迟发性性腺功能减退症中医证候特点及中西医结合诊疗思路研究

发布时间：2018-05-10 14:22

本文选题：迟发性性腺功能减退症 + 睾酮　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究背景:迟发性性腺功能减退症是一种与年龄增长密切相关的临床综合征,与每一位中老年男性息息相关。迟发性性腺功能减退症可给人体多个系统、器官的功能带来不良影响,严重影响着中老年男性的身心健康和生活质量。现代医学对于迟发性性腺功能减退症患者的治疗主要是睾酮替代治疗。在临床上睾酮替代治疗应用广泛,疗效确切。然而睾酮替代治疗有着诸多的禁忌症,并且会带来诸多的风险。中医药在治疗迟发性性腺功能减退症上存在独特的优势,可有效规避睾酮替代治疗所带来的风险。中西医结合治疗迟发性性腺功能减退症是实际临床工作的需要。研究目的:探讨迟发性性腺功能减退症的中医证候特点及迟发性性腺功能减退症的中西医结合诊疗思路。研究方法:文献研究和临床流行病学调查相结合。通过对男科学教材及专著中迟发性性腺功能减退症不同中医证型出现的频次、文献报道的有关迟发性性腺功能减退症流行病学资料、文献报道的有关迟发性性腺功能减退症中医药诊疗用药进行分析研究;同时通过对中国中医科学院广安门医院男科门诊性欲减退患者进行问卷调查,来把握本病的中医证候特点,为临床诊治提供思路,为本病筛查量表的编撰提供参考。研究结果:1.迟发性性腺功能减退症的核心中医证型:"心肾不交证"、"肝肾阴虚证"、"阴阳两虚证"、"心脾两虚证"、"肾阳亏虚证";2.中医药治疗迟发性性腺功能减退症的三大核心药物:"熟地黄"、"柴胡"、"当归";3.迟发性性腺功能减退症三大核心治疗原则:"补肾"、"疏肝"、"补血活血";4."性欲减退、晨勃或阴茎夜间自发勃起减少、勃起功能障碍"是筛查迟发性性腺功能减退症的"三大核心主症";"缺乏生活激情、体能精力下降"是筛查迟发性性腺功能减退症的"两大关键主症";"乏力、情志不舒、腰膝酸软、自我感觉不佳"是筛查迟发性性腺功能减退症的"四大重要条目"。研究结论:1.迟发性性腺功能减退症"启动因素在肾虚、致病之枢在肝郁、调治关键在气血";2.着眼于迟发性性腺功能减退症"脏腑-证候群"的对应关系,可分别从肾论治性功能减退证候群,从脾论治生理体能证候群,从肝论治情志精神证候群,从心论治血管舒缩证候群;3.中西医结合治疗迟发性性腺功能减退症可实现治疗层次的多样化。将性激素指标融入中医辨证,提高辨证用药准确性;靶向治疗-睾酮替代治疗与整体治疗-辨证论治同行。睾酮水平达到睾酮替代治疗的标准,中医中药可配合睾酮替代治疗作为一线治疗;睾酮水平未达到睾酮替代治疗的标准,中医中药可单独作为迟发性性腺功能减退症的一线治疗;睾酮替代治疗效果不明显或失败时,可改为中医中药治疗。中医中药可贯穿于迟发性性腺功能减退症治疗的始终。
[Abstract]:Background: delayed hypogonadism is a clinical syndrome closely related to age growth and is closely related to every middle-aged and elderly male. Delayed hypogonadism may have adverse effects on the function of organs and affect the physical and mental health and quality of life of middle-aged and aged men. Testosterone replacement therapy is the main treatment of delayed hypogonadism in modern medicine. Testosterone replacement therapy is widely used and effective in clinic. Testosterone replacement therapy, however, has many contraindications and risks. Chinese medicine has a unique advantage in the treatment of delayed hypogonadism, which can effectively avoid the risk of testosterone replacement therapy. It is necessary to treat delayed hypogonadism with combination of traditional Chinese and western medicine. Objective: to explore the characteristics of TCM syndromes of delayed hypogonadism and the thinking of diagnosis and treatment of delayed hypogonadism by combination of traditional Chinese and western medicine. Methods: literature study and clinical epidemiological investigation were combined. According to the frequency of different TCM syndromes of delayed hypogonadism in textbooks and monographs of andrology, the epidemiological data of delayed hypogonadism were reported in the literature. The literature reports on the diagnosis and treatment of delayed hypogonadism were analyzed and studied. At the same time, a questionnaire survey was conducted among the outpatients of andrology in Guang'an Men Hospital, Chinese Academy of traditional Chinese Medicine. To grasp the characteristics of TCM syndromes, to provide ideas for clinical diagnosis and treatment, to provide a reference for the compilation of the screening scale. The result of the study was: 1. The core TCM syndromes of delayed hypogonadism are: "heart and kidney do not cross syndrome", "liver and kidney yin deficiency syndrome", "yin and yang deficiency syndrome", "heart and spleen deficiency syndrome", "kidney yang deficiency syndrome" and "kidney yang deficiency syndrome". Chinese medicine treatment of delayed hypogonadism of three major drugs: "cooked Rehmannia glutinosa", "Bupleurum", "angelica" of the three major drugs. The three core therapeutic principles of delayed hypogonadism are "tonifying the kidney", "soothing the liver" and "tonifying blood and promoting blood circulation". Decreased libido, decreased spontaneous erectile in the morning or penile at night, erectile dysfunction "is the" three core main diseases "in screening for delayed hypogonadism, and" lack of passion for life, " The decline of physical stamina is the "two key main symptoms" in the screening of delayed hypogonadism, and the "four important items" in the screening of delayed hypogonadism are "fatigue, unease of emotion, weakness of waist and knee, and poor feeling of self". Conclusion: 1. Delayed hypogonadism "start factor in kidney deficiency, pathogenic armature in liver depression, the key to the treatment of Qi and blood" 2. Focusing on the corresponding relationship between "zang-fu organs and syndromes" of delayed hypogonadism, we can treat the syndrome groups of hypofunctional sexual function from the kidney, the physiological and physical ability from the spleen, and the emotional and mental syndrome from the liver. Treatment of vasomotor syndrome group by heart. Treatment of delayed hypogonadism with combination of traditional Chinese and western medicine can achieve multiple therapeutic levels. Sex hormone index into TCM syndrome differentiation to improve the accuracy of drug differentiation; targeted therapy-testosterone replacement therapy and holistic treatment-syndrome differentiation. Testosterone level reached the standard of testosterone replacement therapy. Traditional Chinese medicine can be combined with testosterone replacement therapy as the first line treatment. Traditional Chinese medicine can be used as the first line treatment of delayed hypogonadism alone, and if the effect of testosterone replacement therapy is not obvious or failure, it can be changed to traditional Chinese medicine treatment. Traditional Chinese medicine can run through the treatment of delayed hypogonadism.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R697.22

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