HIV/AIDS患者与平和质人群脏腑热态差异的研究
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摘要
研究目的
人体体表热态能反应内在脏腑功能。本研究选择251例HIV/AIDS患者及118例平和体质人群,利用红外热像检测设备,采集HIV/AIDS患者三个不同阶段的人体脏腑经络热图,与平和质人群的热图参数比较,观察HIV/AIDS患者与平和质人群脏腑经络的热态差异及HIV/AIDS人群不同阶段的脏腑经络的热态变化趋势,以期获得HIV/AIDS人群的脏腑经络热态特征,以推断其脏腑功能的改变。
研究方法
本研究为前瞻性临床研究。2008—2009年在北京地坛医院和佑安医院,收集已确诊的HIV/AIDS患者三次不同治疗阶段的红外热像；平和质人群来源于正常体检人群,中医体质量表评价为平和质,现代医学检查各项指标均在正常值范围内,在2008-2009年陆续进行红外数据采集。采图的环境固定,且温度湿度有严格的控制。用SSPS13.0统计系统对HIV/AIDS患者和正常人群组进行相关统计分析,分析两组人群热态差异,同时对HIV/AIDS患者三个不同治疗阶段的热态数据进行统计,分析不同治疗阶段HIV/AIDS患者的热态变化趋势。最后对所获得的数据结论用中医理论进行对应性分析。
研究结果
1 HIV/AIDS患者与正常人群组相比热态变化统计结果：
1.1经穴：督任脉的热态结构中,HIV/AIDS患者与正常人群组督脉相比有显著性差异(p<0.01),热值数据显示HIV/AIDS患者均低于正常人群组。神阙无显著性差异。
1.2三焦：上中下三焦的热态结构中,HIV/AIDS患者与正常人群组热值相比,均有显著性差异(p<0.01),但是上焦热值数据显示HIV/AIDS患者高于正常人群组,而中下焦热值数据显示HIV/AIDS患者皆低于正常人群组。
1.3脏：肺的热态结构中,HIV/AIDS患者与正常人群组相比差异性显著(p<0.01),而且热值数据显示HIV/AIDS患者肺的热值高于正常人群组。心、脾的热态结构中,HIV/AIDS患者与正常人群组相比差异性不明显(p>0.05)。肝、肾、命门的热态结构中,HIV/AIDS患者与正常人群组相比差异性显著(p<0.01),而且热值数据显示HIV/AIDS患者这几组热值均低于正常人群组。
1.4腑：胃、小肠、膀胱、左右大肠等的热态结构中,HIV/AIDS患者与正常人群组热值相比皆有统计学意义(p<0.01),热值数据显示均低于正常人群组。
2. HIV/AIDS患者三个阶段的热态变化统计结果：
2.1经穴：督、任脉及神阙的热态结构中,阶段1与阶段2的热值相比有显著性差异(p<0.01),阶段1与阶段3的热值相比有差异(p<0.05),但是督任脉阶段2与阶段
3相比无统计学意义,而神阙阶段2与阶段3相比有差异(p<0.05)。
2.2三焦：上焦的热态结构中,阶段1、2与阶段3的热值相比皆有显著性差异(p<0.01)；中焦的热态结构中,三个阶段数据统计显示无显著差异；下焦的热态结构中,只有阶段1与阶段2相比热值有统计学意义(p<0.05)。
2.3脏：肺的热态结构中,只有阶段1、2与阶段3相比有显著差异(p<0.01),三次热值相比,阶段3最低；心的热态结构中,三个阶段两两相比皆有统计学意义(p<0.01),三个阶段心的热值依次降低；肝的热态结构中,三个阶段热值无统计学意义；脾的热态结构中,阶段1、2与阶段3相比有差异(p<0.05),三次热值相比,阶段3最低；肾、命门的热态结构中,阶段1与阶段2、3相比皆有显著性差异(p<0.01),三个阶段肾、命门的热值皆为依次降低。
2.4腑：胃、膀胱的热态结构中,三个阶段热值无统计学意义；小肠的热态结构中,阶段1与阶段2、3相比具有显著性差异(p<0.05),阶段1热值最高；左右大肠的热态结构中,皆只有阶段2与阶段3相比有显著差异(p<0.05),三个阶段中皆为阶段3热值最高。
研究结论
1 HIV/AIDS患者总体热值(包括督任脉、中下焦、肝、肾、命门、胃、小肠、膀胱、左右大肠)低于正常人群组热值；神阙的热值无明显差异；但是上焦、肺的热值HIV/AIDS患者反而高于正常人群组。这几点初步提示了HIV/AIDS患者与正常人群组全身热态结构的差异,相较于正常人群组来说,HIV/AIDS患者的热值更低一点。说明HIV/AIDS患者的正气已经明显低于正常人群,而三焦的通行元气和运行水液的功能亦受到一定的影响,上焦所主的气的升发和宣散的功能受到阻碍,以致郁而生热。而由于气机的升降失常则中焦的消化吸收并输布水谷精微的功能和下焦的排泄糟粕和尿液的功能亦受累及。由于脏的热值已经明显低于正常人热值,提示病人可有脏的化生和贮藏精气的功能有一定的下降。而病人的腑的热值亦明显低于正常人热值,提示病人可有腑的受盛和传化水谷(包括水谷精微和糟粕)的功能的降低。
2.纵断面参数统计结果初步提示了HIV/AIDS患者不同治疗阶段身体的热态变化趋势,督任脉、神阙及下焦的热值第一次的热值最高,第二次最低。上焦、肺、心、肾、命门、小肠的热值变化趋势为三次依次降低。中焦、肝、胃、膀胱的热值无明显差异。左右大肠皆为第三次最高。脾的热值为第三次最小。由HIV/AIDS患者三次督任脉及神阙的热值看来,HIV/AIDS患者的正气有下降后上升的趋势。而上焦、肺、心、肾、命门的热值依次降低可提示：其脏化生和贮藏精微的功能有所下降；小肠的热值后两次与第一次相比有明显降低,说明小肠泌别清浊的功能有所下降。而肝的功能变化亦不明显；腑中胃、膀胱的热值无明显差异可提示胃的受盛功能、膀胱的贮存和排泄尿液的功能暂不受影响。大肠的功能也有异常变化,提示大肠有湿热积滞,而且第三次时最为严重。脾的热值第三次有明显降低,表明其运化、升清、统血功能亦有所受损。
Objective
The thermal state of the surface of human body do react the internal organs function. This study selected 251 cases of AIDS and 118 people of the constitution with balanced yin and yang, using infrared imaging test equipment, acquisition of the thermography of AIDS treatment in patients with three different stages of human organs and meridians, and compared with the thermography of cases of the constitution with balanced yin and yang, to observe the thermal differences between the cases of AIDS and people of the constitution with balanced yin and yang whose zang and fu organs and meridians, and AIDS groups in different stages of treatment of the organs and meridians of the hot trends, in order to obtain HIV-infected people in the zang and fu organs and meridians thermal characteristics.
Methods
This study is a prospective clinical study. From 2008 to 2009, we have collected infrared thermal imaging of 3 stages of AIDS patients who have been diagnosed in Beijing Ditan Hospital and You'an Hospital; People of the constitution with balanced yin and yang who are coming from a normal physical examination, and who have the constitution with balanced yin and yang evaluated by the constitution scale of TCM and without any diseases, and with the infrared thermal imaging in the phase of 2008-2009. The environment of collecting thermograph is constant, and the temperature and the humidity are strictly controlled.Then discuss the experimental data and analyze the experimental results.
Results
1. The differences of thermal states between AIDS patients and people of the constitution with balanced yin and yang:
1.1 There are significant differences between AIDS patients and people of the constitution with balanced yin and yang on governor vessels and conception vessels (p<0.01);and the calorific value of AIDS patients below that of people of the constitution with balanced yin and yang. No significant difference exists between the two groups' calorific values of shen que.
1.2 There are significant differences between AIDS patients and people of the constitution with balanced yin and yang on the calorific value of the triple energizer (p<0.01).The calorific value of the upper energizer of AIDS patients is higher than that of people of the constitution with balanced yin and yang. While the calorific value of the other two energizers is lower.
1.3 Significant differences exist between AIDS patients and people of the constitution with balanced yin and yang of the calorific values of the Lungs、the Liver、the Kidney、the Lifegate (p<0.01).And the calorific value of the Lungs of the AIDS patients is higher.While the calorific values of the Liver, the Kidney, the Lifegate of the AIDS patients are lower than people of the constitution with balanced yin and yang(p<0.01).There is no significant difference between the two groups' calorific values of the Heart and the Spleen(p>0.05).
1.4 There is significant difference between the two groups' calorific values of the stomach、the small intestine、the bladder and the large intestine (p<0.01).And the calorific value of AIDS patients is lower.
2 The differences of thermal states about AIDS patients with 3 different stages:
2.1 About the calorific values of governor vessels、conception vessels and shenque, there are differences between every two stages except stage 2 and stage 3 (p<0.05).
2.2 There are significant differences between stage 1 and stage 3 about the calorific values of the upper energizers, and so be between stage 2 and stage 3 (p<0.01). There is no significant difference between every two stages about the middle energizers and the lower energizers except between stagel and stage 2 of the lower energizer (p<0.05).
2.3 There are significant differences between every 2 stages about the calorific values of the Lung except between stage 1 and stage 3 (p<0.01).There are significant differences between every 2 stages about the calorific values of the Heart and the calorific value is getting lower and lower every time (p<0.01).There is no significant difference between every two stages about the calorific values of the Liver. The change status of the Spleen is the same with the Lung.The Kidney is the same situation with the Life-gate whose calorific value is getting lower and lower among three stages.And there is significant differences between stage land stage 2 and between stage 1 and stage 3 (p<0.01).
2.4 There is no significant difference between every two stages about the calorific values of the stomach and the bladder.Compare with stage 1, the calorific value of the small intestine is very different from stage 2 and stage 3 (p<0.05).The calorific values of the Large intestine is different between stages 2 and stage 3, and it's the highest of the third stage.
Conclusion
1 The thermal status of AIDS patients is lower than normal group (including the governor vessel and conception vessel、the middle energizer and the lower energizer、the Liver、the Kidney、the Life gate、the stomach、the small intestine、the bladder、the left and the right large intestine). There is no significant difference between the two groups about the calorific value of the shenque. While the calorific value of the upper energizer and the Lung is higher than the normal group.This suggests the differences between AIDS group and the normal group on body thermal structure.Compared with normal group, the AIDS group has a lower calorific value.This illustrates that the healthy qi of AIDS patients is significantly lower than normal group, while the functions of transmitting yuan-qi and transporting water of the triple energizer are affected to some extent, the function of ascending and distributing qi of the upper energizer has been hampered which generating heat. And the function of absorbing and distributing food nutrients of the middle energizer and the functions of excreting faeces and urine of the lower energizer is involved apparently because of the disorder movements of qi.As the calorific value of zang-organs is much lower than normal group, it suggests that the functions of storing and generating essence of zang-organs of patients have declined. The calorific value of the patient's fu-organs is also much lower than normal group, it suggests that the functions of receiving and transporting food nutrients and dregs of fu-organs of AIDS patients have lowed.
2 The statistical results of longitudinal parameters preliminarily suggest that the thermal state of the AIDS group in different stages, That is to say, the calorific value of the governor vessel and conception vessel、shenque and the lower energizer is the highest at stage 1, and the lowest at stage 2. The calorific value of the upper energizer. the Lung、the Heart、the Kidney、the Life-gate and the small intestine lower for the 3 stages. There is no significant difference among the calorific values of the middle energizer. the Liver、the stomach、the bladder of the 3 stages.The calorific value of the large intestine is the highest at stage 3. While the calorific value of the Spleen is the lowest at stage 3.From the calorific values of the governor vessel and conception vessel and shenque of AIDS groups, it seems that healthy qi of AIDS groups has a downward trend after rising. While the trend of lowering of the calorific value about the upper energizer. the Lung、the Heart、the Kidney、the Life-gate suggests that the functions ofgenerating and storing essence of zang-organs have lowed to some extent; Compare to stage 1, the calorific value of the small intestine is lower significantly which suggests that the function of separating the lucid from the turbid have descended to some extent.However, the function of the Liver has no significantly changed;the calorific value of the stomach and bladder of fu-organs have no significant differences that may suggest the functions of receiving and storing of the stomach and excreting urine of the bladder may not be affected. The function of the large intestine also has abnormal changes which suggests the large intestine has a stagnant of humid and heat, and it is the most serious at the stage 3.The calorific value of the spleen decreases significantly at the stage 3, which shows that the function of transportation and elevating lucid、commanding blood has also been damaged to some extent.
人体体表热态能反应内在脏腑功能。本研究选择251例HIV/AIDS患者及118例平和体质人群,利用红外热像检测设备,采集HIV/AIDS患者三个不同阶段的人体脏腑经络热图,与平和质人群的热图参数比较,观察HIV/AIDS患者与平和质人群脏腑经络的热态差异及HIV/AIDS人群不同阶段的脏腑经络的热态变化趋势,以期获得HIV/AIDS人群的脏腑经络热态特征,以推断其脏腑功能的改变。
研究方法
本研究为前瞻性临床研究。2008—2009年在北京地坛医院和佑安医院,收集已确诊的HIV/AIDS患者三次不同治疗阶段的红外热像；平和质人群来源于正常体检人群,中医体质量表评价为平和质,现代医学检查各项指标均在正常值范围内,在2008-2009年陆续进行红外数据采集。采图的环境固定,且温度湿度有严格的控制。用SSPS13.0统计系统对HIV/AIDS患者和正常人群组进行相关统计分析,分析两组人群热态差异,同时对HIV/AIDS患者三个不同治疗阶段的热态数据进行统计,分析不同治疗阶段HIV/AIDS患者的热态变化趋势。最后对所获得的数据结论用中医理论进行对应性分析。
研究结果
1 HIV/AIDS患者与正常人群组相比热态变化统计结果：
1.1经穴：督任脉的热态结构中,HIV/AIDS患者与正常人群组督脉相比有显著性差异(p<0.01),热值数据显示HIV/AIDS患者均低于正常人群组。神阙无显著性差异。
1.2三焦：上中下三焦的热态结构中,HIV/AIDS患者与正常人群组热值相比,均有显著性差异(p<0.01),但是上焦热值数据显示HIV/AIDS患者高于正常人群组,而中下焦热值数据显示HIV/AIDS患者皆低于正常人群组。
1.3脏：肺的热态结构中,HIV/AIDS患者与正常人群组相比差异性显著(p<0.01),而且热值数据显示HIV/AIDS患者肺的热值高于正常人群组。心、脾的热态结构中,HIV/AIDS患者与正常人群组相比差异性不明显(p>0.05)。肝、肾、命门的热态结构中,HIV/AIDS患者与正常人群组相比差异性显著(p<0.01),而且热值数据显示HIV/AIDS患者这几组热值均低于正常人群组。
1.4腑：胃、小肠、膀胱、左右大肠等的热态结构中,HIV/AIDS患者与正常人群组热值相比皆有统计学意义(p<0.01),热值数据显示均低于正常人群组。
2. HIV/AIDS患者三个阶段的热态变化统计结果：
2.1经穴：督、任脉及神阙的热态结构中,阶段1与阶段2的热值相比有显著性差异(p<0.01),阶段1与阶段3的热值相比有差异(p<0.05),但是督任脉阶段2与阶段
3相比无统计学意义,而神阙阶段2与阶段3相比有差异(p<0.05)。
2.2三焦：上焦的热态结构中,阶段1、2与阶段3的热值相比皆有显著性差异(p<0.01)；中焦的热态结构中,三个阶段数据统计显示无显著差异；下焦的热态结构中,只有阶段1与阶段2相比热值有统计学意义(p<0.05)。
2.3脏：肺的热态结构中,只有阶段1、2与阶段3相比有显著差异(p<0.01),三次热值相比,阶段3最低；心的热态结构中,三个阶段两两相比皆有统计学意义(p<0.01),三个阶段心的热值依次降低；肝的热态结构中,三个阶段热值无统计学意义；脾的热态结构中,阶段1、2与阶段3相比有差异(p<0.05),三次热值相比,阶段3最低；肾、命门的热态结构中,阶段1与阶段2、3相比皆有显著性差异(p<0.01),三个阶段肾、命门的热值皆为依次降低。
2.4腑：胃、膀胱的热态结构中,三个阶段热值无统计学意义；小肠的热态结构中,阶段1与阶段2、3相比具有显著性差异(p<0.05),阶段1热值最高；左右大肠的热态结构中,皆只有阶段2与阶段3相比有显著差异(p<0.05),三个阶段中皆为阶段3热值最高。
研究结论
1 HIV/AIDS患者总体热值(包括督任脉、中下焦、肝、肾、命门、胃、小肠、膀胱、左右大肠)低于正常人群组热值；神阙的热值无明显差异；但是上焦、肺的热值HIV/AIDS患者反而高于正常人群组。这几点初步提示了HIV/AIDS患者与正常人群组全身热态结构的差异,相较于正常人群组来说,HIV/AIDS患者的热值更低一点。说明HIV/AIDS患者的正气已经明显低于正常人群,而三焦的通行元气和运行水液的功能亦受到一定的影响,上焦所主的气的升发和宣散的功能受到阻碍,以致郁而生热。而由于气机的升降失常则中焦的消化吸收并输布水谷精微的功能和下焦的排泄糟粕和尿液的功能亦受累及。由于脏的热值已经明显低于正常人热值,提示病人可有脏的化生和贮藏精气的功能有一定的下降。而病人的腑的热值亦明显低于正常人热值,提示病人可有腑的受盛和传化水谷(包括水谷精微和糟粕)的功能的降低。
2.纵断面参数统计结果初步提示了HIV/AIDS患者不同治疗阶段身体的热态变化趋势,督任脉、神阙及下焦的热值第一次的热值最高,第二次最低。上焦、肺、心、肾、命门、小肠的热值变化趋势为三次依次降低。中焦、肝、胃、膀胱的热值无明显差异。左右大肠皆为第三次最高。脾的热值为第三次最小。由HIV/AIDS患者三次督任脉及神阙的热值看来,HIV/AIDS患者的正气有下降后上升的趋势。而上焦、肺、心、肾、命门的热值依次降低可提示：其脏化生和贮藏精微的功能有所下降；小肠的热值后两次与第一次相比有明显降低,说明小肠泌别清浊的功能有所下降。而肝的功能变化亦不明显；腑中胃、膀胱的热值无明显差异可提示胃的受盛功能、膀胱的贮存和排泄尿液的功能暂不受影响。大肠的功能也有异常变化,提示大肠有湿热积滞,而且第三次时最为严重。脾的热值第三次有明显降低,表明其运化、升清、统血功能亦有所受损。
Objective
The thermal state of the surface of human body do react the internal organs function. This study selected 251 cases of AIDS and 118 people of the constitution with balanced yin and yang, using infrared imaging test equipment, acquisition of the thermography of AIDS treatment in patients with three different stages of human organs and meridians, and compared with the thermography of cases of the constitution with balanced yin and yang, to observe the thermal differences between the cases of AIDS and people of the constitution with balanced yin and yang whose zang and fu organs and meridians, and AIDS groups in different stages of treatment of the organs and meridians of the hot trends, in order to obtain HIV-infected people in the zang and fu organs and meridians thermal characteristics.
Methods
This study is a prospective clinical study. From 2008 to 2009, we have collected infrared thermal imaging of 3 stages of AIDS patients who have been diagnosed in Beijing Ditan Hospital and You'an Hospital; People of the constitution with balanced yin and yang who are coming from a normal physical examination, and who have the constitution with balanced yin and yang evaluated by the constitution scale of TCM and without any diseases, and with the infrared thermal imaging in the phase of 2008-2009. The environment of collecting thermograph is constant, and the temperature and the humidity are strictly controlled.Then discuss the experimental data and analyze the experimental results.
Results
1. The differences of thermal states between AIDS patients and people of the constitution with balanced yin and yang:
1.1 There are significant differences between AIDS patients and people of the constitution with balanced yin and yang on governor vessels and conception vessels (p<0.01);and the calorific value of AIDS patients below that of people of the constitution with balanced yin and yang. No significant difference exists between the two groups' calorific values of shen que.
1.2 There are significant differences between AIDS patients and people of the constitution with balanced yin and yang on the calorific value of the triple energizer (p<0.01).The calorific value of the upper energizer of AIDS patients is higher than that of people of the constitution with balanced yin and yang. While the calorific value of the other two energizers is lower.
1.3 Significant differences exist between AIDS patients and people of the constitution with balanced yin and yang of the calorific values of the Lungs、the Liver、the Kidney、the Lifegate (p<0.01).And the calorific value of the Lungs of the AIDS patients is higher.While the calorific values of the Liver, the Kidney, the Lifegate of the AIDS patients are lower than people of the constitution with balanced yin and yang(p<0.01).There is no significant difference between the two groups' calorific values of the Heart and the Spleen(p>0.05).
1.4 There is significant difference between the two groups' calorific values of the stomach、the small intestine、the bladder and the large intestine (p<0.01).And the calorific value of AIDS patients is lower.
2 The differences of thermal states about AIDS patients with 3 different stages:
2.1 About the calorific values of governor vessels、conception vessels and shenque, there are differences between every two stages except stage 2 and stage 3 (p<0.05).
2.2 There are significant differences between stage 1 and stage 3 about the calorific values of the upper energizers, and so be between stage 2 and stage 3 (p<0.01). There is no significant difference between every two stages about the middle energizers and the lower energizers except between stagel and stage 2 of the lower energizer (p<0.05).
2.3 There are significant differences between every 2 stages about the calorific values of the Lung except between stage 1 and stage 3 (p<0.01).There are significant differences between every 2 stages about the calorific values of the Heart and the calorific value is getting lower and lower every time (p<0.01).There is no significant difference between every two stages about the calorific values of the Liver. The change status of the Spleen is the same with the Lung.The Kidney is the same situation with the Life-gate whose calorific value is getting lower and lower among three stages.And there is significant differences between stage land stage 2 and between stage 1 and stage 3 (p<0.01).
2.4 There is no significant difference between every two stages about the calorific values of the stomach and the bladder.Compare with stage 1, the calorific value of the small intestine is very different from stage 2 and stage 3 (p<0.05).The calorific values of the Large intestine is different between stages 2 and stage 3, and it's the highest of the third stage.
Conclusion
1 The thermal status of AIDS patients is lower than normal group (including the governor vessel and conception vessel、the middle energizer and the lower energizer、the Liver、the Kidney、the Life gate、the stomach、the small intestine、the bladder、the left and the right large intestine). There is no significant difference between the two groups about the calorific value of the shenque. While the calorific value of the upper energizer and the Lung is higher than the normal group.This suggests the differences between AIDS group and the normal group on body thermal structure.Compared with normal group, the AIDS group has a lower calorific value.This illustrates that the healthy qi of AIDS patients is significantly lower than normal group, while the functions of transmitting yuan-qi and transporting water of the triple energizer are affected to some extent, the function of ascending and distributing qi of the upper energizer has been hampered which generating heat. And the function of absorbing and distributing food nutrients of the middle energizer and the functions of excreting faeces and urine of the lower energizer is involved apparently because of the disorder movements of qi.As the calorific value of zang-organs is much lower than normal group, it suggests that the functions of storing and generating essence of zang-organs of patients have declined. The calorific value of the patient's fu-organs is also much lower than normal group, it suggests that the functions of receiving and transporting food nutrients and dregs of fu-organs of AIDS patients have lowed.
2 The statistical results of longitudinal parameters preliminarily suggest that the thermal state of the AIDS group in different stages, That is to say, the calorific value of the governor vessel and conception vessel、shenque and the lower energizer is the highest at stage 1, and the lowest at stage 2. The calorific value of the upper energizer. the Lung、the Heart、the Kidney、the Life-gate and the small intestine lower for the 3 stages. There is no significant difference among the calorific values of the middle energizer. the Liver、the stomach、the bladder of the 3 stages.The calorific value of the large intestine is the highest at stage 3. While the calorific value of the Spleen is the lowest at stage 3.From the calorific values of the governor vessel and conception vessel and shenque of AIDS groups, it seems that healthy qi of AIDS groups has a downward trend after rising. While the trend of lowering of the calorific value about the upper energizer. the Lung、the Heart、the Kidney、the Life-gate suggests that the functions ofgenerating and storing essence of zang-organs have lowed to some extent; Compare to stage 1, the calorific value of the small intestine is lower significantly which suggests that the function of separating the lucid from the turbid have descended to some extent.However, the function of the Liver has no significantly changed;the calorific value of the stomach and bladder of fu-organs have no significant differences that may suggest the functions of receiving and storing of the stomach and excreting urine of the bladder may not be affected. The function of the large intestine also has abnormal changes which suggests the large intestine has a stagnant of humid and heat, and it is the most serious at the stage 3.The calorific value of the spleen decreases significantly at the stage 3, which shows that the function of transportation and elevating lucid、commanding blood has also been damaged to some extent.
引文
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