【摘要】：目的口苦是中醫(yī)學(xué)理論體系中具有較大理論與臨床意義的癥狀。本課題以對口苦癥狀的流行病學(xué)調(diào)查為基礎(chǔ),并結(jié)合人體試驗(yàn)與文獻(xiàn)研究,就以下問題進(jìn)行研究。1,調(diào)查北京市4所三甲醫(yī)院14歲以上住院病人口苦癥狀的發(fā)生狀況、科室與疾病分布及影響口苦癥狀發(fā)生的相關(guān)因素,以明確與口苦癥狀關(guān)系密切的疾病因素及其他相關(guān)因素;2,調(diào)查全國14歲以上健康人群口苦癥狀的發(fā)生狀況以及導(dǎo)致口苦癥狀發(fā)生的相關(guān)因素,以明確口苦癥狀在健康人群的發(fā)生率,以及相關(guān)行為因素及體質(zhì)因素;3,通過人體試驗(yàn),研究健康成人不同個體對苦味主觀感受的個體差異,以及性別、吸煙兩個因素對苦味感受的影響;4,通過文獻(xiàn)學(xué)研究及中西醫(yī)理論體系的對比研究,系統(tǒng)整理歷代醫(yī)家對" 口苦"病機(jī)及治療的認(rèn)識,探討中西醫(yī)身體觀的差異,并以口苦為例,探討中西醫(yī)診療思維的差異。方法1,選取北京市4所三甲醫(yī)院,使用統(tǒng)一的流行病學(xué)調(diào)查表,對4所醫(yī)院符合納入標(biāo)準(zhǔn)的住院病人進(jìn)行流行病學(xué)調(diào)查。調(diào)查內(nèi)容主要包括個人基本信息,如性別、年齡、身高、體重、民族等;口苦癥狀的發(fā)生情況,包括發(fā)生頻率、程度、發(fā)生時間以及是否伴有其他味覺異常等;生活習(xí)慣,包括吸煙、飲酒、睡眠時間、飲食口味、膳食結(jié)構(gòu)等;癥狀學(xué)情況,如上腹部疼痛、反酸、口腔潰瘍、口臭,以及情緒相關(guān)癥狀;既往病史,主要包括牙科治療、腹部或中耳手術(shù)以及脂肪肝、膽囊炎、鼻炎、中耳炎、慢性咽炎等疾病;此外還有針對肝病及胃-食管疾病的輔助檢查項(xiàng)目。2,通過"問卷星"平臺在網(wǎng)絡(luò)上發(fā)布流行病學(xué)調(diào)查問卷,對全國14歲以上健康人群口苦癥狀發(fā)生狀況及其影響因素進(jìn)行流行病學(xué)調(diào)查。調(diào)查內(nèi)容主要包括個基本信息、口苦癥狀發(fā)生的狀況、生活習(xí)慣,同時引入中醫(yī)體質(zhì)學(xué)量表,對調(diào)查對象是否存在濕熱體質(zhì)或氣郁體質(zhì)進(jìn)行評估。所有數(shù)據(jù)使用EPidata3.1錄入后,使用SPSS20.0進(jìn)行統(tǒng)計(jì)學(xué)分析。3,選用苦丁茶作為苦味試劑,采用隨機(jī)、單盲、對照的臨床試驗(yàn)方法,將志愿者隨機(jī)編為3組,每組志愿者均分別接收不同濃度的苦丁茶浸出液,然后借鑒VAS法,由志愿者在"苦味標(biāo)度線"上標(biāo)記出剛剛接受測試液苦味程度。錄入數(shù)據(jù),采用t檢驗(yàn)或非參檢驗(yàn),分別按照性別和是否吸煙進(jìn)行統(tǒng)計(jì)分析。4,選擇9名健康志愿者,采用三向交叉拉丁方實(shí)驗(yàn)設(shè)計(jì),每位志愿者均接受三種不同濃度的苦丁茶浸出液,然后由志愿者在"苦味標(biāo)度線"上標(biāo)出剛剛接受測試液的苦味程度。通過拉丁方分析,研究苦味感受能力的個體差異。5,系統(tǒng)考察歷代中醫(yī)學(xué)文獻(xiàn),從醫(yī)學(xué)理論形成初期的社會文化背景及后期的醫(yī)學(xué)發(fā)展著手,對比研究中西醫(yī)理論體系,從身體觀角度入手,以口苦癥狀為例,探討中西醫(yī)兩個醫(yī)學(xué)體系診療思維的差異。結(jié)果1,對北京市4所三甲醫(yī)院住院病人的調(diào)查共調(diào)查病人782人,收集有效問卷766份,口苦癥狀發(fā)生率為53.79%。口苦癥狀的發(fā)生率與年齡層成正相關(guān)。住院病人口苦發(fā)生率最高的科室依次為肝病科(66.67%),消化科(61.80%),神經(jīng)內(nèi)科(60.66%)。在具體疾病方面,脂肪肝、膽囊炎、胃-食管疾病、慢性咽炎、牙科治療為口苦癥狀發(fā)生的危險(xiǎn)因素(OR值及相應(yīng)的95%CI均大于1),幽門螺桿菌感染是口苦的重要危險(xiǎn)因素,OR=2.463。癥狀方面,上腹部疼痛、噯氣、反酸、脅痛、口腔潰瘍、口臭、陰囊潮濕/帶下、頭痛、眩暈均為口苦癥狀發(fā)生的危險(xiǎn)因素(OR值及相應(yīng)的95%CI均大于1)。行為因素方面,吸煙是口苦癥狀發(fā)生的危險(xiǎn)因素,且隨日吸煙數(shù)的升高,口苦癥狀的發(fā)生率亦相應(yīng)升高。飲食上,食用過多肉類是口苦癥狀發(fā)生的危險(xiǎn)因素,而進(jìn)食新鮮蔬菜水果則是口苦癥狀發(fā)生的保護(hù)性因素。情緒方面,焦慮、煩躁、抑郁與自覺壓力均為口苦癥狀發(fā)生的危險(xiǎn)因素,且口苦癥狀發(fā)生率與不良情緒的程度成正相關(guān)。2,對全國健康人群的網(wǎng)絡(luò)調(diào)查共收集有效問卷715份,口苦癥狀發(fā)生率為43.92%�？诳喟Y狀的發(fā)生率與年齡層近似成正比。行為因素方面,口苦癥狀發(fā)生與吸煙密切相關(guān),進(jìn)食過多肉類為口苦癥狀發(fā)生的危險(xiǎn)因素,且口苦癥狀發(fā)生率與日常進(jìn)食肉類比例成正比;進(jìn)食新鮮水果蔬菜則是口苦癥狀發(fā)生的保護(hù)性因素。體質(zhì)方面,濕熱體質(zhì)與氣郁體質(zhì)均為口苦癥狀發(fā)生的危險(xiǎn)因素,濕熱體質(zhì)口苦癥狀的發(fā)生率高于氣郁體質(zhì),濕熱體質(zhì)與氣郁體質(zhì)的兼夾體質(zhì)口苦癥狀發(fā)生率高于非兼夾體質(zhì)。3,對健康人群苦味味覺感受度的研究發(fā)現(xiàn),女性對不同濃度苦味試液所感受到的苦味程度均高于男性,證明女性對苦味的感受能力比男性敏感;不吸煙人群對不同濃度苦味試液所感受到的苦味程度均高于吸煙人群,證明不吸煙人群對苦味的敏感性高于吸煙人群。對個體苦味感受能力的拉丁方研究則顯示,不同個體對苦味的感受能力存在個體差異。4,比較中西醫(yī)理論形成與發(fā)展的過程,認(rèn)為中醫(yī)學(xué)理論體系在形成初期,以術(shù)數(shù)理論為基本工具,在生成論的自然哲學(xué)下,借助陰陽五行等說理工具,對人體生命現(xiàn)象和疾病現(xiàn)象進(jìn)行的理論構(gòu)建。而現(xiàn)代西方醫(yī)學(xué),則是在文藝復(fù)興的背景下,以機(jī)械論的哲學(xué)思想,在現(xiàn)代理化突破及新的認(rèn)識工具等的基礎(chǔ)上,形成的一套新的醫(yī)學(xué)理論體系。結(jié)論1,北京市14歲以上住院病人口苦癥狀平均發(fā)生率為53.79%,我國14歲以上健康人群口苦癥狀平均發(fā)生率為43.92%。2,影響口苦癥狀發(fā)生的因素有很多。在疾病方面,口苦癥狀與消化系統(tǒng)疾病,如肝病、胃-食管疾病及神經(jīng)系統(tǒng)疾病的關(guān)系最為密切;行為方面,吸煙、進(jìn)食大量肉食及腌漬食品為口苦癥狀的危險(xiǎn)因素;進(jìn)食新鮮水果蔬菜則是其保護(hù)性因素;情緒方面,焦慮、煩躁、抑郁等不良情緒及過大的壓力是口苦癥狀發(fā)生的危險(xiǎn)因素;體質(zhì)上,濕熱體質(zhì)及氣郁體質(zhì)為口苦癥狀的高發(fā)體質(zhì)。3,不同個體對苦味的味覺感受能力有較大的差異,女性人群、不吸煙人群對苦味的敏感度高于男性、吸煙人群。4,中西醫(yī)對口苦癥狀診療意義的不同認(rèn)識,是由于中西醫(yī)截然不同的身體觀與疾病觀導(dǎo)致的,這也是中西醫(yī)理論難以通約的根本原因。
[Abstract]:The purpose of the invention is to have a large theoretical and clinically relevant symptom in the theoretical system of traditional Chinese medicine. This topic is based on the epidemiological investigation of bitter and bitter symptoms, and studies the following problems in combination with the human body test and the literature study. the related factors of the distribution of the department and the disease and the symptoms of the bitter oral and bitter symptoms, so as to identify the disease factors and other related factors which are closely related to the symptoms of the oral and bitter symptoms;2. To investigate the occurrence of the bitter symptoms of the healthy people over the age of 14 and the related factors leading to the occurrence of the bitter symptoms of the oral cavity, to determine the incidence of bitter symptoms in the healthy population, as well as related behavioral factors and physical factors; and 3, to study the individual differences of the subjective feelings of the bitter taste of different individuals in healthy adults and the influence of the two factors of sex and smoking on the bitter taste through the human body test; and 4, Through the study of the literature and the comparative study of the theoretical system of the traditional Chinese and western medicine, the system has finished the understanding of the pathogenesis and treatment of the "bitter taste" in the past dynasties, and probes into the difference of the traditional Chinese medicine and the western medicine, and takes the bitter taste as an example to study the difference of the thinking of the traditional Chinese medicine and the western medicine. Method 1,4 hospitals in Beijing were selected, and a unified epidemiological survey was used to conduct an epidemiological survey of 4 hospitals in accordance with the criteria for inclusion. The contents of the survey include basic personal information such as gender, age, height, body weight, ethnicity, etc. The occurrence of bitter symptoms, including frequency, degree, time of occurrence, and other taste abnormalities, including smoking, drinking, sleep time, Diet taste, dietary structure, etc. Symptoms, such as abdominal pain, anti-acid, oral ulceration, bad breath, and mood-related symptoms, including dental treatment, abdominal or middle ear surgery and fatty liver, cholecystitis, rhinitis, otitis media, chronic pharyngitis, etc.; In addition, there was an auxiliary examination project for liver disease and stomach-esophageal disease.2, an epidemiological survey was published on that network through the "questionnaire star" platform, and the epidemiological investigation was carried out on the incidence of the bitter symptoms and the influencing factors of the healthy population over the age of 14. The contents of the investigation mainly include basic information, the status and living habits of the bitter symptoms, and the introduction of the physical constitution of the Chinese medicine. All the data were recorded with EPidata3.1, and the statistical analysis was carried out using SPSS10.0.3. The bitt tea was used as the bitter agent, and the volunteers were randomly assigned to 3 groups by using a randomized, single-blind and controlled clinical trial method. Each group of volunteers received a different concentration of the Kudingcha extract. The degree of bitterness of the test solution just accepted was then marked on the "bitter-scale line" by the volunteers using the VAS method. the data is input, the t-test or the non-parametric test is adopted, the statistical analysis is carried out according to the sex and whether or not smoking is carried out respectively,4,9 healthy volunteers are selected, three-way cross-Latin square experimental design is adopted, and each volunteer is used for receiving three different concentrations of the Kudingcha leaching solution, The degree of bitterness of the test solution just accepted by the volunteers was then marked on the "bitter-scale line". Through the analysis of the Latin square, the individual difference of the bitter taste ability was studied.5. The systematic study of the literature of the traditional Chinese medicine, from the medical theory to the initial social and cultural background and the later medical development, compared the theoretical system of the traditional Chinese and western medicine, from the perspective of the body view, Taking the symptoms of bitter taste as an example, the differences of the treatment thinking of the two medical systems of the traditional Chinese medicine and the western medicine are discussed. As a result,782 of the patients in 3 hospitals in Beijing were investigated,766 cases of effective questionnaires were collected, and the incidence of bitter and bitter symptoms was 53.79%. The incidence of bitter symptoms was positively correlated with age. The highest incidence of the incidence of stomachache in the in-patient department was the liver disease (66.67%), the digestive system (61.80%), and the neurology department (60.66%). In the case of specific diseases, fatty liver, cholecystitis, stomach-esophageal disease, chronic pharyngitis, dental treatment were the risk factors of oral and bitter symptoms (OR and corresponding 95% CI were both greater than 1), and H. pylori infection was an important risk factor for bitter taste, OR = 2.463. The risk factors (OR value and corresponding 95% CI of the corresponding 95% CI of the upper abdominal pain, the abdominal pain, the antiacid, the pain of the oral cavity, the oral ulcer, the bad breath, the scrotum wet/ the lower, the headache, and the vertigo were all the symptoms of the oral and bitter symptoms (the OR value and the corresponding 95% CI were both greater than 1). In terms of behavioral factors, smoking is a risk factor in the occurrence of bitter symptoms, and the incidence of bitter symptoms is also increased with the increase of daily smoking number. Eating too much meat on a diet is a risk factor for bitter symptoms, while eating fresh vegetable and fruit is a protective factor for bitter symptoms. The emotional aspect, anxiety, restlessness, depression and self-conscious pressure are the risk factors of oral and bitter symptoms, and the incidence of bitter symptoms is positively related to the degree of bad mood. The incidence of bitter symptoms is approximately proportional to age. In the aspect of behavior, the symptoms of bitter taste are closely related to smoking, the risk factors of eating too much meat as a bitter symptom, and the incidence of bitter symptoms are directly proportional to the proportion of the daily eating meat; and the fresh fruit and vegetables are the protective factors of the bitter symptoms. In that aspect of constitution, the damp-heat constitution and the air-stagnation constitution are the risk factors of the bitter symptom, the occurrence rate of the damp-heat constitution oral bitter symptom is higher than that of the qi-stagnation constitution, the heat-heat constitution and the air-stagnation constitution, and the incidence of the bitter symptom of the body is higher than that of the non-human body. The study of the taste of the bitter taste of the healthy population found that the degree of bitterness of the female to the bitter test solution of different concentration was higher than that of the male, and it was shown that the feeling of the female to the bitter taste was more sensitive than that of the male. The degree of bitterness of the non-smoking population to the bitter test solution at different concentrations is higher than that of the smoking population, and the sensitivity of the non-smoking population to the bitter taste is higher than that of the smoking group. The study of the Latin square of the ability of the individual's bitter taste shows that individual differences in the perceived ability of different individuals to the bitter taste.4. The process of the formation and development of the theory of traditional Chinese and western medicine is of the view that the theoretical system of traditional Chinese medicine is the basic tool in the early stage and in the theory of the number of operation. In the natural philosophy of the generation theory, by means of the theory of Yin and Yang and the five elements, the theory of life and disease of the human body is constructed. The modern western medicine, under the background of the Renaissance, is a new medical theory system based on the philosophy of mechanical theory, the modern physical and chemical breakthrough and the new knowledge tool. Conclusion 1. The average incidence of bitter symptoms in patients over 14 years of age in Beijing is 53.79%, and the average incidence of bitter symptoms in the healthy population over 14 years of age is 43.92%. In the aspect of disease, the symptoms of the mouth and the digestive system are the most closely related to the digestive system diseases, such as the liver disease, the stomach-esophageal disease and the nervous system diseases; the behavior, the smoking, the consumption of a large amount of meat and the salted food are the risk factors of the bitter symptoms, and the fresh fruit vegetables are the protective factors thereof; The emotional aspect, anxiety, restlessness, depression and other bad mood and excessive pressure are the risk factors of the bitter symptoms of the mouth; the body constitution, the damp-heat physical constitution and the qi-stagnation constitution are the high-incidence body constitution of the bitter symptoms, and 3, the taste perception ability of the different individual to the bitter taste has a great difference, the female population, The sensitivity of the non-smoking population to the bitter taste is higher than that of the male and the smokers.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R24

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