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高泌乳素血症临床用药规律的中医文献研究及导师李坤寅教授治验总结

发布时间:2018-06-01 12:01

  本文选题:高泌乳素血症 + 中药频次 ; 参考:《广州中医药大学》2017年博士论文


【摘要】:目的:1.通过系统查阅中文数据库,收集、筛选并整理近三十年有关高泌乳素血症的临床研究文献,挖掘其中药处方用药规律,为临床治疗高泌乳素血症提供系统化的用药思路。2.通过三年的跟师学习,抄方并笔录心得,系统总结出导师李坤寅教授治疗高泌乳素血症的用药经验,以飨同道。方法:1.以"高泌乳素血症"、"高催乳素血症"、"闭经溢乳"、"闭经泌乳"为主题词或关键词,在相关期刊论文(CNKI)、维普数据库(VIP)、中国万方数据库全面搜索1986年1月—2016年12月的文献。按照设定的纳入标准、剔除标准,严格筛选文献,并把纳入研究的文献的数据进行规范化:记录文献发表的年份、是否设置对照组、治疗组的样本量、治疗疗程数目、是否合并西药治疗或其他中医特色疗法;重点记录治疗高泌乳素血症的方药组成,对于高泌乳素血症的兼证加减用药,则不予记录。关于中药药名的规范化,及中药归类、归经方法,则参照黄兆胜主编的《中药学》教材(人民卫生出版社,2002年第1版)。利用excel软件建立基本资料数据库、方剂及药物数据库,并按照中药的归类、归经、四气五味等建立子数据库,将所得信息量化录入其中;将其导入至SPSS18.0统计分析软件包中,对数据进行频数分析、聚类分析。2.在跟师学习的过程中,勤于抄方,思考总结,并笔录心得,及时与导师交流学习,从病因病机、辨证思路、用药特色等方面概括导师经验,并通过典型验案,逐层分析其治疗思路。结果:1.临床用药规律的中医文献研究1.1 一般资料本课题收集近三十年(1986年至2016年)的文献,符合纳入标准的文献共计61篇,最早发表于1993年,2016年的文献数量最多,计六篇。其中有36篇在研究过程中设立了对照组,占59.0%。中药治疗组的样本量最少为20例,最多者为366例,样本量为30例者最多见(18%),36.07%的文献样本量在30例-39例之间。55篇文献是采用单方治疗的,其余6篇为辨证论治。所有文献的治疗组均以内服中药为主,65.6%的文献治疗组为纯中药治疗。研究疗程多为3个以内,研究多数以一个月为一疗程,总疗程长度几乎都在6个月以内,以3个月的疗程长度为多见。1.2用药分析纳入的61篇文献,共载有中药107味,总药物频数为717味次,每味中药平均使用6.7味次。每个方剂使用4-26味中药,平均每个方剂使用中药11.75味。1.2.1中药的归类及频次分析107味中药归属到16个类别中,其中归属于补虚药的中药最多味(29味中药,使用频数累计达284次,占总药物频数的39.61%);其次为活血化瘀药(13味中药,频数达75次)。中药种类数排名前五的,还有理气药、清热药、化痰止咳平喘药,分别包括11、10、10味中药,频数依次为55次、58次、29次。中药种类数排名第七、第八、第九的利水渗湿药、消食药、解表药,其使用频数均较高(44次、65次、53次),平均每味中药的使用频数分别为8.8次、16.25次、13.25次。以中药平均使用频数做标准,对比各大类别,平均频数从高到低分别为:消食药、解表药、补虚药、利水渗湿药、清热药、活血化瘀药、理气药、开窍药、收涩药、平肝息风药、化痰止咳平喘药、安神药与化湿药、泻下药与祛风湿药、温里药。1.2.2各类别的高频中药分析分别建立每个类别中药的子数据库,按照使用频次,将该类别的中药从高到低地排序,累积频率超过50%的药物则纳为该类别的高频中药。对于中药总频数少于10次的类别,则不作高频中药分析。最终得出各类别的高频中药统一列出:白芍、当归、甘草、白术、枸杞子、牛膝、郁金、丹参、香附、枳壳、牡丹皮、赤芍、桅子、半夏、山茱萸、茯苓、麦芽、柴胡。补血药的总频数占补虚药这一大类的近半数(41.55%),其次为补气药。1.2.3中药的性味归经分析中药的四气归属,以温性药最多(43味中药,累计频次248),寒性药次之(34味中药,累计频次238),平性药再次之(23味中药,累计频次213)。热性药(4味中药,累计频次9)、凉性药(3味中药,累计频次9)的数量较少。中药的五味归属,以甘味药最多(61味中药,累计频次484),苦味药次之(45味中药,累计频次326),辛味药再次之(40味中药,累计频次275),此三味药累计频次1085次,占85.5%。而酸味药虽仅有8味,其频次却有106次,频数亦不少。淡味药、咸味药、涩味药的种类及频次则较少。中药的归经,以肝经药最多(66味中药,频次534,占总频次61.68%)。其次则为脾经(34味中药,频次342)、肾经(44味中药,频次259),脾经药虽然味数不及肾经药,但使用频次较之高,位居众经第二。再次之为心经(29味中药,频次209)、胃经(32味中药,频次183)。入肝经、脾经、肾经、心经、胃经的药物总频次合计1527,占总数的83.99%。余归经药物的频次则较低。1.2.4整体药物中的高频中药分析按频数从高到低排序,中药频次高于7次(即该种药物的使用频率不低于1%)者,便纳为整体药物中的高频中药:白芍(53味次)、麦芽(49味次)、柴胡(49味次)、当归(47味次)、茯苓(35味次)、甘草(26味次)、香附(25味次)、白术(18味次)、枸杞子(18味次)、牛膝(18味次)、淫羊藿(17味次)、熟地黄(16味次)、牡丹皮(16味次)、菟丝子(15味次)、山茱萸(15味次)、山药(14味次)、山楂(12味次)、郁金(11味次)、丹参(10味次)、赤芍(10味次)、半夏(10味次)、栀子(9味次)、生地黄(8味次)。其中有9味为补虚药,4味清热药,3味活血化瘀药,2味消食药,而补虚药囊括补血药3味、补气药3味。23味高频药物集中在寒性、温性、平性;其味集中于甘、苦、辛、酸,以甘味最多见;主要入肝经、肾经、脾经、心经、胃经,侧重于肝经。将23味高频中药单独制一频次表,按频次从高到低排序,将累计频率达50%的高频中药单独列出,所得组合即成一核心方剂:白芍、麦芽、柴胡、当归、茯苓、甘草。此核心方剂含补血药2味。1.2.5治疗高泌乳素血症中药的聚类分析根据聚类树状图,可得出四个组合:C1:白芍、柴胡、当归、麦芽。C2:白术、甘草、香附、茯苓。C3:淫羊藿、枸杞子、菟丝子、郁金、半夏、山楂、丹参、赤芍、牛膝。C4:牡丹皮、栀子、生地黄、山茱萸、山药、熟地黄。四个聚类组合可分别概括为中医药治疗高泌乳素血症的基本方、肝脾同调之方、补肾活血之方、滋阴下火之方。2.导师李坤寅教授治验总结导师李坤寅教授认为,高泌乳素血症的重要病机是肝肾不调,肾虚而肝郁,在遣方用药时,秉承肝肾同调的大旨,据其兼证,加减化裁;用药常选麦芽、郁金、陈皮、柴胡、白芍、浙贝母、猫爪草、蒲公英等;根据女子所处阶段,循时而用药,分期而调理;不拘泥于一法,伍以西药甲磺酸溴隐亭、维生素B6片等,衷中参西,以期降低病人血清泌乳素水平。结论:1.治疗高泌乳素血症的用药思路及规律:疏肝解郁以治本,结合补肾健脾之法,再配合化湿祛瘀之药以治标,适当添加回乳通经之品。临床上治疗高泌乳素血症,可参考运用基本方(白芍、麦芽、柴胡、当归、茯苓、甘草),并据其证候特点,酌用上述聚类组合的方剂。2.导师李坤寅教授在治疗高泌乳素血症时,谨守病机,肝肾同调,巧用麦芽、郁金、柴胡、白芍、浙贝、蒲公英等特色药,分期调理,衷中贯西,身心同治。
[Abstract]:Objective: 1. through systematic consulting Chinese database, collecting, screening and sorting out the clinical literature about hyperprolactinemia in the last thirty years, excavating the rule of drug use in the prescription of traditional Chinese medicine, providing a systematic way of thinking for the clinical treatment of hyperprolactinemia,.2. through three years of learning from the teacher, copy and record his mind, and systematically sum up the Tutor LI. Professor Kun Yin's experience in the treatment of hyperprolactinemia in the same way. Methods: 1. "hyperprolactinemia", "hyperprolactinemia", "amenorrhea milk", "amenorrhea milk" as the theme or key words, in the Chinese journal full text database (CNKI), VP number base (VIP), the Chinese Wanfang database comprehensive search for January 1986 - December 2016 literature According to the set criteria, eliminate the standard, select the literature strictly, and standardize the data of the literature included in the study: record the year of the published literature, whether the control group is set up, the sample size of the treatment group, the number of treatment courses, the combination of Western medicine treatment or other traditional Chinese medicine treatment, and the prescription for the treatment of hyperprolactinemia. The composition of the medicine will not be recorded for the combination of hyperprolactinemia, the normalization of the name of the Chinese medicine, the classification of Chinese medicine, the classification of traditional Chinese medicine and the method of returning to meridian, refer to the textbook of Chinese pharmacy, compiled by Huang Zhaosheng (people's Health Press, first edition 2002). The basic data database, prescription and drug database are established by using the Excel software, and according to the Chinese medicine database. The classification of the drugs, return to meridian, four Qi and five flavors and so on, set up a sub database to quantify the information and import the information into the SPSS18.0 statistical analysis software package and analyze the data frequency. In the process of learning with the teacher,.2. is diligent in copying, thinking and summarizing and communicating with the tutor in time, from etiology and pathogenesis and syndrome differentiation. Ideas, drug characteristics and other aspects summarized the tutor experience, and through typical cases, analyze the treatment ideas by layer by layer. Results: 1. the 1.1 general data of TCM literature study on the law of clinical medication collected in the literature of nearly thirty years (1986 to 2016), which were in line with the inclusion criteria of 61 articles, the earliest published in 1993, the number of 2016 literature. The maximum amount was six. 36 of them set up a control group in the study process, which accounted for 20 cases in the 59.0%. Chinese medicine treatment group, with the maximum number of 366 cases, the sample size of 30 cases (18%), 36.07% literature sample in the 30 cases between the.55 literature and the other 6 articles for the treatment of syndrome differentiation. All the literatures were treated with syndrome differentiation. The treatment group was given mainly traditional Chinese medicine, and 65.6% of the literature treatment group was treated with pure Chinese medicine. The course of the study was more than 3. Most of the studies were treated with one month, the length of the total course of treatment was almost 6 months, and the length of the course of treatment was more than 61 literature, which included 107 flavors of traditional Chinese medicine, and the frequency of total medicine was 717, with the length of 3 months of treatment. The average use of traditional Chinese medicine is 6.7 times. Each prescription uses 4-26 flavors of traditional Chinese medicine. The average prescription is classified into 16 categories by the classification and frequency analysis of 11.75 flavors of traditional Chinese medicine, 11.75 flavors of traditional Chinese medicine and frequency analysis. Among them, the most flavors belong to the traditional Chinese medicine (29 flavors, 284 times, 39.61% of the total drug frequency). The second is the medicine for activating blood and removing blood stasis (13 traditional Chinese medicine, frequency of 75 times). The number of kinds of Chinese medicine ranks the top five, and there are physical drugs, antipyretic drugs, expectorant antitussive antiasthmatic drugs, including 11,10,10 flavored Chinese medicine respectively, respectively 55 times, 58 times, 29 times. The number of kinds of Chinese medicine ranks seventh, eighth, ninth of the leuditic wetting medicine, digestion and digestion medicine, its frequency of use is higher (44 Times, 65 times, 53 times), the average use frequency of traditional Chinese medicine was 8.8 times, 16.25 times, 13.25 times. The average frequency of traditional Chinese medicine was used as the standard, and the average frequency was compared to the major categories. The average frequency was from high to low. The average frequency of the Chinese medicine was as follows: the digestion medicine, the antipyretic medicine, the antipyretic medicine, the antipyretic medicine, the blood activating medicine, the medicine, the astringent medicine, the relieving medicine, the phlegm and the phlegm. Antitussive and antiasthmatic drugs, anantiotic and humidifying drugs, purging drugs and dispelling wind dampness drugs, the high frequency traditional Chinese medicine analysis of each category of warm medicine.1.2.2 respectively set up the sub database of each category of Chinese medicine. According to the frequency of use, the traditional Chinese medicine of this category is sorted from high to low, and the cumulative frequency of more than 50% is used as the high frequency traditional Chinese medicine of this category. The high frequency traditional Chinese medicine was not analyzed in the category of less than 10 times. Finally, it was concluded that the high frequency traditional Chinese medicine of various categories was listed in the same list: Paeonia lactiflora, angelica, licorice, Alba, Chinese wolfberry, tulip, Salvia miltiorrhiza, Radix Paeoniae, peony root, peony, Pinellia ternata, Fructus Corni, Poria, malt, bupleurum. In addition, the sexual flavor of Chinese medicine.1.2.3 was followed by the four Qi attribution of traditional Chinese medicine, with the most warm medicine (43 flavors of traditional Chinese medicine, 248), the second of the cold sex medicine (34 flavors of traditional Chinese medicine, 238 of the cumulative frequency), the third of the traditional Chinese medicine (23 flavors of traditional Chinese medicine, 213). The number of hot drugs (4 traditional Chinese medicine, 9), and the quantity of cold sex medicine (3 Chinese traditional medicine, 9 frequency 9) Less. The five flavor of traditional Chinese medicine, with the most sweet medicine (61 flavors of traditional Chinese medicine, the cumulative frequency of 484), bitter medicine the second (45 flavors of traditional Chinese medicine, 326), again (40 flavors of traditional Chinese medicine, 275), the cumulative frequency of three drugs 1085 times, and the acid medicine, although only 8, its frequency is 106, a lot of frequency. Mild taste medicine, salty medicine, astringent The type and frequency of the herbal medicine were less. The Chinese medicine was treated with the most medicine (66 flavors, 534, 61.68%). The second was the spleen meridian (34 traditional Chinese medicine, 342), the kidney meridian (44 traditional Chinese medicine, 259), while the spleen meridian was less than the kidney meridian, but the frequency was higher and the number was second. The second was the heart meridian (29 flavors of traditional Chinese medicine, frequency). 209), stomach meridian (32 flavors of traditional Chinese medicine, frequency 183). The total frequency of the drugs into the liver, the spleen meridian, the kidney meridian, the heart meridian and the stomach meridian total the total frequency of 1527, and the frequency of the 83.99%. of the total drugs in the total medicine of the lower.1.2.4 is sorted from high to low by frequency, and the frequency of traditional Chinese medicine is higher than 7 times (that is, the use frequency of this kind of drug is not less than 1%). The high frequency traditional Chinese medicine in the whole medicine: Paeonia lactiflora (53 flavor times), malt (49 flavor), Chinese Angelica (47 times), tuckahoe (35 taste), licorice (26 times), Rhizoma Atractylodes (18 times), Chinese wolfberry (18 times), Achyranthes (18 flavour), epimedium (17 times), Radix Rehmanniae (16), peony (16 taste), dodder (15 taste times), Cornus officinalis, Cornus officinalis (15 times), yam (14 flavor), hawthorn (12 flavors), tulips (11 times), Salvia miltiorrhiza (10 flavors), red peony (10 flavors), pinellia (10 flavors), gardenia (9 times), and Rehmannia (8 flavors). Among them, 9 is supplemental medicine, 4 taste medicine, 3 flavor activating blood stasis medicine, 2 taste elimination medicine, and supplemental medicine including supplementing blood drugs,.23 flavor high frequency medicine concentrated in cold Sexual, warm, flat; its taste is concentrated in Gansu, bitter, symplectic, acid, most common; mainly into the liver, the kidney meridian, the spleen meridian, the heart meridian, the stomach meridian, and focus on the liver meridian. The 23 flavors of high frequency traditional Chinese medicine alone made a frequency list, according to the frequency from high to low, the accumulative frequency of high frequency Chinese medicine is listed separately, the combination is a core prescription: Paeonia lactiflora, malt, Chai This core prescription contains 2 flavors of.1.2.5 for hyperprolactinemia in the cluster analysis of Chinese medicine for hyperprolactinemia, according to the cluster tree chart, we can get four combinations: C1: Paeonia lactiflora, Radix Bupleuri, Radix Angelicae, malt.C2: albai, Glycyrrhiza, Fuling.C3: epimedium, Lycium chinensis, dodder, tulip, pinellia, haw, Radix Salviae, Radix Paeoniae,.C4: Peony Skin, gardenia, rehmannia, Cornus, yam, yam. Four cluster combinations can be summed up as the basic prescription of Chinese medicine for hyperprolactinemia, the prescription of the liver and spleen, the recipe for invigorating the kidney and activating blood, and Professor Li Kunyin, the tutor of Professor Li Hun Yin, the instructor of the fire of Nourishing Yin, that the important pathogenesis of hyperprolactinemia is that the liver and kidney are not adjusted, Kidney deficiency and liver depression, according to the main purpose of the liver and kidney concurrently, according to the essence of the liver and kidney, according to its syndrome, adding and subtraction, the drugs often choose malt, tulips, tangerine, bupleurum, Paeonia, Fritillaria thunbergii, cat claw grass, dandelion, etc. Conclusion: 1. in order to reduce the level of serum prolactin in patients. Conclusion: the thought and law of treating hyperprolactinemia by treating hyperprolactinemia, combining the treatment of stagnation of liver and strengthening the kidney and invigorating the spleen, combined with the medicine of dampness and removing stasis to treat the standard, and appropriately add the medicine to the menstruation of hyperprolactinemia. Hu, angelica, tuckahoe, licorice), and according to the characteristics of its syndrome, Professor Li Kaiyin, the.2. tutor of the combination of the above clustering combination, is in the treatment of hyperprolactinemia, keeping the disease machine, liver and kidney with the same tune, using malt, tulip, bupleurum, Radix Paeoniae, Thunbergi, dandelion and other characteristic drugs.
【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】:R249;R271.9

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