基于机体对寒冷刺激的适应性改变原理探讨阳虚证畏寒肢冷实质

Investigation of the Essence of Chilliness and Cold Limbs of Yang Deficiency Syndrome in Chinese Medicine based on the Adaptability of Body to Cold Stimulation

中医药理论十分注重机体与环境之间的相互作用。本研究在中医文献学考察基础上,结合现代医学知识,层层递进,探索性分析了阳虚证畏寒肢冷的实质,并比较了中、西医学对此问题的认识,为阳虚证实质研究提供思考。首先回顾了《黄帝内经》有关"阳虚"的概念,梳理了"阳虚—外寒—冬季"概念之间的密切联系,认为阳虚证患者的畏寒肢冷与冬季时健康机体在外之阳气不足的表现非常相似;接着,参考健康机体对寒冷刺激的适应性改变原理,以体表组织血流量(热量)的减少类比冬季时的机体"外寒"状态;进一步,分析归纳造成体表组织血流量(热量)减少的生理性及病理性因素,得出结论:阳虚证畏寒肢冷的可能实质是疾病造成的体表组织血流量(热量)减少,已知的病理性因素有心衰、循环功能障碍和甲状腺功能减退。最后,"以方测证",发现许多温里药及补阳药具有或强心、或扩张外周血管、或升高体表温度的药理作用,验证本结论。

Chinese medicine （CM） theories attach great importance to the interaction between the human body and the environment. From this entry point, based on a great number of related CM literatures and knowledge of modern medicine, this paper investigated the essence of chilliness and cold limbs of yang deficiency syndrome. The differences on cognition and solution to this problem between CM theory and modern medicine theory were also analyzed. Firstly, the close relationship between the CM concepts of yang deficiency, ＂external cold＂, and winter was put forward after a review of yang deficiency in CM scripture Huangdi Neijing. Chilliness and cold limbs of yang deficiency patients was believed to be highly similar to the body state of ＂external cold＂ of healthy people in winter. Secondly, the state of ＂external cold＂ was described as a reduction of body surface blood flow （heat） with refer- ences to the adaptability to cold stimulation. Then according to a collection of physiological and pathological factors which may cause such reduction, we proposed that the essence of chilliness and cold limbs of yang deficiency pa-tients may probably be the state of reduction of body surface blood flow （heat） due to some pathological factors already known as heart failure, poor circulation, and thyroid dysfunction. Thirdly, by using the method of ＂syndrome differentiation through formula effects assessment＂, this recognition was confirmed because the pharmacological activities of cardiotonic or peripheral vasodilating, or surface temperature increasing were found in a great number of single medicines and prescriptions applied to yang deficiency syndrome in CM.