基于八卦-藏象类比关系回顾性分析超重及肥胖症患者中医证候特点

Retrospective analysis of characteristics of TCM patterns based on the analogy between the Eight Trigrams and visceral manifestation in overweight and obesity patients

摘要

目的 回顾性分析超重及肥胖症患者的中医证候特点。方法 基于HIS系统纳入2022年1月1日至2023年6月30日就诊于东直门医院通州院区肾病内分泌三区的620例超重及肥胖症患者的一般资料、八卦及中医证候信息等，采用卡方检验、logistic回归分析方法进行分析，探究超重及肥胖症患者中医证候的分布特点及其与八卦的相关性。结果 共纳入超重及肥胖症患者620例（超重216例、肥胖症404例），性别差异具有统计学意义（P＜0.05）。中医证型以脾气虚证最为常见，其次分别为肾气虚证、气郁证、热盛证及湿阻证。进一步通过logistic回归分析方法分析超重及肥胖症患者八宫卦与中医证型的相关性，显示坤宫卦与脾气虚证、艮宫卦与肾阴虚证、离宫卦与心气虚证、坎宫和震宫卦与湿阻证、巽宫卦与热盛证均呈正相关（P＜0.05）。结论 表明八卦-藏象在超重及肥胖症中的对应关系，有利于通过推演八卦初步辨明本病中医证候，更好地指导中医临床诊治并提供相应依据。

Abstract

Objective To retrospectively analyze characteristics of overweight and obesity patients from a Traditional Chinese Medicine (TCM) pattern perspective. Methods Based on data from the Hospital Information System (HIS), the study included 620 overweight and obese patients who visited the Nephrology and Endocrinology Department at Tongzhou Campus of Dongzhimen Hospital from January 1, 2022, to June 30, 2023. The patients’ general information, Eight Trigrams characteristics, and TCM pattern types were collected. Chi-square tests and logistic regression analysis were conducted to explore the distribution characteristics of TCM pattern types in overweight and obese patients and their correlation with the Eight Trigrams. Results A total of 620 overweight and obesity patients were included (216 overweight, 404 obesity), with significant gender differences (P＜0.05). The most common TCM pattern was spleen qi deficiency, followed by kidney qi deficiency, qi stagnation, excessive heat, and damp obstruction. Logistic regression analysis revealed positive correlations between certain trigrams and TCM pattern types: Kun trigram with spleen qi deficiency, Gen trigram with kidney yin deficiency, Li trigram with heart qi deficiency, Kan and Zhen trigrams with damp obstruction, and Xun trigram with excessive heat (P＜0.05). Conclusion The results indicate that there are specific correspondences between the Eight Trigrams and visceral manifestations in overweight and obesity. This correlation aids in initially identifying TCM pattern types through the Eight Trigrams, which can further guide TCM clinical diagnosis and treatment, providing a valuable reference.

关键词

超重及肥胖 / 八卦-藏象 / 回顾性分析 / 中医证候特点

Key words

overweight and obesity / Eight Trigrams and visceral manifestations / retrospective analysis / characteristics of TCM patterns

参考文献

[1] PAN X F, WANG L, PAN A . Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.

[2] HARIHARAN R, ODJIDJA E N, SCOTT D, et al. The dietary inflammatory index, obesity, type 2 diabetes, and cardiovascular risk factors and diseases[J]. Obes Rev, 2022, 23(1): e13349.

[3] LITWIN M, KULAGA Z . Obesity, metabolic syndrome, and primary hypertension[J]. Pediatr Nephrol, 2021, 36(4): 825-837.

[4] POWELLl—WILEY T M, POIRIER P, BURKE L E, et al. Obesity and cardiovascular disease: a scientific statement from the American heart association[J]. Circulation, 2021, 143(21): e984-e1010.

[5] CHEN Z, IONA A, PARISH S, et al. Adiposity and risk of ischaemic and haemorrhagic stroke in 0·5 million Chinese men and women: a prospective cohort study[J]. Lancet Glob Health, 2018, 6(6): e630-e640.

[6] DE PERGOLA G, SILVESTRIS F . Obesity as a major risk factor for cancer[J]. J Obes, 2013, 2013: 291546.

[7] ENGIN A . Obesity—associated breast cancer: analysis of risk factors[J]. Adv Exp Med Biol, 2017, 960: 571-606.

[8] BROWN K A . Metabolic pathways in obesity—related breast cancer[J]. Nat Rev Endocrinol, 2021, 17(6): 350-363.

[9] 孟庆云 . 《易经》与“藏象学说”[J]. 中医药文化, 2015, 10(5): 27-31.

[10] 中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等 . 中国居民肥胖防治专家共识[J]. 西安交通大学学报（医学版）, 2022, 43(4): 619-631.

[11] WANG L, ZHOU B, ZHAO Z, et al. Body—mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004—18[J]. Lancet, 2021, 398(10294): 53-63.

[12] CHEN K, SHEN Z, GU W, et al. Prevalence of obesity and associated complications in China: a cross—sectional, real—world study in 15.8 million adults[J]. Diabetes Obes Metab, 2023, 25(11): 3390-3399.

[13] 李东垣 . 脾胃论[M]. 侯坤, 校注. 北京: 中国科学技术出版社, 2024: 7.

[14] 朱震亨 . 丹溪治法心要[M]. 张奇文, 朱锦善, 王叙爵, 校注. 济南: 山东科学技术出版社, 1985: 1.

[15] 申拱辰 . 外科启玄[M]. 北京: 人民卫生出版社, 1955: 16.

[16] 朱燕波, 王琦, 吴承玉, 等 . 18 805例中国成年人中医体质类型与超重和肥胖关系的Logistic回归分析[J]. 中西医结合学报, 2010, 8(11): 1023-1028.

[17] 赵莎, 许徐秀生, 孙菁, 等 . 基于脑肠轴从脾胃论治单纯性肥胖症[J]. 现代中医临床, 2024, 31(5): 82-85.

[18] 叶天士 . 临证指南医案[M]. 华岫云, 校注. 北京: 华夏出版社, 1995: 499.

[19] 易经[M]. 王辉, 宋学海, 校注. 昆明: 云南人民出版社, 2011: 364.

[20] 冯兆张 . 冯氏锦囊秘录[M]. 王新华, 校注. 北京: 人民卫生出版社, 1998: 581-582.

[21] 何梦瑶 . 医碥[M]. 吴昌国, 校注. 北京: 中国中医药出版社, 2009: 4-5.

[22] 王士雄 . 温热经纬[M]. 蒋文明, 校注. 北京: 中国中医药出版社, 2009: 113-148.

[23] 杨玲玲, 倪诚, 李英帅, 等 . 王琦治疗肥胖经验[J]. 中医杂志, 2013, 54(21): 1811-1813.

[24] 傅山 . 傅青主女科[M]. 欧阳兵, 校注. 北京: 人民卫生出版社, 2006: 37.

[25] 杨亚伟, 约日古丽·麦海提, 于泽楷, 等 . 腹型肥胖者539例证候要素特征分析[J]. 环球中医药, 2022, 15(11): 2097-2103.

[26] 李威, 唐思源, 张文婷, 等 . 基于“心与小肠相表里”探讨食物成瘾性肥胖与脑肠轴的相关性[J]. 中西医结合研究, 2024, 16(2): 123—126, 133.

[27] 李洪海, 韩琦, 马月香 . 基于易象思维探析八卦—脏腑体系[J]. 北京中医药大学学报, 2021, 44(7): 585-590.

[28] 张介宾 . 景岳全书[M]. 夏之秋, 校注. 北京: 中国中医药出版社, 1994: 128-129.

[29] 黄灿灿, 何瑞琪, 崔楠, 等 . 基于“龙雷之火”理论刍议温补脾肾法治疗非肥胖型多囊卵巢综合征[J]. 时珍国医国药, 2020, 31(10): 2447-2449.

[30] 李建煌, 祝维峰 . 肉桂“补土归原”理论阐释及临床应用分析[J]. 山西中医学院学报, 2019, 20(3): 204—205, 208.

基金资助

国家自然科学基金项目(82174351)

北京中医药大学东直门医院临床研究和成果转化能力试点项目(DZMG-QNZX-24009)

北京市通州区科技创新人才资助项目(JCQN2024022)

中华中医药学会雏鹰计划中医临床青年人才研修项目()