發(fā)布時(shí)間：2018-01-10 23:10

  本文關(guān)鍵詞：補(bǔ)腎活血法治療腎虛血瘀型月經(jīng)過少臨床研究　出處：《廣州中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 月經(jīng)過少 腎虛血瘀 補(bǔ)腎活血 分期治療 臨床研究

【摘要】：目的:本研究立足于腎虛血瘀型月經(jīng)過少患者的基本病機(jī)特點(diǎn),順應(yīng)月經(jīng)周期的改變,發(fā)揮中醫(yī)周期分期治法的特色,選擇了在經(jīng)后期以歸腎丸補(bǔ)腎填精、養(yǎng)血調(diào)經(jīng),經(jīng)前及經(jīng)行以桃紅四物湯活血化瘀、養(yǎng)血調(diào)經(jīng)的分期方法治療腎虛血瘀型月經(jīng)過少的女性患者。觀察補(bǔ)腎活血分法在腎虛血瘀型月經(jīng)過少女性中的臨床療效,以探討補(bǔ)腎活血分期法在治療腎虛血瘀型月經(jīng)過少過程中可能存在的機(jī)理。方法:對2015年10月至2016年10月前來銘祥門診求醫(yī)的女性患者,根據(jù)開題調(diào)研過程中選定的中醫(yī)診斷標(biāo)準(zhǔn)確診為月經(jīng)過少,并且中醫(yī)辨證為腎虛血瘀型患者共75例,她們被隨機(jī)分為補(bǔ)腎活血組、補(bǔ)腎組、活血組,根據(jù)不同組別的治療方案,一共服藥3個(gè)月經(jīng)周期。分別記錄治療前、治療后月經(jīng)量及中醫(yī)證候評分,采用治療前后自身對照法及組間對照法,借此探討補(bǔ)腎活血分期法對腎虛血瘀型月經(jīng)過少的臨床療效。結(jié)果:本臨床研究采用為期一年的隨機(jī)對照試驗(yàn)方法,一共為75例符合納入標(biāo)準(zhǔn)的中醫(yī)診斷及辨證為腎虛血瘀型的月經(jīng)過少女性患者進(jìn)行提供了口服的中藥治療,根據(jù)隨機(jī)原則分為3組,并給予不同的治療方案。每組各25例,即分別按照分期治療原則口服歸腎丸及桃紅四物湯,或單純口服歸腎丸或桃紅四物湯,一共需要服藥3個(gè)月經(jīng)周期。1、腎虛血瘀型的月經(jīng)過少女性患者經(jīng)隨機(jī)分組后組間均衡性三組腎虛血瘀型的月經(jīng)過少女性患者在年齡、宮腔操作史及病程等數(shù)據(jù)方面平行性較好。彼此的差異經(jīng)過統(tǒng)計(jì)學(xué)檢驗(yàn)后可以進(jìn)行后續(xù)的進(jìn)一步評估比較(p0.05)。納入研究的腎虛血瘀型的月經(jīng)過少女性患者各不同組間年齡比較:入選補(bǔ)腎活血組患者最小年齡24歲,最大37歲,平均31.00±4.12歲;而進(jìn)入補(bǔ)腎組的腎虛血瘀型的月經(jīng)過少女性患者中年齡最小25歲,最大36歲,平均30.56±3.04歲;進(jìn)入活血組的腎虛血瘀型的月經(jīng)過少女性患者中年齡最小24歲,最大36歲,平均30.36±4.00 歲。進(jìn)入補(bǔ)腎活血組的腎虛血瘀型的月經(jīng)過少女性患者病程最短5個(gè)月,最長36個(gè)月,平均20.12±9.52月;而進(jìn)入補(bǔ)腎組的腎虛血瘀型的月經(jīng)過少女性患者中病程最短6個(gè)月,最長35個(gè)月,平均19.64±9.27月。進(jìn)入活血組的腎虛血瘀型的月經(jīng)過少女性患者中病程最短5個(gè)月,最長35個(gè)月,平均19.65±9.33月。進(jìn)入補(bǔ)腎活血組的腎虛血瘀型的月經(jīng)過少女性患者有15例曾有宮腔操作,而進(jìn)入補(bǔ)腎組的腎虛血瘀型的月經(jīng)過少女性患者中接受過宮腔操作的女士有17位。進(jìn)入活血組的腎虛血瘀型的月經(jīng)過少女性患者中有16位接受過宮腔操作。進(jìn)入補(bǔ)腎活血組的腎虛血瘀型的月經(jīng)過少女性患者經(jīng)量平均積分為7.08±1.47,經(jīng)色、質(zhì)平均積分為3.24±2.27,經(jīng)行時(shí)間平均積分為4.08±1.47,總積分為12.12±6.73;而進(jìn)入補(bǔ)腎組的腎虛血瘀型的月經(jīng)過少女性患者經(jīng)量平均積分為7.08±1.46,經(jīng)色、質(zhì)平均積分為3.12±2.37,經(jīng)行時(shí)間平均積分為3.96±1.43,總積分為11.88±7.67;進(jìn)入活血組的腎虛血瘀型的月經(jīng)過少女性患者經(jīng)量平均積分為7.32±1.52,經(jīng)色、質(zhì)平均積分為3.12±2.52,經(jīng)行時(shí)間平均積分為4.32±1.52,總積分為12.72±7.76。進(jìn)入補(bǔ)腎活血組的腎虛血瘀型的月經(jīng)過少女性患者腰酸足跟痛積分為5.52±2.40,耳鳴耳聾積分為1.20±1.50,性欲減退積分為0.72±1.31,五心煩熱積分為3.12±1.83,小腹刺痛積分為2.52±2.40,總積分為13.44±6.93;而進(jìn)入補(bǔ)腎組的腎虛血瘀型的月經(jīng)過少女性患者腰酸足跟痛積分為6.00±2.60,耳鳴耳聾積分為1.56±1.53,性欲減退積分為0.60±1.22,五心煩熱積分為2.52±2.69,小腹刺痛積分為3.00±2.60,總積分為13.68±7.45;進(jìn)入活血組的腎虛血瘀型的月經(jīng)過少女性患者腰酸足跟痛積分為5.52±2.55,耳鳴耳聾積分為1.68±1.52,性欲減退積分為0.24±0.83,五心煩熱積分為3.24±2.11,小腹刺痛積分為2.52±2.55,總積分為 14.28±5.83。三組腎虛血瘀型的月經(jīng)過少女性患者以上數(shù)據(jù)統(tǒng)計(jì)后差異均衡性好,無統(tǒng)計(jì)學(xué)意義,可以進(jìn)行下一步比較(p0.05)。2、腎虛血瘀型的月經(jīng)過少女性患者治療前后自身比較進(jìn)入補(bǔ)腎活血組的月經(jīng)過少的女性患者在接受補(bǔ)腎活血分期治療后,經(jīng)量增多,經(jīng)色、質(zhì)明顯改善,經(jīng)行時(shí)間延長,月經(jīng)量總體情況明顯較治療前改善,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05);進(jìn)入補(bǔ)腎組的月經(jīng)過少的女性在接受月經(jīng)全周期單純服用歸腎丸后,經(jīng)量增多,經(jīng)色、質(zhì)明顯改善,經(jīng)行時(shí)間延長,月經(jīng)量總體情況明顯較治療前改善,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05);進(jìn)入活血組的月經(jīng)過少的女性在接受月經(jīng)全周期單純服用桃紅四物湯后,經(jīng)量增多、經(jīng)行時(shí)間延長明顯較治療前改善,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),但是經(jīng)色、質(zhì)并沒有明顯改善,月經(jīng)量總積分與治療前相比無明顯差異(P0.05)。進(jìn)入補(bǔ)腎活血組的月經(jīng)過少的女性患者在接受補(bǔ)腎活血分期治療后,腰酸足痛、耳鳴耳聾、五心煩熱、小腹刺痛、中醫(yī)證候總體情況明顯較治療前改善,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),但是性欲減退方面和治療前比較差別不明顯(P0.05);進(jìn)入補(bǔ)腎組的月經(jīng)過少的女性在接受月經(jīng)全周期單純服用歸腎丸后,腰酸足痛、耳鳴耳聾、五心煩熱、小腹刺痛、中醫(yī)證候總體情況明顯較治療前改善,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),但是性欲減退方面和治療前比較差別不明顯(P0.05);進(jìn)入活血組的月經(jīng)過少的女性在接受月經(jīng)全周期單純服用桃紅四物湯后,腰酸足痛、五心煩熱、小腹刺痛、中醫(yī)證候總體情況明顯較治療前改善,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),但是耳鳴耳聾、性欲減退方面和治療前比較差別不明顯(P0.05)。3、治療后三組腎虛血瘀型的月經(jīng)過少女性患者比較三組腎虛血瘀型月經(jīng)過少的女性患者在接受治療3個(gè)月經(jīng)周期后,在經(jīng)量改善方面,補(bǔ)腎活血組補(bǔ)腎組活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05);在經(jīng)色、質(zhì)改善方面,補(bǔ)腎活血組及補(bǔ)腎組均優(yōu)于活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),前兩者之間卻無明顯差異(P0.05);在延長經(jīng)行時(shí)間方面,補(bǔ)腎活血組及補(bǔ)腎組均優(yōu)于活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),前兩者之間卻無明顯差異(P0.05);綜合評估總積分,在總體月經(jīng)量評估改善方面,補(bǔ)腎活血組補(bǔ)腎組活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05)。三組腎虛血瘀型月經(jīng)過少的女性患者在接受治療3個(gè)月經(jīng)周期后,在腰酸足痛改善方面,補(bǔ)腎活血組及補(bǔ)腎組均優(yōu)于活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),前兩者之間卻無明顯差異(P0.05);在耳鳴耳聾改善方面,補(bǔ)腎活血組及補(bǔ)腎組均優(yōu)于活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),前兩者之間卻無明顯差異(P0.05);在性欲減退方面,無論接受哪種治療方案,彼此之間都沒有明顯差別,都沒有明顯改善(P0.05);在五心煩熱改善方面,三種治療方案效果類似(P0.05);在小腹刺痛方面,補(bǔ)腎活血組及活血組均優(yōu)于補(bǔ)腎組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05),前兩者之間卻無明顯差異(P0.05);綜合評估總積分,在總體中醫(yī)證候改善方面,補(bǔ)腎活血組補(bǔ)腎組=活血組,差異經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有意義(P0.05)。結(jié)論:1、腎虛血瘀型月經(jīng)過少患者的中醫(yī)證候的癥狀表現(xiàn)主要包括"腰酸足痛"、"耳鳴耳聾"、"五心煩熱"、"小腹刺痛",而"性欲減退"表現(xiàn)不明顯。2、在改善月經(jīng)量總體情況方面,補(bǔ)腎活血分期法和全周期單純補(bǔ)腎法均能明顯改善腎虛血瘀型月經(jīng)過少患者的經(jīng)量,經(jīng)色、質(zhì)、經(jīng)行時(shí)間,補(bǔ)腎活血分期法在增加月經(jīng)量方面更具有優(yōu)勢;而全周期單純活血法可改善經(jīng)量增多、經(jīng)行時(shí)間延長,對經(jīng)色、質(zhì)改善不明顯。3、在改善腎虛血瘀型月經(jīng)過少女性患者中醫(yī)證候各方面,補(bǔ)腎活血分期法能明顯改善腰酸足痛、耳鳴耳聾、五心煩熱、小腹刺痛;全周期單純補(bǔ)腎法能明顯改善腰酸足痛、耳鳴耳聾,在改善五心煩熱。小腹刺痛方面較弱;全周期單純活血法可改善腰酸足痛、五心煩熱、小腹刺痛,對耳鳴耳聾、性欲減退無明顯干預(yù)。3、補(bǔ)腎活血分期法在綜合改善腎虛血瘀型月經(jīng)過少患者的月經(jīng)量、色、質(zhì)、經(jīng)行時(shí)間、中醫(yī)證候各方面均有明顯優(yōu)勢。
[Abstract]:Objective: This study based on the characteristics of the basic pathogenesis in patients with kidney deficiency and blood stasis type of menstruation, menstrual cycle with the change of TCM cycle therapy characteristics, selected in the late with Guishen Pill Bushentianjing, nourishing menstruation, premenstrual and menstrual blood stasis with Taohongsiwu Decoction live, female patients with stage method for the treatment of kidney deficiency and blood stasis nourishing menstruation menstruation. Observation of Bushen Huoxue method had the clinical curative effect of women in the menstrual blood stasis, in order to investigate the mechanism of Bushen Huoxue staging method in the treatment of kidney deficiency and blood stasis menstruation may exist in the process. Methods: from October 2015 to October 2016 to come to the clinic for treatment of female patients with min-shian the diagnosis according to the diagnostic standard of Chinese medicine research in the process of the selected topic and menstruation, TCM syndrome of kidney deficiency and blood stasis patients were 75 cases, they were randomly divided into kidney activating blood group, supplementation Kidney group, blood group, according to the different treatment groups, a total of 3 menstrual cycles. The medication were recorded before treatment, after the treatment of menstruation and TCM syndrome scores before and after treatment, using self-control method and group control method, so as to explore the clinical curative effect of Bushen Huoxue Method on the staging of kidney deficiency and blood stasis of hypomenorrhea. Results the clinical study with randomized controlled trials for a year, a total of 75 patients met the inclusion criteria of TCM diagnosis and syndrome differentiation of kidney deficiency and blood stasis type in patients with menorrhagia who provide oral treatment of traditional Chinese medicine, according to the principle of random divided into 3 groups and given different treatment. Each group had 25 cases. Namely, in accordance with the principle of oral Guishen Pill in the treatment of stage and Taohong Siwu Decoction, or simple oral Guishen Pill or Taohong Siwu Decoction, a total of 3 menstrual cycles need medication.1, kidney deficiency and blood stasis type of patients with menorrhagia girl Machine group between the two groups of three groups of kidney deficiency and blood stasis period female patients in the data age, history of uterine cavity operation and course etc. parallel better. Their differences through statistical tests can be carried out after further evaluation of follow-up comparison (P0.05). In kidney deficiency and blood stasis type of period women patients in different groups of age: selected minimum age of Bushen Huoxue group were 24 years old, the oldest 37 years old, average 31 + 4.12 years; kidney deficiency and blood stasis into kidney group period female patients aged from 25 years old to 36 years, average 30.56 + 3.04 years; kidney deficiency and blood stasis into blood group the girl had menstruation in patients with at least 24 years of age, 36 years, an average of 30.36 + 4 years. Kidney deficiency and blood stasis into Bushen Huoxue group of menorrhagia women patients with the shortest duration of 5 months, the longest 36 months, an average of 20.12 + 9.52 months; and Kidney deficiency and blood stasis group into the kidney period female patients had the shortest duration of 6 months, the longest 35 months, an average of 19.64 + 9.27 months. Blood stasis into blood group period female patients had the shortest duration of 5 months, the longest 35 months, an average of 19.65 + 9.33 June. Up into the kidney deficiency and blood stasis group of the kidney and promoting blood circulation period female patients 15 cases had uterine cavity operation, blood stasis and tonifying the kidney into group period underwent uterine cavity operation in patients with MS girls 17. Kidney deficiency and blood stasis group into Huoxue period women in 16 patients who underwent intrauterine operation. Blood stasis into Bushen Huoxue group of menorrhagia women patients with average score was 7.08 + 1.47, the color, quality average score was 3.24 + 2.27, the average score was 4.08 + 1.47, the total score was 12.12 + 6.73; enter the kidney tonifying kidney group The girl had menstrual deficiency and blood stasis type of patients with the average score was 7.08 + 1.46, the color, quality average score was 3.12 + 2.37, the average score was 3.96 + 1.43, the total score was 11.88 + 7.67; kidney deficiency and blood stasis type into the blood group menorrhagia women were divided into 7.32. 1.52, the amount of the product color, the average quality score was 3.12 + 2.52, the average score was 4.32 + 1.52, the total score of kidney deficiency and blood stasis type 12.72 + 7.76. into the Bushenhuoxue group the menorrhagia women patients back heel pain score was 5.52 + 2.40, 1.20 + 1.50 points for tinnitus and deafness, sexual desire impairment score was 0.72 + 1.31, Fanre score was 3.12 + 1.83, 2.52 + 2.40 points for the abdominal pain, the total score was 13.44 + 6.93; kidney deficiency and blood stasis and into the kidney group after female patients back heel pain score was 6 + 2.60, 1.56 + 1.53 points for tinnitus and deafness, sexual desire Impairment score was 0.60 + 1.22, Fanre score was 2.52 + 2.69, 3 + 2.60 points for the abdominal pain, the total score was 13.68 + 7.45; kidney deficiency and blood stasis group into Huoxue period female patients back heel pain score was 5.52 + 2.55, 1.68 + 1.52 points for tinnitus and deafness, hyposexuality integral 0.24 + 0.83, Fanre score was 3.24 + 2.11, 2.52 + 2.55 points for the abdominal pain, the total score was 14.28 + three 5.83. group of kidney deficiency and blood stasis type of patients with menorrhagia girl after the statistical data above a well balanced difference, no statistical significance can proceed to the next step is (P0.05).2, female patients with kidney deficiency and blood stasis type after menstruation before and after treatment of the patient's own girl to compare the Bushenhuoxue group too little in Bushen Huoxue stage after treatment, an increase in the volume, color, quality improved significantly, the prolonged menstruation was significantly higher than the overall situation of governance Before treatment, with statistical significance (P0.05); menstruation into Bushen group too few women in the menstrual cycle for simply taking Guishen Pill, an increase in the volume, color, quality improvement, the time prolonged, the overall situation of menstruation was significantly improved compared with before treatment, with statistical there is significance (P0.05); menstruation into Huoxue group too little acceptance of women in menstrual cycle treated with Taohong Siwu Decoction, an increase in the volume, the time was significantly improved compared with before treatment, with statistical significance (P0.05), but the color, quality has not improved significantly, the total amount of menstrual integral compared with before treatment had no significant difference (P0.05). Women with menstrual in Bushen Huoxue group too little in an Bushenhuoxue stage after treatment, backache, foot pain, tinnitus and deafness, five upset hot, abdomen stabbing pain, the overall situation of TCM symptom treatment Before treatment, with statistical significance (P0.05), but the loss of libido and compared to that before treatment the difference was not significant (P0.05); menstruation into Bushen group too few women in the menstrual cycle for simply taking Guishen Pill, backache, foot pain, tinnitus and deafness, five upset hot, abdominal pain, general TCM syndrome was significantly improved compared with before treatment, with statistical significance (P0.05), but the loss of libido and compared to that before treatment the difference was not significant (P0.05); menstruation into Huoxue group too little acceptance of women in menstrual cycle treated with Taohong Siwu Decoction, backache podalgia, Fanre, lower abdomen the general situation of pain, TCM syndrome was significantly improved compared with before treatment, with statistical significance (P0.05), but the tinnitus and deafness, loss of libido and after treatment no significant difference (P0.05.3), the three groups after treatment of kidney deficiency and blood stasis Women with menorrhagia women compared three groups of patients with kidney deficiency and blood stasis in the treatment of hypomenorrhea after 3 menstrual cycles, the amount of improvement, Bushen Huoxue group Bushen Huoxue group group, with statistical significance (P0.05); in the color, quality improvement, Bushen Huoxue group and Bushen group are better than that of Huoxue group, with statistical significance (P0.05), but no significant difference between them (P0.05); in prolonging the time, Bushen Huoxue group and Bushen Huoxue group were better than the group, with statistical significance (P0.05), but no significant difference between them (P0.05) comprehensive evaluation; total integral, improvement in the overall assessment of menstruation, Bushen Huoxue group group Bushen Huoxue group, with statistical significance (P0.05). The three groups of female patients with kidney deficiency and blood stasis in the treatment of hypomenorrhea after 3 menstrual cycles, in the back Foot pain improvement, Bushen Huoxue group and Bushen Huoxue group were better than the group, with statistical significance (P0.05), but no significant difference between them (P0.05); the improvement in tinnitus and deafness, Bushen Huoxue group and Bushen Huoxue group were better than that of group differences by statistical significance testing (P0.05 between the two), but no significant difference (P0.05); the loss of libido, no matter what kind of accepted treatment, there was no difference between each other, there is no obvious improvement (P0.05); the improvement in five upset hot, three kinds of treatment was similar effect (P0.05); in the lower abdomen pain, kidney blood group and Huoxue group was better than the kidney group, with statistical significance (P0.05), but no significant difference between them (P0.05); a comprehensive assessment of the total score, the improvement of syndrome of TCM in general, Bushen Huoxue group Bushen Huoxue group = group, with statistical difference. Test with significance (P0.05). Conclusion: 1. The symptoms of TCM syndrome of kidney deficiency and blood stasis patients with hypomenorrhea include "backache podalgia", "tinnitus and deafness", "five upset hot", "belly pain", and "Libido" performance is not obvious in.2, improve the overall situation of menstruation hand, Bushenhuoxue staging method and full cycle pure tonifying kidney can significantly improve patients with kidney deficiency and blood stasis type hypomenorrhea by volume, color, quality, the time, Bushenhuoxue staging method has more advantages in increasing the amount of menstrual cycle; and Huoxue method can be improved by the increase of the amount of the time, to improve the quality, color, no obvious improvement in.3, kidney deficiency and blood stasis after the female patients with TCM syndrome, Bushen Huoxue staging method can significantly improve the back foot pain, tinnitus and deafness, five upset hot, full belly pain; simple cycle tonifying kidney can significantly improve the back foot pain, tinnitus and ear Deaf, hot trouble in improving five. Alvine weak cycle tingling; simple circulation can improve the back foot pain, five upset hot, the lower abdomen pain, loss of libido of tinnitus and deafness, without significant intervention,.3, menstrual Bushenhuoxue staging method in comprehensive improvement of kidney deficiency and blood stasis hypomenorrhea color, quality, by for each time, TCM has obvious advantages.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R271.111

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