补肾活血法治疗肾虚血瘀型月经过少临床研究

发布时间：2018-01-10 23:10

本文关键词：补肾活血法治疗肾虚血瘀型月经过少临床研究　出处：《广州中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:本研究立足于肾虚血瘀型月经过少患者的基本病机特点,顺应月经周期的改变,发挥中医周期分期治法的特色,选择了在经后期以归肾丸补肾填精、养血调经,经前及经行以桃红四物汤活血化瘀、养血调经的分期方法治疗肾虚血瘀型月经过少的女性患者。观察补肾活血分法在肾虚血瘀型月经过少女性中的临床疗效,以探讨补肾活血分期法在治疗肾虚血瘀型月经过少过程中可能存在的机理。方法:对2015年10月至2016年10月前来铭祥门诊求医的女性患者,根据开题调研过程中选定的中医诊断标准确诊为月经过少,并且中医辨证为肾虚血瘀型患者共75例,她们被随机分为补肾活血组、补肾组、活血组,根据不同组别的治疗方案,一共服药3个月经周期。分别记录治疗前、治疗后月经量及中医证候评分,采用治疗前后自身对照法及组间对照法,借此探讨补肾活血分期法对肾虚血瘀型月经过少的临床疗效。结果:本临床研究采用为期一年的随机对照试验方法,一共为75例符合纳入标准的中医诊断及辨证为肾虚血瘀型的月经过少女性患者进行提供了口服的中药治疗,根据随机原则分为3组,并给予不同的治疗方案。每组各25例,即分别按照分期治疗原则口服归肾丸及桃红四物汤,或单纯口服归肾丸或桃红四物汤,一共需要服药3个月经周期。1、肾虚血瘀型的月经过少女性患者经随机分组后组间均衡性三组肾虚血瘀型的月经过少女性患者在年龄、宫腔操作史及病程等数据方面平行性较好。彼此的差异经过统计学检验后可以进行后续的进一步评估比较(p0.05)。纳入研究的肾虚血瘀型的月经过少女性患者各不同组间年龄比较:入选补肾活血组患者最小年龄24岁,最大37岁,平均31.00±4.12岁;而进入补肾组的肾虚血瘀型的月经过少女性患者中年龄最小25岁,最大36岁,平均30.56±3.04岁;进入活血组的肾虚血瘀型的月经过少女性患者中年龄最小24岁,最大36岁,平均30.36±4.00 岁。进入补肾活血组的肾虚血瘀型的月经过少女性患者病程最短5个月,最长36个月,平均20.12±9.52月;而进入补肾组的肾虚血瘀型的月经过少女性患者中病程最短6个月,最长35个月,平均19.64±9.27月。进入活血组的肾虚血瘀型的月经过少女性患者中病程最短5个月,最长35个月,平均19.65±9.33月。进入补肾活血组的肾虚血瘀型的月经过少女性患者有15例曾有宫腔操作,而进入补肾组的肾虚血瘀型的月经过少女性患者中接受过宫腔操作的女士有17位。进入活血组的肾虚血瘀型的月经过少女性患者中有16位接受过宫腔操作。进入补肾活血组的肾虚血瘀型的月经过少女性患者经量平均积分为7.08±1.47,经色、质平均积分为3.24±2.27,经行时间平均积分为4.08±1.47,总积分为12.12±6.73;而进入补肾组的肾虚血瘀型的月经过少女性患者经量平均积分为7.08±1.46,经色、质平均积分为3.12±2.37,经行时间平均积分为3.96±1.43,总积分为11.88±7.67;进入活血组的肾虚血瘀型的月经过少女性患者经量平均积分为7.32±1.52,经色、质平均积分为3.12±2.52,经行时间平均积分为4.32±1.52,总积分为12.72±7.76。进入补肾活血组的肾虚血瘀型的月经过少女性患者腰酸足跟痛积分为5.52±2.40,耳鸣耳聋积分为1.20±1.50,性欲减退积分为0.72±1.31,五心烦热积分为3.12±1.83,小腹刺痛积分为2.52±2.40,总积分为13.44±6.93;而进入补肾组的肾虚血瘀型的月经过少女性患者腰酸足跟痛积分为6.00±2.60,耳鸣耳聋积分为1.56±1.53,性欲减退积分为0.60±1.22,五心烦热积分为2.52±2.69,小腹刺痛积分为3.00±2.60,总积分为13.68±7.45;进入活血组的肾虚血瘀型的月经过少女性患者腰酸足跟痛积分为5.52±2.55,耳鸣耳聋积分为1.68±1.52,性欲减退积分为0.24±0.83,五心烦热积分为3.24±2.11,小腹刺痛积分为2.52±2.55,总积分为 14.28±5.83。三组肾虚血瘀型的月经过少女性患者以上数据统计后差异均衡性好,无统计学意义,可以进行下一步比较(p0.05)。2、肾虚血瘀型的月经过少女性患者治疗前后自身比较进入补肾活血组的月经过少的女性患者在接受补肾活血分期治疗后,经量增多,经色、质明显改善,经行时间延长,月经量总体情况明显较治疗前改善,差异经统计学检验有意义(P0.05);进入补肾组的月经过少的女性在接受月经全周期单纯服用归肾丸后,经量增多,经色、质明显改善,经行时间延长,月经量总体情况明显较治疗前改善,差异经统计学检验有意义(P0.05);进入活血组的月经过少的女性在接受月经全周期单纯服用桃红四物汤后,经量增多、经行时间延长明显较治疗前改善,差异经统计学检验有意义(P0.05),但是经色、质并没有明显改善,月经量总积分与治疗前相比无明显差异(P0.05)。进入补肾活血组的月经过少的女性患者在接受补肾活血分期治疗后,腰酸足痛、耳鸣耳聋、五心烦热、小腹刺痛、中医证候总体情况明显较治疗前改善,差异经统计学检验有意义(P0.05),但是性欲减退方面和治疗前比较差别不明显(P0.05);进入补肾组的月经过少的女性在接受月经全周期单纯服用归肾丸后,腰酸足痛、耳鸣耳聋、五心烦热、小腹刺痛、中医证候总体情况明显较治疗前改善,差异经统计学检验有意义(P0.05),但是性欲减退方面和治疗前比较差别不明显(P0.05);进入活血组的月经过少的女性在接受月经全周期单纯服用桃红四物汤后,腰酸足痛、五心烦热、小腹刺痛、中医证候总体情况明显较治疗前改善,差异经统计学检验有意义(P0.05),但是耳鸣耳聋、性欲减退方面和治疗前比较差别不明显(P0.05)。3、治疗后三组肾虚血瘀型的月经过少女性患者比较三组肾虚血瘀型月经过少的女性患者在接受治疗3个月经周期后,在经量改善方面,补肾活血组补肾组活血组,差异经统计学检验有意义(P0.05);在经色、质改善方面,补肾活血组及补肾组均优于活血组,差异经统计学检验有意义(P0.05),前两者之间却无明显差异(P0.05);在延长经行时间方面,补肾活血组及补肾组均优于活血组,差异经统计学检验有意义(P0.05),前两者之间却无明显差异(P0.05);综合评估总积分,在总体月经量评估改善方面,补肾活血组补肾组活血组,差异经统计学检验有意义(P0.05)。三组肾虚血瘀型月经过少的女性患者在接受治疗3个月经周期后,在腰酸足痛改善方面,补肾活血组及补肾组均优于活血组,差异经统计学检验有意义(P0.05),前两者之间却无明显差异(P0.05);在耳鸣耳聋改善方面,补肾活血组及补肾组均优于活血组,差异经统计学检验有意义(P0.05),前两者之间却无明显差异(P0.05);在性欲减退方面,无论接受哪种治疗方案,彼此之间都没有明显差别,都没有明显改善(P0.05);在五心烦热改善方面,三种治疗方案效果类似(P0.05);在小腹刺痛方面,补肾活血组及活血组均优于补肾组,差异经统计学检验有意义(P0.05),前两者之间却无明显差异(P0.05);综合评估总积分,在总体中医证候改善方面,补肾活血组补肾组=活血组,差异经统计学检验有意义(P0.05)。结论:1、肾虚血瘀型月经过少患者的中医证候的症状表现主要包括"腰酸足痛"、"耳鸣耳聋"、"五心烦热"、"小腹刺痛",而"性欲减退"表现不明显。2、在改善月经量总体情况方面,补肾活血分期法和全周期单纯补肾法均能明显改善肾虚血瘀型月经过少患者的经量,经色、质、经行时间,补肾活血分期法在增加月经量方面更具有优势;而全周期单纯活血法可改善经量增多、经行时间延长,对经色、质改善不明显。3、在改善肾虚血瘀型月经过少女性患者中医证候各方面,补肾活血分期法能明显改善腰酸足痛、耳鸣耳聋、五心烦热、小腹刺痛;全周期单纯补肾法能明显改善腰酸足痛、耳鸣耳聋,在改善五心烦热。小腹刺痛方面较弱;全周期单纯活血法可改善腰酸足痛、五心烦热、小腹刺痛,对耳鸣耳聋、性欲减退无明显干预。3、补肾活血分期法在综合改善肾虚血瘀型月经过少患者的月经量、色、质、经行时间、中医证候各方面均有明显优势。
[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.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R271.111

【参考文献】