以血压及脉压特征辅助量化湿热体质调治效果的临床研究
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摘要
目的:目前中医对湿热体质界定主要依赖患者自述的症状表现和医生进行四诊。前者存在表现多样性及叙述主观性,后者亦存在表现复杂性和医生的经验及知识背景不同而造成的差异性,均有难以精确量化的缺陷。虽然已有研究人员进行了体质界定标准化、客观化研究,希冀用各种现代化检测方法给体质一个统一有效的“金标准”,但迄今为止收效甚微。而所涉及到的各种物理、生化、基因检测大都价格昂贵且费时费力,更限制了它们在临床的推广应用。这就使寻找一种临床切实可行且效果良好的体质界定方法成为当前中医体质研究的重中之重。
方法:通过传统文献梳理与现代文献分析相结合的方法探讨中医湿热体质相关理论的源流、内涵和外延;对98例湿热体质患者的血压及脉压的测量、统计,分析湿热体质患者者血压及脉压的特征,以及对其中36例湿热体质患者经过清热化湿,理气升阳法治疗二个疗程前后血压、脉压变化以及症状体征的变化进行观察。验证测量血压及脉压是否可以应用于对湿热体质的界定和对湿热体质调治效果的衡量。
结果:1.98例不同年龄段诊断为湿热体质的患者收缩压处于正常值下限水平(平均109.67±8.69mmHg),舒张压处于正常值水平上限(平均79.44±7.52mmHg),平均脉压处于正常值下限水平(30.33±5.21mmHg);
2.36湿热体质患者经过两个疗程治疗后,患者的湿热状态解除,而血压及脉压的变化要先于患者的主观症状描述。
结论:1.湿热体质患者普遍具有收缩压处于正常值下限、舒张压处于正常值上限而脉压处于正常值下限的特点;
2.经中药行清热化湿,理气升阳法调治后患者湿热体质好转,同时收缩压可上升并接近正常值的平均水平,舒张压下降接近正常值的平均水平而使脉压也接近正常平均值;
3.因此检测血压及脉压可作为界定湿热体质及衡量其调治效果的客观依据,具有准确、便捷的优势。
Objective: At present, it mainly deponds on two ways to define muggy in Traditional Chinese Medicine. The first way is that patients describe the symp tom by t he mselves. But thi s way is subjective. The second way is that doctors diagnose s y mptom through tongue diagnosis and pulse-taking. But for this way, the symptom perfor ma nce is complicated and due to differe nt doctors have different experience and knowledge, so the diagnosis is different. The two ways al l have the defect to get accurate quantification. Though r esearch about defi ning muggy standarly and objectively has been done, researchers hope to find an e ffe ctive standard to define muggy through mo dern testing methods. So far the effection is less. And the various physical, biological and genetic testing methods are expensive and ti me-consuming, and are more li mited for the c linical application.So it is the most i mportant to find a practicable and effective method to define muggy for clinical application of Traditional Chinese Medicine.
Method: Research the origin, connotation and extension of therories which are related to muggy in Traditional Chinese Medicine through reviewing the traditional and mo dern literature. Measure and record blood pressure and pp for 98 muggy patients. And 36 muggy patients were treated for two courses of treatment t hrough Traditional Chinese Medicine. Then observe differ ence of blood pressure, pp and s y mptom before treat ment a nd after t reatment. Prove if measur ing blood presure and pp ca n be appl ied to define muggy and measure the effection for adjusting muggy.
Result:1.For the 98 muggy patients whose age groups were different, their SBP was in normal lower limit (average 109.67±8.69mmHg) , DBP was in nor mal upper limit (average 79.44±7.52mmHg) and pp was in norma l lower limit (average 30.33±5.21mmHg).
2.For the 36 muggy patients, their muggy si tuation was relieved after two courses of treat ment. And the change of blood pressure and pp happened before subjective sy mptom description of pa tients.
Conclution: 1. SBP of muggy patients was in normal lower limits, DBP of muggy patients was in nor mal uppe r limits, and PP of muggy patients was in the lower limits of nor mal. 2. Muggy patients have improvement after Traditional Chinese Medicine treatment. At the sa me ti me, their SBP and PP all reach the average normal value.
3. So it is an objective reference to exa m blood pressure and PP for defi ning mu ggy and measuring treatment effection, which is accurate and convenient.
方法:通过传统文献梳理与现代文献分析相结合的方法探讨中医湿热体质相关理论的源流、内涵和外延;对98例湿热体质患者的血压及脉压的测量、统计,分析湿热体质患者者血压及脉压的特征,以及对其中36例湿热体质患者经过清热化湿,理气升阳法治疗二个疗程前后血压、脉压变化以及症状体征的变化进行观察。验证测量血压及脉压是否可以应用于对湿热体质的界定和对湿热体质调治效果的衡量。
结果:1.98例不同年龄段诊断为湿热体质的患者收缩压处于正常值下限水平(平均109.67±8.69mmHg),舒张压处于正常值水平上限(平均79.44±7.52mmHg),平均脉压处于正常值下限水平(30.33±5.21mmHg);
2.36湿热体质患者经过两个疗程治疗后,患者的湿热状态解除,而血压及脉压的变化要先于患者的主观症状描述。
结论:1.湿热体质患者普遍具有收缩压处于正常值下限、舒张压处于正常值上限而脉压处于正常值下限的特点;
2.经中药行清热化湿,理气升阳法调治后患者湿热体质好转,同时收缩压可上升并接近正常值的平均水平,舒张压下降接近正常值的平均水平而使脉压也接近正常平均值;
3.因此检测血压及脉压可作为界定湿热体质及衡量其调治效果的客观依据,具有准确、便捷的优势。
Objective: At present, it mainly deponds on two ways to define muggy in Traditional Chinese Medicine. The first way is that patients describe the symp tom by t he mselves. But thi s way is subjective. The second way is that doctors diagnose s y mptom through tongue diagnosis and pulse-taking. But for this way, the symptom perfor ma nce is complicated and due to differe nt doctors have different experience and knowledge, so the diagnosis is different. The two ways al l have the defect to get accurate quantification. Though r esearch about defi ning muggy standarly and objectively has been done, researchers hope to find an e ffe ctive standard to define muggy through mo dern testing methods. So far the effection is less. And the various physical, biological and genetic testing methods are expensive and ti me-consuming, and are more li mited for the c linical application.So it is the most i mportant to find a practicable and effective method to define muggy for clinical application of Traditional Chinese Medicine.
Method: Research the origin, connotation and extension of therories which are related to muggy in Traditional Chinese Medicine through reviewing the traditional and mo dern literature. Measure and record blood pressure and pp for 98 muggy patients. And 36 muggy patients were treated for two courses of treatment t hrough Traditional Chinese Medicine. Then observe differ ence of blood pressure, pp and s y mptom before treat ment a nd after t reatment. Prove if measur ing blood presure and pp ca n be appl ied to define muggy and measure the effection for adjusting muggy.
Result:1.For the 98 muggy patients whose age groups were different, their SBP was in normal lower limit (average 109.67±8.69mmHg) , DBP was in nor mal upper limit (average 79.44±7.52mmHg) and pp was in norma l lower limit (average 30.33±5.21mmHg).
2.For the 36 muggy patients, their muggy si tuation was relieved after two courses of treat ment. And the change of blood pressure and pp happened before subjective sy mptom description of pa tients.
Conclution: 1. SBP of muggy patients was in normal lower limits, DBP of muggy patients was in nor mal uppe r limits, and PP of muggy patients was in the lower limits of nor mal. 2. Muggy patients have improvement after Traditional Chinese Medicine treatment. At the sa me ti me, their SBP and PP all reach the average normal value.
3. So it is an objective reference to exa m blood pressure and PP for defi ning mu ggy and measuring treatment effection, which is accurate and convenient.
引文
[1]王琦.中医体质学[M],北京:中国医药科技出版社,2005.8:5
[2]廖岩,王琦.关于湿热体质研究的几个问题[J].2009,(3)41:3.
[3]王琦.中医体质学[M].北京:中国医药科技出版社,1995.1:5.
[4]王琦.中医体质学[M].北京:中国医药科技出版社,1995.296~299
[5]鲁明源.《内经》体质思想及应用.山东中医药大学[D].2001:39—41.
[6]金永日.对《金匮要略》中体质相关问题的认识[J].福建中医学院学报.2008(18)5:57-58
[7]清.叶天士.临证指南医案[M].上海:上海科学技术出版社,1959.265,362..
[8]王方,顾星.浅谈《伤寒论》与《温病条辨》体质思想之异同[J].中医药导报.2006(12)3:11-26
[9]陈辉,陶汉华.体质学说与仲景桂枝汤证[J].中医药学刊.2005(23)4:675
[10]王琦,盛增秀.中医体质学说[M].南京:江苏科技出版社.1982:115
[11]匡调元.中医体质病理学[M].上海:上海科学普及出版社.1996:88
[12]何裕民,王莉,等.体质的聚类研究[J].中国中医基础医学杂志.1996,2(5):7-9
[13]田代华.论体质与证候[J].山东中医学院学报.1983,7(1):6
[14]中医体质分类与判定[M].中国中医药出版社,2009,4
[15]鲁明源.《内经》体质思想及应用.山东中医药大学[D].2001:39—41
[16]李连成.湿阻的流行病学调查[J].中医杂志,1992,(6):44.
[17]李连成.湿阻的流行病学调查[J].中医杂志,1992,(6):44
[18]王彦晖.中医湿病学[J].北京:人民卫生出版社,1997:6。
[19]王前奔.论体质和证的关系[J].江苏中医.1992,6:18
[20]王琦.王琦医学论文集[M].北京:中国百科全书出版社.1994
[21]陈家旭.体质因素在中医诊断中的意义[J].甘肃中医学院学报.1996,3(1):1
[22]张庆祥.辩证论治与体质关系探讨.[J]山东中医药大学学报.2005,29(4)
[23]宋红普.体质分析与辨证论治[J].中医研究.1998,11(4):1
[24]李成平,史立人.辨证的本质是辨体质[J].福建中医药.1990,21(1):23-25
[25]PhilippeF,ChemalyE,BlatherJetal.Aorticpulsepressureandextentofcoronaryarterydiseaseinpercutaneoustiansluminalcoronaryangioplasty candidates. Am J Hypertens, 2002;15 (4: suppll):A126
[26] Nilcos A,John P, Lekakis CM et al.Pulse pressure in normotensive:A marker of cardiovascular disease Am J Hypertens, 2001; 14: 195一199
[27] Chemla D, Antony I,Hebert J et al. Increased aortic puls pressure associated with concentric left ventricular hypertrophy in arterial hypertension.Am Hypertens, 2002; 15(4):A164
[28] Boutouyrie P, Bussy C, Laoolley P et al. Association between local pulse pressure, mean blood pmssure and large-artery remolding. Circulation, 1999; 100: 1387—1393
[29]杨文.脉压差与年龄肥胖和糖尿病的关系[J].心肺血管病杂志,2003,22(2):97-98.
[30]宋天然.对知情同意书和知情同意过程的探讨[J].医学.2005,26(10):66—68
[31]杨志寅.临床执业医师手册[M].北京：中国医药科技出社.2003:621-624
[32]杨文.脉压差与年龄肥胖和糖尿病的关系[J].心肺血管病杂志,2003,22(2):97-98.
[33]张芸,曹中朝,鸿嘎鲁.脉压的临床应用及研究进展, Acta AcadMedNeiMongol 2007,(10), 29:5
[34]段留法,脉压及其临床意义.国外医学.老年医学分册,2003,（3）24：2
[35]王琦.中医体质学[M].北京:中国医药科技出版社.1995.11
[36]王睿林.人类基因组学及基因芯片与中医体质学[J].中医药学刊,2004,22(9): 1613一1614
[37] Franklin SS, Khan SA, Nathan D,et al. Pulse pressure useful in predicting risk for coronary heart disease?[J].The Framingham Heart Study Circulation, 1999: 100: 354一360
[38]王筠默.上海中医药杂志[J].1957,（9）：44
[39]阎应举.青医学报[J].1962,（1）：64
[40]朱思明.苏医学报（江苏中医学院）[J].1957,（3）：148
[41] Waud RA.J Pharmacol Exp ther,1940,69：309
[42]朱思明。苏医学报（江苏中医学院）[J].1957,（3）：148
[43]菊地健三等,日本药理学杂志[J].1960,56（6）：1373
[44]第一附属医药冠心病研究小组.中西医结合资料汇编（湖南医学院[J].1973：62.
[45]陈凌云,杨国祥.半夏药理研究概况[J].云南中医报,1997,20(4):17-19
[46]张宝恒.甘草药理作用研究的进展[J].药学学报,1963,10(11):68
[47]西安医学院药理教研组,西安医学院学报[J].1958,(2)：3
[48]唐汝愚.生理学报[J].1958,22（3）：249.
[49]王筠默.上海中医药学院论文汇编[J]。1959,（2）：3.
[50]唐汝愚.生理学报[J].1958,22（3）：249.
[51]陈敏珠,等.生理学报[J].1961,（3,4）：227.
[52]经利彬,等.国立北平研究院生理研究生中文报告会刊[J].1936,（4）：289.
[53]经利彬,等.国立北平研究院生理研究生中文报告会刊[J].1936,（4）：289.
[54]朱玲,杨峰,唐德才.枳实的药理研究进展[J].中医药学报,2004,32(2):65—66.
[55]平井爱山等.国外医学.中医中药分册[J].1984,（1）：53
[56]虞天锡等.上海中医药杂志[J].1985,（12）：3}
[57]王钡茂等.中国药理学通报[J].1986,2（5）：26
[2]廖岩,王琦.关于湿热体质研究的几个问题[J].2009,(3)41:3.
[3]王琦.中医体质学[M].北京:中国医药科技出版社,1995.1:5.
[4]王琦.中医体质学[M].北京:中国医药科技出版社,1995.296~299
[5]鲁明源.《内经》体质思想及应用.山东中医药大学[D].2001:39—41.
[6]金永日.对《金匮要略》中体质相关问题的认识[J].福建中医学院学报.2008(18)5:57-58
[7]清.叶天士.临证指南医案[M].上海:上海科学技术出版社,1959.265,362..
[8]王方,顾星.浅谈《伤寒论》与《温病条辨》体质思想之异同[J].中医药导报.2006(12)3:11-26
[9]陈辉,陶汉华.体质学说与仲景桂枝汤证[J].中医药学刊.2005(23)4:675
[10]王琦,盛增秀.中医体质学说[M].南京:江苏科技出版社.1982:115
[11]匡调元.中医体质病理学[M].上海:上海科学普及出版社.1996:88
[12]何裕民,王莉,等.体质的聚类研究[J].中国中医基础医学杂志.1996,2(5):7-9
[13]田代华.论体质与证候[J].山东中医学院学报.1983,7(1):6
[14]中医体质分类与判定[M].中国中医药出版社,2009,4
[15]鲁明源.《内经》体质思想及应用.山东中医药大学[D].2001:39—41
[16]李连成.湿阻的流行病学调查[J].中医杂志,1992,(6):44.
[17]李连成.湿阻的流行病学调查[J].中医杂志,1992,(6):44
[18]王彦晖.中医湿病学[J].北京:人民卫生出版社,1997:6。
[19]王前奔.论体质和证的关系[J].江苏中医.1992,6:18
[20]王琦.王琦医学论文集[M].北京:中国百科全书出版社.1994
[21]陈家旭.体质因素在中医诊断中的意义[J].甘肃中医学院学报.1996,3(1):1
[22]张庆祥.辩证论治与体质关系探讨.[J]山东中医药大学学报.2005,29(4)
[23]宋红普.体质分析与辨证论治[J].中医研究.1998,11(4):1
[24]李成平,史立人.辨证的本质是辨体质[J].福建中医药.1990,21(1):23-25
[25]PhilippeF,ChemalyE,BlatherJetal.Aorticpulsepressureandextentofcoronaryarterydiseaseinpercutaneoustiansluminalcoronaryangioplasty candidates. Am J Hypertens, 2002;15 (4: suppll):A126
[26] Nilcos A,John P, Lekakis CM et al.Pulse pressure in normotensive:A marker of cardiovascular disease Am J Hypertens, 2001; 14: 195一199
[27] Chemla D, Antony I,Hebert J et al. Increased aortic puls pressure associated with concentric left ventricular hypertrophy in arterial hypertension.Am Hypertens, 2002; 15(4):A164
[28] Boutouyrie P, Bussy C, Laoolley P et al. Association between local pulse pressure, mean blood pmssure and large-artery remolding. Circulation, 1999; 100: 1387—1393
[29]杨文.脉压差与年龄肥胖和糖尿病的关系[J].心肺血管病杂志,2003,22(2):97-98.
[30]宋天然.对知情同意书和知情同意过程的探讨[J].医学.2005,26(10):66—68
[31]杨志寅.临床执业医师手册[M].北京：中国医药科技出社.2003:621-624
[32]杨文.脉压差与年龄肥胖和糖尿病的关系[J].心肺血管病杂志,2003,22(2):97-98.
[33]张芸,曹中朝,鸿嘎鲁.脉压的临床应用及研究进展, Acta AcadMedNeiMongol 2007,(10), 29:5
[34]段留法,脉压及其临床意义.国外医学.老年医学分册,2003,（3）24：2
[35]王琦.中医体质学[M].北京:中国医药科技出版社.1995.11
[36]王睿林.人类基因组学及基因芯片与中医体质学[J].中医药学刊,2004,22(9): 1613一1614
[37] Franklin SS, Khan SA, Nathan D,et al. Pulse pressure useful in predicting risk for coronary heart disease?[J].The Framingham Heart Study Circulation, 1999: 100: 354一360
[38]王筠默.上海中医药杂志[J].1957,（9）：44
[39]阎应举.青医学报[J].1962,（1）：64
[40]朱思明.苏医学报（江苏中医学院）[J].1957,（3）：148
[41] Waud RA.J Pharmacol Exp ther,1940,69：309
[42]朱思明。苏医学报（江苏中医学院）[J].1957,（3）：148
[43]菊地健三等,日本药理学杂志[J].1960,56（6）：1373
[44]第一附属医药冠心病研究小组.中西医结合资料汇编（湖南医学院[J].1973：62.
[45]陈凌云,杨国祥.半夏药理研究概况[J].云南中医报,1997,20(4):17-19
[46]张宝恒.甘草药理作用研究的进展[J].药学学报,1963,10(11):68
[47]西安医学院药理教研组,西安医学院学报[J].1958,(2)：3
[48]唐汝愚.生理学报[J].1958,22（3）：249.
[49]王筠默.上海中医药学院论文汇编[J]。1959,（2）：3.
[50]唐汝愚.生理学报[J].1958,22（3）：249.
[51]陈敏珠,等.生理学报[J].1961,（3,4）：227.
[52]经利彬,等.国立北平研究院生理研究生中文报告会刊[J].1936,（4）：289.
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