中醫(yī)心身醫(yī)學(xué)-心身疾病的剛?cè)徂q證

1、中醫(yī)心身醫(yī)學(xué)心身疾病的剛?cè)徂q證 一、應(yīng)對心身疾病的挑戰(zhàn) 1、Coping with psychosomatic diseases 二、中醫(yī)心身醫(yī)學(xué)理論與臨床 2、The theory and clinical research of TCM Psychosomatic Medicine2一、應(yīng)對心身疾病的挑戰(zhàn)1.Coping with psychosomatic diseases3 隨著世界經(jīng)濟的發(fā)展、社會的進步和科學(xué)的日新月異，人類的疾病譜和死亡譜發(fā)生了根本的轉(zhuǎn)變。Disease spectrum and the cause of death have changed dramaticall

2、y over the years, which have changed from mal nutrition and infection mainly to physical disorder resulting from mental or emotional and social causes, which are psychosomatic diseases.4 由過去的傳染病和營養(yǎng)不良為主，轉(zhuǎn)化為由心理社會因素生活行為等因素引起的心身疾病為主.醫(yī)學(xué)模式已由生物醫(yī)學(xué)模式向生物心理社會醫(yī)學(xué)模式轉(zhuǎn)化。5 中國也進入快速發(fā)展時期，社會轉(zhuǎn)型，市場經(jīng)濟，競爭加劇，人際關(guān)系復(fù)雜，情緒壓力增大。 2

3、1世紀是一個快速多變的，充滿了壓力與挑戰(zhàn)的時代 21st century is a time full of rapid changes, pressure and challenges. 6亞健康健康疾病心身疾病其他7 1、消化系統(tǒng)心身疾?。何负褪改c潰瘍(胃痛)、慢性胃炎(胃痞)、胃神經(jīng)癥(胃脹)、潰瘍性結(jié)腸炎(泄瀉、痢疾)、腸神經(jīng)癥(泄瀉)、習(xí)慣性便秘(便秘)、慢性肝炎(脅痛)、慢性膽囊炎(膽脹)、等。 Psychosomatic diseases in the digestive system include gastric and duodenal ulcer (stomachac

4、he), chronic gastritis (mass in the stomach), gastric neurosis (distension of the stomach), ulcerative colon (diarrhea and dysentery) 8 2、心血管系統(tǒng)心身疾?。涸l(fā)性高血壓病(眩暈)、原發(fā)性低血壓病(眩暈)、冠心病(胸痹)、心律失常(心悸)、心臟神經(jīng)癥(胸痹)、雷諾氏癥(厥證)、受體高敏癥(心悸)、心因性暈厥(厥癥)等。 Psychosomatic diseases in the cardiovascular system include primary hy

5、pertension (dizziness), essential hypotension (dizziness), coronary heart disease (obstruction of qi in the chest)9 3、呼吸系統(tǒng)心身疾?。?支氣管哮喘(哮喘)、過度換氣綜合癥(喘證)、 神經(jīng)性咳嗽(肝咳)等。 Psychosomatic diseases in the respiratory system include bronchial asthma (asthma), hyperventilation syndrome (dyspnea). syndrome) and ne

6、rvous cough (dry cough10 4、神經(jīng)系統(tǒng)心身疾?。耗X卒中(中風(fēng))、癲癇(癇證)、血管神經(jīng)性頭痛(頭痛)、緊張性頭痛(頭痛)等。Psychosomatic diseases in the nervous system include cerebral apoplexy (stroke), epilepsy (epilepsy), angioneurotic headache (headache) and tonic headache (headache).11 5、內(nèi)分泌系統(tǒng)心身疾?。?糖尿病(消渴)、甲亢(癭病)、 肥胖病(痰病)、尿崩癥(消渴)、 心因性多飲(消渴)等。

7、Psychosomatic diseases in the endocrine system include diabetes (diabetes), hyperthyroidism (goiter), obesity (phlegm syndrome), diabetes insipidus (diabetes), and psychogenic excessive drink of water (diabetes).12 6、泌尿生殖系統(tǒng)心身疾?。呵傲邢傺?白濁)，過敏性膀胱炎(淋癥)、尿道綜合癥(淋癥)、原發(fā)性性功能障礙(陽痿、早泄)等 Psychosomatic diseases in

8、 the urogenital system include prostatitis (gonorrhea), allergic cystitis (stranguria), urethral syndrome (stranguria) and primary sexual disorder (impotence and premature ejaculation).13 7、骨骼肌肉系統(tǒng)心身疾?。侯愶L(fēng)濕(痹證)、全身肌肉痛(痹證)、書寫痙攣(振顫)、局部性肌痙攣(振顫)等。 Psychosomatic diseases in the skeletal and muscular systems

9、 include rheumatoid disease (arthralgia syndrome), pain in muscles throughout the body (arthralgia syndrome), writing spasm (tremor) and local muscular spasm (tremor). 14 8、外科系統(tǒng)心身疾?。?包括腹部手術(shù)不適綜合證(腹痛)、 腸粘連癥(便秘)，等。 Psychosomatic diseases in the surgical department include uncomfortable syndrome of abdo

10、minal operation (abdominal pain) and intestinal adhesion (constipation).15 9、婦產(chǎn)科心身疾?。喊ㄍ唇?jīng)(痛經(jīng))、閉經(jīng)(經(jīng)閉)、月經(jīng)不調(diào)(月經(jīng)先期、后期、先后不定)、功能性子宮出血(崩漏)、更年期經(jīng)前后諸癥)、不孕癥(不孕)Psychosomatic in the department ofgynecology andobstetricsincludedysmenorrhea(dysmenorrhea), amenia(amenia), irregular menstruation (advanced ordelayed

11、enstruation),dysfunctional uterine bleeding (metrorrhagiaandmetrostaxis), menopausalsyndrome(diseasesaroundmenopause) and infertility (infertility).16 10、兒科心身疾?。荷窠?jīng)性厭食癥(厭食)、遺尿癥(遺尿)、 腹痛(腹痛)、頭痛(頭痛)等。Psychosomatic diseases in the department of pediatrics include nervous anorexia (anorexia), enuresis (en

12、uresis), abdominal pain (abdominal pain) and headache (headache).17 11、皮膚科心身疾?。?濕疹(濕毒瘡)、牛皮癬(白瘡)、痤瘡(粉刺)、斑禿(油風(fēng))、慢性麻疹(風(fēng)疹塊)、多汗癥(汗證)、皮膚瘙癢癥(風(fēng)搔癢)等。Psychosomatic diseases in the department of dermatology include eczema (noxious dampness), psoriasis, acne (acne), alopecia areata (alopecia areata), chronic ur

13、ticaria (rubella), hyperhidrosis (sweating syndrome) and cutaneous pruritus (pruritus cutis).18 12、眼科心身疾?。涸l(fā)性青光眼(五風(fēng)內(nèi)障)、中心性視網(wǎng)膜炎(視惑)、飛蚊癥(云霧移晴)、白內(nèi)障(園翳內(nèi)障)、眼睛癔癥(暴盲)等 Psychosomatic diseases in the department of ophthalmology include primary glaucoma (glaucoma), central choroido-retiritis (blurring vision)

14、, flying mosquito disease (vitreous opacity), cataract (cataract) and ocular hysteria (sudden loss of vision).19 13、耳鼻喉科心身疾?。?心因性耳聾(耳聾)、美尼爾氏征(眩暈)、 失音(喉喑)、過敏性鼻炎(鼻鼽)等。 Psychosomatic diseases in the department of otolaryngology include psychogenic deafness (deafness), Menieres disease (dizziness), apho

15、nia (aphonia due to throat disease) and allergic rhinitis (allergic rhinitis). 20 14、口腔科心身疾?。?口臭(口臭)、口腔潰瘍(口瘡)、 特發(fā)性舌痛(舌痛)、心因性牙痛(牙痛)等。 Psychosomatic diseases in the department of stomatology include ozostomia (ozostomia), stomatocace (aphthae), idiopathic glossalgia (glossalgia), psychogenic toothache

16、 (toothache). 21 15、腫瘤科心身疾?。何赴?積聚)、肝癌(脅痛) 腸癌(便血)、 食道癌(噎嗝)等。 Psychosomatic diseases in the department of tumor include carcinoma of stomach (abdominal mass), liver cancer (hypochondriac pain), intestinal cancer (hemafecia) and carcinoma of esophagus (dysphagia).22心身性亞健康Sub-Health23 應(yīng)對心身疾病的挑戰(zhàn)是世界醫(yī)學(xué)的共同責(zé)

17、任，1977年美國提出醫(yī)學(xué)模式轉(zhuǎn)變，但至今沒有形成完整的理論和方法，沒有實現(xiàn)心身整合的目標(biāo)。It is our resposibility to cope with psychosomatic diseases. However since 1977 changing the medicine model was emeraged in the US, there is not a complete theory and clinical method yet.24 1990年去日本九州大學(xué)醫(yī)學(xué)部向國際心身醫(yī)學(xué)會理事長池見酉次郎教授學(xué)習(xí)。251996年去日本九州大學(xué)醫(yī)學(xué)部心療內(nèi)科，進修心身醫(yī)學(xué)

18、?，F(xiàn)任亞洲心身醫(yī)學(xué)會會長久保千春教授。26 中醫(yī)學(xué)治療心身疾病有得天獨厚的優(yōu)勢，受到國際心身醫(yī)學(xué)界的重視。國際心身醫(yī)學(xué)界權(quán)威人士指出：“世界心身醫(yī)學(xué)要向中醫(yī)學(xué)尋找智慧?！?At an international conference on psychosomatic medicine in 1992, authoritative sources pointed out: “Psychosomatic medicine in the world should look for wisdom from TCM”. 27 存在決定意識，需求決定發(fā)展，防治心身疾病成為醫(yī)學(xué)發(fā)展的方向，壓力性疾病即心身疾

19、病越來越多，超過以往任何時期。 Demand determines development. The prevention and cure of psychosomatic diseases is the new direction of medicine. 中醫(yī)學(xué)的創(chuàng)新與發(fā)展28二、中醫(yī)心身醫(yī)學(xué)理論與臨床2.The theory and clinical research of TCM Psychosomatic Medicine291、中醫(yī)學(xué)發(fā)展的新時代(1)The new stage of TCM30 第一個時代春秋戰(zhàn)國時期 The first stage-Spring and Aut

20、umn and Warring States periods of China (770 BC -221 BC) 精氣學(xué)說、陰陽學(xué)說、五行學(xué)說、臟象學(xué)說、以及病因病機，診斷治療，預(yù)防養(yǎng)生等各個方面。 黃帝內(nèi)經(jīng)31 第二個時代 東漢時期 The second stage-Eastern Han Dynasty (25AD-220AD) 三陰三陽的傷寒病六經(jīng)辯證 經(jīng)方派 傷寒論32第三個時代金元時期The third stage-Jin and Yuan Dynasty (1115AD-1368AD) 劉完素 張子和 李東垣 朱丹溪 寒涼 攻下 補土 滋陰金元四大家33第四個時代清代The fou

21、rth stage-Qing Dynasty (1644-1911AD) 葉天士 吳鞠通 等溫病衛(wèi)氣營血辯證和三焦辯證 溫?zé)嵴?4The fifth stage-Psychosomatic Medicine心身醫(yī)學(xué)的時代第五個時代35 2、心身疾病的中醫(yī)病因病機研究 (2) Research on Etiology and Pathogenesis of TCM psychosomatic medicine36 “形神合一論”“天人合一論”“臟腑相關(guān)論”“陰陽五行學(xué)說”?！癟he theory on combination of physique and mentality into one”

22、, “the theory on correspondence between man and universe”, “the theory on relations between zang and fu” and “the theory on yin-yang and five elements” Neijing (Internal Classic)37“主明則下安，主不明則十二官危，使道閉塞不通，形乃大傷”“悲哀愁憂則心動，心動則五臟六腑皆搖”“精神內(nèi)傷，身必敗亡” 精辟地闡述了心理對生理的影響.“Mentality in order makes physique healthy Men

23、tality in disorder makes twelve organs sick, tracts obstructed and physique seriously damaged.” “Sadness and depression make the heart disturbed, affecting all internal organs.”Neijing38“人之有生也，有陰有陽，有短有長，有柔有剛”。中醫(yī)的心理生理具有陰陽剛?cè)釋α⒔y(tǒng)一的特點,歸納為“中醫(yī)剛?cè)嵝纳碚摗?剛?cè)嵝睦砩韺W(xué)說)。 “People by birth have yin and yang, short and

24、long, flexibilityandrigidity.”Therefore,TCM psychophysiology is characterized by the unity of opposites between yin and yang and between flexibility and rigidity. The authors sum it up as “the flexible-rigid theory on TCM psychosomatic medicine” (the flexible-rigid doctrine on psychophysiology).39關(guān)于

25、病因內(nèi)經(jīng)的正(內(nèi)因)，邪(外因)學(xué)說與現(xiàn)代心身醫(yī)學(xué)認識一致。內(nèi)因有先天稟賦、氣質(zhì)、體質(zhì)。外因有七情、六淫和飲食勞逸等。是心理、社會、生物、生活方式、行為等各種應(yīng)激因素。 Neijing is identical to modern psychosomatic medicine in the theory on internalandexternalfactors.Internalfactorsincludecongenitalendowment,temperament and physique. External factors include seven emotions, six clim

26、atic conditions,diet, labor and rest. 40 調(diào)查內(nèi)因可以找出心理素質(zhì)和生理素質(zhì)的虛弱所在，即正氣虛的表現(xiàn)。調(diào)查外因則可找出心理、社會、生物、行為諸種致病因素，即邪氣實的表現(xiàn)。 Investigation into internal factors can find what are feeble in psychological and physiological quality, which is manifested in deficiency of vital qi.Investigation into external factors can fi

27、nd disease-causing factors of psychology, sociality, biology and behavior, which is manifested in excess of pathogen.41If the patient was noble in the past and is now humble, although he had not attacked by the evil, he has disease produced from the interior. If he was rich in the past and is now po

28、or that causes the diseases.凡診病者，必問嘗貴后賤，雖不中邪，病從內(nèi)生，名曰脫營INTERNAL CLASSIC42 Anger injuries liver, joy injuries heart, grief injuries lung, thinking injuries spleen and fear injuries kidney Internal classic怒傷肝 、喜傷心、思傷脾、憂傷肺、 恐傷腎43 3、心身疾病的治療 (3)The treatment to psychosomatic diseases 44心身疾病的中醫(yī)治療，歷來強調(diào)“先治其心

29、，而后醫(yī)其身”。筆者近10多年來，把中醫(yī)心身治療方法歸納為9種，即中醫(yī)心理治療、中醫(yī)行為矯正治療，中醫(yī)心理藥物治療，辯證治療，食物療法，針灸治療，推拿療法，道家松靜療法，藥枕浴足療法。45In the treatment of psychosomatic diseases, TCM always stresses “psychological treatment before physiological treatment”. The authors have for more than a decade summarized TCM methods for the treatment of

30、psychosomatic diseases as of 9 types.(九寶合璧)464、心身疾病的剛?cè)徂q證 （4） Rigid-Gental Differentiation of Psychosomatic diseases根據(jù)國內(nèi)外的資料和自己的臨床實踐總結(jié)如下：47 發(fā)病后首先傷肝，波及心、脾、肺，日久及腎。初期多為肝脾同病，肝心同病，肝肺同病，后期多為肝腎陰虛或肝脾腎的陽虛。末期陰竭、陽亡、陰陽離絕而終。 In early stage, the diseases are mainly at both liver and spleen, both liver and heart, o

31、r both liver and lung. In late stage, the diseases are mainly manifested in yin-deficiency of the liver and kidney or yang-deficiency of the liver, spleen and kidney. In the end, the patient dies of yin-failure, yang-vanish and complete separation of yin from yang.48 病性為剛?cè)岵荒芟酀?，而致疏泄失職，氣滯血瘀，痰阻濕困或氣逆化火?/p>

32、火熱傷陰，升降失司，日久由實轉(zhuǎn)虛，脾虛肝郁或腎虛肝旺，極少純虛證。 （看下張英文）49The nature of illness belongs to flexibility and rigidity unable to supplement each other, causing abnormal flow of qi, qi stagnation, blood stasis, obstruction of phlegm, retention of dampness, fire due to adverse flow of qi, impairment of yin due to fire,

33、 and disorder in ascension and descension. Lingering illness will transform from excess to deficiency syndrome with deficiency of the spleen, stagnation of the liver-qi or deficiency of the kidney and excess of the liver-fire. Very few patients suffer from deficiency syndrome.50心身疾病經(jīng)過及時合理的治療，多有較好的療效

34、，但容易因情志因素復(fù)發(fā)。 Fairly good curative effects can be achieved in most patients with psychosomatic diseases through reasonable and timely medical treatment. However, these diseases easily recur due to emotional factors.51少數(shù)患者因治療不當(dāng)，可由實轉(zhuǎn)虛，最后陰亡或陽亡而終。另有少數(shù)患者可因劇烈的情志刺激、氣血暴逆或氣血暴脫，精去神亡。 Patients with improper tre

35、atment can transform from excess to deficiency and will finally die of yin-vanish or yang-vanish. Other patients could die of suddenly adverse flow of qi and blood or sudden collapse of qi and blood due to violent emotional stimulation.52心身疾病剛?cè)岜孀C論治心理社會壓力 情志過激傷肝剛 證柔 證病機素體性急陽剛疏泄太過肝旺成剛證實證肝氣上逆抑肝降逆肝火上炎瀉肝

36、降火心肝火旺瀉肝清心心肝火旺痰瘀互結(jié)瀉肝清心化痰活血虛證心肝陰虛柔肝養(yǎng)心肝腎陰虛肝陽上亢滋陰平肝潛陽肝腎陰虛風(fēng)動滋補肝腎熄風(fēng)陰損及陽滋陰助陽結(jié)局陰亡陽亡素體性緩陰柔疏泄不及成柔證肝郁氣滯疏肝理氣肝郁血瘀疏肝活血肝郁脾困疏肝理脾肝郁痰濕阻肺疏肝化痰理肺肝郁脾虛疏肝健脾心肝氣虛補肝養(yǎng)心脾腎陽虛溫補脾腎陽損及陰補陽助陰陽亡陰亡53心身疾病剛證柔證辯證論治心理社會壓力、情志刺激首先傷肝實證素體性急陽剛疏泄太過肝旺一剛證肝氣上逆一抑肝降逆肝火上炎一瀉肝降火心肝火旺一瀉肝清心心肝火旺痰瘀互結(jié)一瀉肝清心化痰活血素體性緩陰柔疏泄不及一肝郁一柔證肝郁氣滯一疏肝理氣肝郁血瘀疏肝活血肝郁脾困一疏肝理脾肝郁痰濕阻肺一

37、疏肝理肺化痰虛證心肝陰虛柔肝養(yǎng)心肝腎陰虛肝陽上亢滋陰平肝潛陽肝腎陰虛風(fēng)動滋補肝腎熄風(fēng)陰損及陽滋陰助陽肝郁脾虛一疏肝健脾心肝氣虛一補肝養(yǎng)心脾腎陽虛溫補脾腎陽損及陰一補陽助陰結(jié)局陰亡陽亡陽亡陰亡54There are 2 classes, 4 items, 16 families in differentiation of syndromes according to the Rigid-Gental theory.552 classes are: Rigid Symptom, Gental symptom4 items are: Rigid-excess Symptom Gental-exces

38、s symptom Rigid-deficiency Symptom Gental-deficiency symptom 56Rigid-excess Symptom剛實證Up inverse of liver Qi 肝氣上逆Excessive fire of liver 肝火上炎Excessive fire of liver and heart 心肝火旺Excessive fire of liver and heart with phlegm and blood stasis 心肝火旺痰瘀互結(jié)57Gental-excess Symptom柔實證Stasis of liver Qi 肝郁氣滯S

39、tasis of liver blood 肝郁血瘀Stasis of liver and spleen Qi 肝郁脾困Stasis of liver Qi and phlegm stagnate in lung 肝郁痰濕阻肺58Rigid-deficiency Symptom剛虛癥Insufficient yin of liver and heart 心肝陰虛Insufficient yin of liver and kidney with inverse liver yang 肝腎陰虛肝陽上亢Insufficient yin of liver and kidney with internal

40、 wind activity 肝腎陰虛風(fēng)動Insufficient yin result in insufficient yang 陰損及陽59Gental-deficiency Symptom柔虛癥Stasis of liver and insufficient of spleen 肝郁脾虛Insufficient Qi of heart and liver 心肝氣虛Insufficient Yang of spleen and kidney 脾腎陽虛Insufficient Yang result in insufficient Yin 陽損及陰60Rigid Symptom 癥狀Gent

41、al symptom 癥狀irritated spirit易怒 tired spirit易疲 red complexion面紅 sallow complexion面白 Obesity肥胖Emaciation瘦弱tongue coating is yellow苔黃tongue coating is white苔白Halitosis口臭 fishy smell口腥 61Rigid Symptom 癥狀Gental symptom癥狀Edgy急躁 Gentle溫和 Impatient無耐心Patient耐心speak loudly & quickly聲高語快speak softly & slowly

42、聲柔語慢Active活躍Quiet安靜Easily express emotion善于表達感情 Hardly express emotion不易表達感情 62 心身疾病的中醫(yī)診斷，繼承傳統(tǒng)的四診，辨病和辨證，再吸收現(xiàn)代心身醫(yī)學(xué)的心理診斷和軀體診斷兩部分內(nèi)容。軀體診斷與一般西醫(yī)診斷相同。為中醫(yī)心身疾病的療建立客觀依據(jù)。 On diagnosis of psychosomatic diseases in TCM, four traditional diagnoses, differentiation of diseases and syndromes should be inherited, an

43、d psychological and physiological diagnoses in modern psychosomatic medicine should be absorbed. TCM is identical to Western medicine in physiological diagnosis. 635、病 例 Case Report64Case Report Mr. Han, 49y 男，49歲Complaint: chest pain and tightness for 3 days主訴：胸憋胸痛3天65History: he complained chest p

44、ain and tightness for 3 days and felt gradually severe because of nervous. He went to a hospitals emergency department and was not excluded of cardiac infarct by ECG. But later coronary arteriography showed normal and no evidence of infarct. 工作緊張的人、癥狀不斷加劇、急診住院、冠狀造影排除心梗病 例66Treatment to symptoms was not effective. The doctor there referre