“生长壮老取决于肾”的健康状况调查分析

【作者】 王莉；

【导师】 吕爱平；

【作者基本信息】 辽宁中医药大学 ， 中医基础理论， 2019， 博士

【摘要】 目的:调查9-70岁健康状态人群的头发、耳目、唾液、骨牙等十个维度114个条目的表现特征,探讨不同年龄段、不同性别健康志愿者的差异及演变规律,深入挖掘反映“生长壮老取决于肾”的外在征象及规律性知识,为丰富中医“肾藏精”藏象理论及与肾相关疾病的治疗提供理论支持,为健康人的中医预防养生提供方向性的指导。材料与方法:理论研究:通过理论研究方法,对“生长壮老取决于肾”进行古代文献的源流探究,对这一理论在各个历史时期的发生、演变规律进行回顾与分析。从生长壮老各阶段与肾中精气的关系入手,分析肾中精气对生命的开始、生长发育、衰老等阶段的影响,确认肾中精气对人生长壮老各阶段的不同作用,进一步阐明“生长壮老取决于肾”的理论意义。临床流行病学调查:本课题研究团队自2010年12月到2013年8月,在天津、上海、沈阳三地,对922例健康人群进行了调查。问卷涉及人体健康状况的114个条目,共分十个维度:头发、唾液、耳目、骨牙、四肢肌肉、皮肤、二阴二便、生殖、智力、其他症状。临床医师或中医学专业教师在经过培训之后,对调查对象就“生长壮老取决于肾”流行病学调查信息采集表(9-70岁使用)进行信息采集,并填写量表。应用SPSS 21.0统计学软件进行数据分析,描述计量资料采用平均数±标准差,不同年龄段之间多重比较采用Games-Howell法进行,不同性别人群间比较采用T检验,条目之间比较采用因子分析,维度之间相关性采用Spearman相关分析。结果:1.“生长壮老”各年龄段男性健康人群外在征象变化趋势男性各维度随着年龄增长总体呈下降趋势,最低值均出现在65岁以上段。头发维度峰值出现在9-16岁年龄段。与9-16岁段头发维度值比较,25-32岁段、33-40岁段、41-48岁段、49-56岁段、57-64岁段、65以上段显著下降(P<0.05)。骨牙维度峰值出现在17-24岁段。与17-24岁段骨牙维度值比较,33-40岁段、41-48岁段、49-56岁段、57-64岁段、65以上段显著下降(P<0.05)。唾液维度峰值出现在9-16岁段。与9-16岁段唾液维度值比较,57-64岁段下降,有显著性差异(P<0.05)。耳目维度峰值出现在9-16岁。与9-16岁段耳目维度值比较,49-56岁段、57-64岁段、65岁以上段显著下降(P<0.05)。四肢肌肉维度峰值出现在41-48岁段。与41-48岁段四肢肌肉维度值比较,65岁以上段显著下降(P<0.05)。皮肤维度峰值出现在9-16岁段。与9-16岁段皮肤维度值比较,49-56岁段、57-64岁段、65岁以上段显著下降(P<0.05)。生殖维度峰值出现在33-40岁段。与33-40岁段生殖维度值比较,65岁以上段显著下降(P<0.05)。二阴二便维度峰值出现在9-16岁段。与9-16岁段二阴二便维度值比较,57-64岁段显著下降(P<0.05)。智力维度峰值出现在9-16岁段。与9-16岁段智力维度值比较,57-64岁段、65岁以上段显著下降(P<0.05)。2.“生长壮老”各年龄段女性健康人群外在征象变化趋势女性各维度总体趋势随年龄增长呈下降趋势,最低值均出现在64岁以上段。头发维度峰值出现在15-21岁段,与15-21岁段比较,29-35岁段、36-42岁段、43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。骨牙维度峰值出现在9-14岁。与9-14岁段比较,36-42岁段、43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。唾液维度峰值出现在9-14岁段、15-21岁段与29-35岁段。与9-14岁段、15-21岁段比较,50-56岁段、57-63岁段显著下降(P<0.05)。与29-35岁段比较。50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。耳目维度峰值出现在9-14岁段。与9-14岁段比较,22-28岁段、29-35岁段、36-42岁段、43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。四肢肌肉维度峰值出现在9-14岁段。与9-14岁段比较,57-63岁段、64岁以上段显著下降(P<0.05)。皮肤维度峰值出现在9-14岁段。与9-14岁段比较,36-42岁段、43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。二阴二便维度峰值出现在9-14岁段。与9-14岁段比较,22-28岁段、29-35岁段、36-42岁段、43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。生殖维度峰值出现在15-21岁段。与15-21岁段比较,43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。智力维度峰值出现在9-14岁段。与9-14岁段比较,29-35岁段、36-42岁段、43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。其他症状维度峰值出现在9-14岁段。与9-14岁段比较,43-49岁段、50-56岁段、57-63岁段、64岁以上段显著下降(P<0.05)。3.“生长壮老”各年龄段男性与女性外在征象变化差异男性皮肤维度在30-39岁段和40-49岁段高于女性,有显著性差异(P<0.05)。男性智力维度30-39岁段显著高于女性(P<0.05)。男性其他症状维度在20-29岁段、30-39岁段、40-49岁段、60岁以上段显著高于女性(P<0.05)。男性生殖维度在9-19岁段、20-29岁段、30-39岁段、40-49岁段、50-59岁段显著高于女性(P<0.05)。4.“生长壮老”过程中,充分反映不同健康人群肾中精气盛衰的征象群研究中发现充分反映男性健康人群“生长壮老”过程中肾中精气盛衰的征象群,包括23项征象,按照重要性依次为:牙齿脱落、性欲减退、牙齿松动、脱发、腰活动受限酸痛、头发稀疏、阳痿、颈活动受限、白发、早泄、膝活动受限酸痛、头发干枯、神疲、乏力、牙齿光泽、健忘、皮肤干燥、气短、皮肤松弛、腰冷、尿后余沥、老花眼、耳聋,其中牙齿脱落、性欲减退、牙齿松动、脱发、腰活动受限酸痛、头发稀疏、阳痿、颈活动受限表现突出。研究中发现充分反映女性健康人群“生长壮老”过程中肾中精气盛衰的征象群,包括19项征象,按照重要性依次为:月经初潮年龄、经质、经色、白发、性欲减退、皮肤松弛、头发干枯、绝经年龄、老花眼、牙齿松动、膝活动受限酸痛、头发稀疏、手背色斑、腰活动受限酸痛、牙齿脱落、面部色斑、脱发、牙齿光泽、腰冷,其中表现突出的条目是月经初潮年龄,绝经年龄、白发、性欲减退、皮肤松弛、头发干枯、老花眼、牙齿松动。研究中发现,不考虑性别差异,充分反映健康人群“生长壮老”过程中肾中精气盛衰的征象群,包括22项征象,按照重要性依次为:白发、头发干枯、应变能力、皮肤松弛、头发稀疏、牙齿松动、唾液、抑郁、老花眼、计算力、牙齿光泽、手背色斑、烦躁、眼神、脱发、耳聋、想象力、牙齿脱落、面部色斑、多唾、腰冷、耳鸣,其中表现突出的征象是白发、头发干枯、应变能力、皮肤松弛、头发稀疏、牙齿松动、唾液、抑郁。5.SF-36健康调查表生理维度与中医量表头发、骨牙、耳目、四肢肌肉、皮肤、二阴二便、生殖、智力、其他症状维度存在相关性。这解释了生理功能、躯体疼痛、总体健康与中医量表中各维度的变化趋势相似的原因。结论:1.“生长壮老取决于肾”理论,奠基于秦汉时期,在晋隋唐时期得到进一步丰富,经过宋金元时期不断地发展,于明清时期渐趋系统与完善,并在近现代时期得以创新。“生长壮老取决于肾”理论,因其强调了肾中精气盛衰对生命各阶段的重要性,为历代医家所重视。2.在“生长壮老”过程中,男性与女性在头发、骨牙、耳目、唾液、四肢肌肉、皮肤、二阴二便、生殖、智力和其他症状维度的变化趋势,均与肾精盛衰的“上升期—平台期—下降期”的传统理论模型基本相符,从而为中医“生长壮老取决于肾”理论从流行病学角度提供了参考。3.在“生长壮老”各阶段中,最能反映男性与女性差别的外在征象是生殖。4.在“生长壮老”各阶段中,最能反映男性肾中精气盛衰的外在征象是:牙齿脱落、性欲减退、牙齿松动、脱发、腰活动受限酸痛、头发稀疏、阳痿、颈活动受限酸痛;最能反映女性肾中精气盛衰的外在征象是:月经初潮年龄、绝经年龄、白发、性欲减退、皮肤松弛、头发干枯、老花眼、牙齿松动;在不考虑性别差异时,最能反映健康人群肾中精气盛衰的外在征象是:白发、头发干枯、应变能力、皮肤松弛、头发稀疏、牙齿松动、唾液、抑郁。5.中医量表中头发、骨牙、耳目、四肢肌肉、皮肤、二阴二便、生殖、智力、其他症状维度,与SF-36健康调查表中的生理功能、躯体疼痛、总体健康存在相关性,可以很好地反映人体“生长壮老”各阶段的生理变化。更多还原

【Abstract】 Purpose: To investigate the performance characteristics of 114 items in 10 dimensions including hair,eyes and ears,saliva,bone and teeth of healthy people and explore the differences and evolution of healthy volunteers of different ages and genders between 9-70 years old.To reveal the external signs and regularity of “ Human’s development relies on kidney” and provide theoretical support for theory of “kidney storing essence” and treatment of kidney-related diseases.To provide guidance for disease prevention and health care of healthy population.Material and method: Theoretical research: By means of theoretical research,this paper probes into the origin and flow of ancient literature,including the occurrence and evolution rules of this theory in various historical periods.Starting from the relationship between each stage of generating-growing-prime-aging and the essence and qi of kidney,this paper analyzes the influence of the essence and qi of kidney on the beginning of life,growth and development,aging,and confirms the different effects of the essence and qi of kidney on each stage of human body,and further clarifying the theoretical significance of “Human’s development relies on kidney”.Epidemiological investigation: From December 2010 to August 2013,the research team investigated 922 healthy people in Tianjin,Shanghai,Shenyang.The questionnaire involved 114 items of human health,which were divided into 10 dimensions: hair,saliva,eyes and ears,bone and teeth,limbs and muscles,skin,excretory organs and functions,reproduction,intelligence and other symptoms.The trained clinicians or TCM teachers collected information from the subjects using the epidemiological questionnaire of “Human’s development relies on kidney”(for 9-70 years old).SPSS 21.0 was used for data analysis.Means ± standard was used to describe measurement data,and Games-Howell method was used for multiple comparisons among different age groups.T test was used for the comparison between different genders.Factor analysis was used to compare items.Spearman correlation was used to calculate the correlation between the dimensions.Results: 1.The change trend of outward signs of healthy male population of all age phases of “generating-growing-prime-aging”.All the male dimensions showed a decreasing trend with age,and the bottom value appeared in over 65 years old population.The peak value of hair dimension appeared in the age group of 9-16 years old,compared with that of 9-16 years old,the values of 25-32 years old,33-40 years old,41-48 years old,49-56 years old,57-64 years old and above 65 years old decreased significantly(P < 0.05).The peak value of bone and tooth dimension appeared in the group aged 17-24 years,which was significantly lower than that in the group aged 33-40 years,41-48 years,49-56 years,57-64 years and above 65 years(P < 0.05).The peak value of salivary dimension appeared in the group aged 9-16 years,and it decreased in the group aged 57-64 years compared with the group aged 9-16 years(P < 0.05).The peak of the dimension of eyes and ears appeared at the age of 9-16 years,which was significantly lower than that of the group aged 49-56 years,57-64 years and over 65 years(P < 0.05).The peak of limb muscle dimension appeared in the 41-48 year old group,which was significantly lower than that in the 41-48 year old group(P < 0.05).The peak value of skin dimension appeared in the group aged 9-16 years old,compared with the group aged 9-16 years old,the group aged 49-56 years old,the group aged 57-64 years old,and the group aged over 65 years old decreased significantly(P < 0.05).The peak value of reproductive dimension appeared in the 33-40 year-old group,which was significantly lower than that in the 33-40 year-old group(P < 0.05).The peak value of excretory organs and functions dimension was found in the group aged 9-16 years,which was significantly decreased in the group aged 57-64 years(P < 0.05)compared with the group aged 9-16 years(P < 0.05).The peak of intelligence dimension occurred in the age group from 9 to 16.Compared with the group aged 9-16,the group aged 57-64 and over 65 decreased significantly(P < 0.05).2.The change trend of outward signs of healthy female population of all age phases of “generating-growing-prime-aging”.The overall trend of females in all dimensions decreased with age,with the bottom value appearing in the group over 64 years old.The peak of hair dimension appeared in the group aged 15-21 years old,compared with the group aged 15-21 years old,there were significant decreases in the groups aged 29-35 years old,36-42 years old,43-49 years old,50-56 years old,57-63 years old and over 64 years old(P < 0.05).The peak value of bone and tooth dimension appeared in the 9-14 years old group,compared with the 9-14 years old group,the values of 36-42 years old group,43-49 years old group,50-56 years old group,57-63 years old group,and 64 years old group decreased significantly(P < 0.05).The peak of salivary dimension appeared in the groups of 9-14 years old,15-21 years old and 29-35 years old,and was significantly decreased in the groups of 50-56 years old and 57-63 years old(P < 0.05)compared with the groups of 9-14 years old and 15-21 years old(P < 0.05).Compared with the group aged 29-35,the ages of 50-56,57-63 and over 64 decreased significantly(P < 0.05).The peak of the dimension of eyes and ears appeared in the group aged 9-14 years old,compared with the group aged 9-14 years old,the values of group aged 22-28 years old,group aged 29-35 years old,group aged 36-42 years old,group aged 43-49 years old,group aged 50-56 years old,group aged 57-63 years old and group aged over 64 years old decreased significantly(P < 0.05).The peak value of limb muscle dimension appeared in the group aged 9-14 years,which was significantly decreased in the group aged 57-63 years and the group aged over 64 years(P < 0.05)compared with the group aged 9-14 years.The peak value of skin dimension appeared in the group aged 9-14 years,compared with the group aged 9-14 years,significantly decreased in the groups aged 36-42 years,43-49 years,50-56 years,57-63 years,and over 64 years(P < 0.05).The peak value of excretory organs and functions dimension was found in the group aged 9-16 years,which was significantly decreased in the group aged 57-64 years(P < 0.05)compared with the group aged 9-16 years(P < 0.05).The peak of intelligence dimension occurred in the age group from 9 to 16.Compared with the group aged 9-16,the number of patients aged 57-64 and over 65 decreased significantly(P < 0.05).3.Differences in the changes of male and female outward signs in all age phases of “generating-growing-prime-aging”.The skin of males was significantly higher than that of females in the groups of 30-39 years old and 40-49 years old(P < 0.05).The intelligence of male 30-39 years old group was significantly higher than that of female(P < 0.05).Other symptoms of male were significantly higher than female in groups of 20-29 years old,30-39 years old,40-49 years old and over 60 years old(P < 0.05).The male reproduction was significantly higher in the groups of 9-19 years old,20-29 years old,30-39 years old,40-49 years old and 50-59 years old(P < 0.05).4.In the process of “generating-growing-prime-aging”,the symptoms of the rise and fall of kidney essence and qi in different healthy people are fully reflected.The syndromes that fully reflect the rise and fall of kidney essence and qi during the process of “generating-growing-prime-aging” in males were screened out,including 23 syndromes,which were in order of importance as follows: Tooth loss,hyposexuality,loose teeth,alopecia,limited waist movement,thinning hair,asynodia,limited neck movement,white hair,premature ejaculation,limited knee movement,dry hair,spiritilessness,asthenia,tooth gloss,forgettery,dry skin,shortness of breath,sagging skin,coldness in waist,dribble of urine,presbyopia,deafness.Among them,the prominent signs are tooth loss,hyposexuality,loose teeth,alopecia,limited waist movement,thinning hair,asynodia,limited neck movement.The syndromes that fully reflect the rise and fall of kidney essence and qi during the process of “generating-growing-prime-aging” in females were screened out,including 19 signs,according to the importance of: menarche age,menstrual texture,menstrual color,white hair,hyposexuality,sagging skin,dry hair,age of menopause,presbyopia,loose teeth,limited knee movement,thinning hair,splash on the back of hand,limited knee movement,tooth loss,facial splash,alopecia,tooth gloss,coldness in waist.Among them,the prominent signs are menarche age,age of menopause,white hair,hyposexuality,sagging skin,dry hair,presbyopia,loose teeth.Regardless of the gender difference,the syndromes that fully reflect the rise and fall of kidney essence and qi during the process of “generating-growing-prime-aging” in healthy population were screened out,including 22 syndrome,according to the importance of: white hair,dry hair,strain capacity,sagging skin,thinning hair,loose teeth,saliva,despondency,presbyopia,computing power,tooth gloss,splash on the back of hand,irritability,eye sight,alopecia,deafness,imagination,tooth loss,facial splash,salivary,coldness in waist,tinnitus. Among them,the prominent signs are white hair,dry hair,strain capacity,sagging skin,thinning hair,loose teeth,saliva,despondency.5.The physiological dimensions of SF-36 health questionnaire were correlated with the dimensions of hair,bone and teeth,ears and ears,muscles of limbs,skin,eryin and defecation,reproduction,intelligence and other symptoms of the TCM scale.This explains why the change trend of physical functioning,bodily pain,general health is similar to that of all dimensions in the TCM survey scale.Conclusion: 1.The theory of “Human’s development relies on kidney” was based on Qin and Han dynasties,enriched in Jin,Sui and Tang dynasties,further developed in Song,Jin and Yuan dynasties,gradually became systematic and perfect in Ming and Qing dynasties and innovated in contemporary and modern times.The theory of “Human’s development relies on kidney” has been emphasized by medical experts in the past for its emphasis on the importance of essence and qi in the kidney to each stage of life.2.At each stage of “generating-growing-prime-aging”,the trends of hair,bone and teeth,eyes and ears,saliva,limb muscles,skin,excretory organs and functions,reproduction,intelligence,other signs of males and females are basically consistent with the theoretical model of "rising period-plateau period-falling period" of kidney essesce,which provides a reference for the theory of traditional Chinese medicine that " Human’s development relies on kidney " by means of epidemiology.3.The dimension that best reflects the difference between males and females in the process of “generating-growing-prime-aging” is the reproduction.4.In the process of “generating-growing-prime-aging”,the external signs that can best reflect the rise and fall of essence and qi in male kidney are tooth loss,hyposexuality,loose teeth,alopecia,limited waist movement,thinning hair,asynodia,limited neck movement.The external signs that can best reflect the rise and fall of essence and qi in female’s kidney are menarche age,age of menopause,white hair,hyposexuality,sagging skin,dry hair,presbyopia,loose teeth.When gender differences are not taken into account,the external signs that best reflect the rise and fall of essence and qi in the kidney of healthy people are white hair,dry hair,strain capacity,sagging skin,thinning hair,loose teeth,saliva,despondency.5.The dimensions of hair,bone and teeth,eyes and ears,limb muscles,skin,genital organs and excretion,reproduction,intelligence and other symptoms in the TCM questionnaire are correlated with the physical function,bodily pain and general health dimensions in the SF-36 health questionnaire,which can well reflect the physiological changes in stages of “generating-growing-prime-aging”.更多还原