阳痿的临床证型与教科书证型的对比分析

发布时间：2018-10-13 07:09

【摘要】：目的：对于男科疾病阳痿,境外中医内科学教材中的证型,与我们在临床上观察到的证型有较大区别,大部分教材把命门火衰列为第一位,亦无提到各证型的发病比例,而且很多证型没有涉及。笔者于2011至2013年,在徐福松教授指导下,在江苏省中医院名医堂的男科专家门诊收集40例阳痿病患,并整理数据,分析阳痿主要临床证型,与主要的5本当代中医内科学教材(境外英语版)做对照比较分析,找出区别及发现需要改进之处,继而探讨国际中医教育。方法：教材与临床的两组数据使用两种方法。第一阶段：1.系统的收集及记录5本中医内科学(境外生用)中对于阳痿的分型。辨证分型方法遵循书中辨证方法。2.系统的整理阳痿的40例临床病例数据,在徐福松老师指导下完成。纳入标准：病人主诉无法维持勃起或勃起困难。纳入标准后的病人以中医四诊舌、脉及主诉症状等区分证型。第二阶段：把数据标准化,整理,统计,分析,比较。结果：通过统计后,发现在5本境外中医内科学教材中,共有10种阳痿证型,最常见的教科书证型为肾阳虚(命门火衰),出现率为100%,及肝气郁滞(100%),湿热下注(100%),其次是心脾两虚(80%),惊恐伤肾(60%),心胆气虚(20%),肾阴虚(阴虚火旺)20%,肾精亏虚(20%),寒凝血滞(20%),以及寒滞肝脉占20%。从临床收集的40组病例数据分析来看,总见8种证型,最常见的临床证型是肾阴虚(阴虚火旺),约70%,其次是肝郁气滞,约32.5%,湿热下注患者占27.5%,痰浊阻滞者为12.5%,命门火衰为12.5%,心脾两虚为10%,惊恐伤肾为7.5%,血脉瘀滞者为2.5%。还有许多患者是两种及两种以上的复合证型。40例病患中14例为单一证型,26例为复合证型。平均每个患者患有1.75个证型。在复合证型中统计,阴虚火旺+肝郁气滞组合最多,约占20%,阴虚火旺+湿热下注组合占15%,阴虚火旺+命门火衰组合占7.5%,痰湿阻滞+心脾两虚占7.5%,阴虚火旺+命门火衰+湿热下注组合占5%,湿热下注+惊恐伤肾组合5%,湿热下注+肝气郁滞组合占2.5%,湿热下注+血脉瘀滞组合占2.5%。结论：分析比较了教材与临床的数据,我们发现临床中确有一些证型并没有被大多数教材包含在内,如阴虚火旺,痰湿阻滞,血脉瘀滞,而这三种证型(所占比例分别为70%、12.5%及2.5%)。而临床收集的40例阳痿病患中未见心胆气虚,寒滞肝脉,寒凝血滞,肾精亏虚这几种教科书中提到的证型,可能与样本较小有关,但在另一方而也说明了这几种证型在临床中不太常见。通过分析教科书证型,我们发现肝气郁滞,湿热下注,心脾两虚,惊恐伤肾这几种证型为多数教材的重要证型,特别是命门火衰,是多数中医内科学教材提及的首要证型,但却不是临床的主要证型。值得一提的是,肾阴虚在临床中占主导地位,不管是单一证型还是复合证型。但仅在一本教材中内科学教材中有所涉及。
[Abstract]:Objective: for impotence in andrology, the syndromes in the textbooks of Chinese medicine abroad are quite different from those we have observed in clinic. And many card types are not involved. From 2011 to 2013, under the guidance of Professor Xu Fusong, 40 patients with impotence were collected from the Department of andrology in the famous Hospital of traditional Chinese Medicine of Jiangsu Province, and the main clinical syndrome types of impotence were analyzed. This paper compares and analyses with 5 main textbooks of contemporary Chinese medicine (foreign English version), finds out the differences and finds out the points that need to be improved, and then probes into the international education of traditional Chinese medicine. Methods: two methods were used for teaching materials and two groups of clinical data. The first stage: 1. Systematic collection and recording of 5 TCM internal medicine (foreign raw use) for impotence classification. The method of syndrome differentiation and classification follows the method of syndrome differentiation in the book. 2. Systematic collation of 40 cases of impotence data, under the guidance of Xu Fusong. Inclusion criteria: the patient's main complaint is unable to maintain an erection or erectile difficulty. The patients included in the standard were divided into syndromes by TCM four-diagnosis tongue, pulse and main complaint symptoms. The second stage: data standardization, collation, statistics, analysis, comparison. Results: after statistics, 10 types of impotence syndrome were found in 5 foreign textbooks of traditional Chinese medicine. The most common type of textbook syndrome is deficiency of kidney yang (senility of Shengmen fire), occurrence rate of 100, stagnation of liver qi (100%), betting on dampness and heat (100%), deficiency of heart and spleen (80%), panic injury of kidney (60%), deficiency of heart and gallbladder qi (20%), deficiency of kidney yin (fire of yin deficiency) (20%), deficiency of kidney essence (20%), deficiency of cold and blood coagulation (20%). Stagnation (20%) and cold stagnation of the liver accounted for 20%. According to the data analysis of 40 groups of cases collected in clinic, there are 8 syndrome types. The most common clinical syndrome type is kidney yin deficiency (Yin deficiency and fire flourishing), about 70 cases, followed by liver stagnation and qi stagnation. About 32.5, the patients with dampness and heat were 27.5am, those with phlegm and turbid block were 12.5, those with dampness and spleen were 12.5, the patients with deficiency of heart and spleen were 10, the patients with panic injury and kidney were 7.5 and those with blood stasis were 2.5. There were also many patients with two or more types of complex syndrome, 14 of 40 patients with single syndrome type and 26 with complex syndrome type. The average patient had 1.75 syndrome types. According to statistics, the combination of Yin deficiency, fire, liver depression and qi stagnation is the most. About 20%, 15% of Yin deficiency Fire, 15% of Yin deficiency Fire, 7.5 of Yin-deficiency Fire, 7.5 of Fire failure, 7.5 of phlegm and dampness Block, 7.5 of deficiency of Heart and spleen, 5 of Yin deficiency of Fire, 5 of Dish and Heat, and 5 of panic injury Kidney. The combination of damp-heat injection and stagnation of liver qi accounted for 2.5%, and the combination of damp-heat injection and blood stasis accounted for 2.5%. Conclusion: by analyzing and comparing the data of teaching materials with clinical data, we find that there are some syndrome types in clinic that are not included in most textbooks, such as Yin deficiency and fire, phlegm dampness block, blood stasis, and these three syndromes (70% 12.5% and 2.5% respectively). However, in the 40 cases of impotence collected clinically, the syndrome types mentioned in the textbooks, such as deficiency of heart and gallbladder qi, cold stagnation of liver vein, cold coagulation and blood stagnation, deficiency of kidney essence, may be related to the smaller sample. But in the other side it also shows that these syndrome types are not very common in clinical practice. Through the analysis of textbook syndrome types, we found that liver qi stagnation, damp-heat betting, deficiency of heart and spleen, and panic injury and kidney are the most important syndromes in most teaching materials, especially the failure of the fire in Shengmen, which are the primary syndromes mentioned in most teaching materials of traditional Chinese medicine. But it is not the main type of clinical syndrome. It is worth mentioning that kidney yin deficiency plays a dominant role in clinical practice, regardless of single syndrome or complex syndrome. However, only one textbook in the teaching of internal medicine has been involved.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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