(P <0.01). Differences were also found in state-anger, trait-anger, anger expression in different types.
Conclsion: (1) Estranged family relationships and estranged interpersonal relationships were the main origin factors ofepigastralgia.
(2) The main negative emotions related to epigastralgiawere anger, stress thinking, and worry. Both single emotion disorder and intertwined emotions could cause epigastralgia. Emotional disorder could induce disease by its own or combine with other factors, such as eating disorder, excess work, et al.
(3)The liver injured by emotion ,the liver failing to maintain the normal flow of qi ,hyperactivity of liver-qi could lead to liver-qi invasion syndrome, expressed on pigastralgia was hyperactive liver-qi attacking the stomach.Deficency of liver-qi could cause liver-qi depression syndrome,expressed on epigastralgia was stagnation of liver-qi and stomach-qi. There were two different pathogenesis of epigastralgia caused by emotions, which were hyperactice liver-qi attacking the stomach and stagnation of liver-qi and stomach-qi.It pointed out that treatingepigastralgiafrom liver could be regarded as the principle of epigastralgia due to the liver injuried by emotions, and method of astring liver-qi and method of dispersing the stagnated liver-qi should be used to treat different type of the disease.
(4) Trait angry an inappropriate expression of angry were the psychological mechanisms ofepigastralgia.The results laid the foundation for psychological intervention to epigastralgia.
方法:采用文献分析法与流行病学调查法。流行病学调查使用自编情志病因调查表与引进并经过初步修订的STAXI-2为调查与分析工具,采用横断面流行病学调查方法,对来自山东省中医院消化内科门诊的107例有明显情志诱因的胃脘痛患者进行问卷调查,主要调查内容包括一般情况、情志病因、相兼病因、社会事件、主要症状、中医诊断、损伤脏腑、西医诊断,并将相关数据进行频数分析、因子分析和聚类分析。为了解情志特质、表达方式与胃脘痛发病的关系,使用STAXI-2对107例胃脘痛患者和选取的107例正常人进行怒状态(state-anger)、易怒特质(trait-anger)、怒表达方式(anger-in/out;anger-expression/contrul)的判别,所得数据采用方差分析,同时比较不同证型之间的差异。
结果:女性,中老年人,脑力劳动者,受教育程度高者更容易因情志因素而引发胃脘痛;家庭关系失和、人际关系不和是胃脘痛发病的主要始发因素;与胃脘痛发病有关的单一情志以怒、思、忧等负性情志为主,怒是最主要的单一致病情志,且有发泄(愤怒)与抑制(郁怒)的不同,因子分析显示多种情志交织组合规律为思虑与恐惧交织、忧郁与悲伤交织,愤怒与郁怒相斥;情志因素可单独为病,也常与劳倦、饮食等致病因素相兼为病;情志病因不仅与功能性胃肠病的发病有关,与器质性胃肠病的发病也不容忽视;除胃脘痛外,其主要伴随症状为腹胀,嗳气,反酸,纳呆,烧心等局部症状,同时也伴有胁痛,头痛等肝经循行所过部位症状,对主要症状分别进行变量聚类和样本聚类进行证候分析,结果显示,两种聚类结果均可聚为两类,且症状显示的证候特点具有一致性,结合中医基础理论分别为肝气犯胃和肝胃气滞两种证候,分别与肝气逆和肝气郁相对应;脏腑损伤规律则显示肝为除胃外最主要损伤脏腑;胃脘痛患者在易怒特质和怒表达方式方面与正常人存在明显差异(P<0.01);而不同证型在怒特质、怒状态和表达方式方面存在一定的差异,呈现不同的特点。
结论:(1)性别、年龄、职业、受教育程度均为情志病因的影响因素,女性、中老年人、脑力劳动者、受教育程度高的人更容易因情志因素而引发胃脘痛。
(2)与胃脘痛发病有关的单一情志以怒、思、忧等负性情志为主,怒是最主要的单一致病情志,且有发泄(愤怒)与抑制(郁怒)的不同,多种情志交织致病时,呈现一定的规律性;情志因素可单独为病,也常与劳倦、饮食等致病因素相兼为病。
(3)情志伤肝,肝失疏泄,肝疏泄太过,出现肝气逆证,胃脘痛则表现为肝气犯胃;疏泄不及出现肝气郁证,胃脘痛则表现为肝胃气滞。为从肝论治胃脘痛的治疗原则提供了依据,并提示对于情志伤肝所致胃脘痛应区分肝气犯胃与肝胃气滞的不同而分别采用敛肝与疏肝之法分而治之。
(4)家庭关系失和、人际关系不和是胃脘痛发病的主要始发因素;胃脘痛患者具有高易怒特质的个性特征和压抑的怒表达方式。从而为胃脘痛的心理干预和治疗的具体环节提供了方向和依据。
(5)情志致病具有共同的规律。即肝是调节情志活动的核心,也是情志首伤之脏;情志伤肝,肝失疏泄,产生疏泄太过与疏泄不及两种始发证候,是情志病证诸证的基础;生活事件是情志致病的始发因素,而气血潜在不畅是情志致病的内在条件,个性特征是情志致病的重要影响因素。
Objective :It has been recognized that epigastralgiais caused by the liver injuried by emotions,the liver failing to maintain the normal flow of qi,stomach-qi being anable to descend normally.But pathogenic manners which are closely related to epigastralgia, and the pathogenic manners’origin, and their internal psychological mechanism are still unclear. The liver failing to maintain the normal flow of qi is divided into hyperactivity of liver-qi and deficency of liver-qi. The relevance of hyperactivity of liver-qi and deficency of liver-qi with specific syndrome of epigastralgia has not been systematically studied yet. Based on self-questionnaire of emotional etiology and Speilberger’s state-trait anger expression inventory 2 (STAXI-2)which was translated and revised preliminary, the emotional etiology, pathogenesis ,state-trait and expression of epigastralgia were systematically studied here in order to effectively prevent and treatepigastralgia.
Methods: Using questionnaire of emotional etiology and STAXI-2,107 cases of epigastralgiainduced by emotional factors were investigate in the Division of Gastroenterology, Internal Medicine Department of Shandong Province Hospital of Traditional Chinese Medicine, by cross-sectional epidemiological investigation methods. The main investigation included: the general situations, the cause of emotion, complicated causes, social events, the main symptoms, TCM diagnosis, viscera injury, Western diagnosis, ect. The data were analyzed by frequency analysis, factor analysis and cluster analysis. In order to make it clear of the relationship of emotional state expression and epigastralgia, 107 cases of normal people were selected to fill in STAXI-2, and their state-anger, trait-anger, anger expression (anger-in/out; anger-expression/contrul) were compared with 107 epigastralgia patients. The data from these two groups were analyzed by variance analysis. At the same time, the type differences were also compared.
Result : People in the classes of high level of education, mental work, middle-aged and elderly old, women were more attacked by emotional factors and led to epigastralgia than other classes. Estranged family relationships and estranged interpersonal relationships were the main origin factors ofepigastralgia. The related negative emotions, such as anger, too much thinking, worry, were main emotional causes of epigastralgia. epigastralgia could be induced by either single or intertwined emotional disorder. Factor analysis showed that the most frequent combinations of the emotional disorder include thought with fear, depression with sadness , anger-out and anger-in. Emotional disorder could induce disease by its own or combine with other factors, such as eating disorder, excess work, et al. Emotional disorders could cause both functional gastrointestinal disease and organic gastrointestinal diseases. The main symptoms were stomach pain, abdominal distention,eructation,acid regurgitation,loss of appetite and pyrosis. Other accompanied symptoms includes side chest pain, headache where the liver meridian runs by. When the main symptoms were analyzed by variable clustering and sample clustering, two categories of clustering results were revealed. Based on basic theory of traditional Chinese medicine, the symptoms were divided into liver-qi invasion and liver-qi depression, and the mostly involved organ injury is liver followed by stomach.
There were significant differences of angry trait and anger expression between epigastralgia patients and normal persons(P <0.01). Differences were also found in state-anger, trait-anger, anger expression in different types.
Conclsion: (1) Estranged family relationships and estranged interpersonal relationships were the main origin factors ofepigastralgia.
(2) The main negative emotions related to epigastralgiawere anger, stress thinking, and worry. Both single emotion disorder and intertwined emotions could cause epigastralgia. Emotional disorder could induce disease by its own or combine with other factors, such as eating disorder, excess work, et al.
(3)The liver injured by emotion ,the liver failing to maintain the normal flow of qi ,hyperactivity of liver-qi could lead to liver-qi invasion syndrome, expressed on pigastralgia was hyperactive liver-qi attacking the stomach.Deficency of liver-qi could cause liver-qi depression syndrome,expressed on epigastralgia was stagnation of liver-qi and stomach-qi. There were two different pathogenesis of epigastralgia caused by emotions, which were hyperactice liver-qi attacking the stomach and stagnation of liver-qi and stomach-qi.It pointed out that treatingepigastralgiafrom liver could be regarded as the principle of epigastralgia due to the liver injuried by emotions, and method of astring liver-qi and method of dispersing the stagnated liver-qi should be used to treat different type of the disease.
(4) Trait angry an inappropriate expression of angry were the psychological mechanisms ofepigastralgia.The results laid the foundation for psychological intervention to epigastralgia.
引文
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