田玉美教授治疗不孕症学术思想及临床经验研究

发布时间：2019-06-20 13:41

【摘要】：研究目的本文试从田玉美教授临床多年的验案着手,将搜集得到的医案中的主要症状、证型、处方进行整理,按照要求进行规范化处理,对其进行频数分析、聚类分析、因子分析,以求窥得田玉美教授治疗不孕症的整体思路及用药规律,为后人能够更好地继承田教授的学术思想提供一定的参考与借鉴。研究方法运用excel表格计算舌、脉、经,中药四气、五味、归经以及证型的频数、频率,并运用SPSS21.0统计软件对录入的中药进行聚类分析、因子分析等描述性统计分析。研究结果1、所涉及不孕症的中药药性描述有9种,按照其出现频数的大小,由大到小依次为温(50)、平(37)、寒(32)、微寒(26)、微温(12)、凉(7)、热(4)、大热(2)、大寒(1)。2、所涉及不孕症的中药药味描述有7种,按照其出现频数的大小,由大到小依次为苦(90)、甘(82)、辛(68)、酸(15)、涩(11)、咸(10)、淡(9)。3、将所涉及到的不孕症中药归经整理后,按照其出现频数的大小,由大到小依次为肝(94)、脾(65)、肾(58)、肺(58)、心(50)。4、所涉及到的不孕症中药可分为10类,其占比由大到小依次为补虚药(18%)、清热药(15%)、活血化瘀药(12%)、理气药(7%)、止血药(6%)、解表药(6%)、利水渗湿药(6%)、收涩药(5%)、化痰止咳平喘药(5%)、安神药(4%)、消食药(4%)、祛风湿药(4%)、化湿药(3%)、温里药(3%)、平肝熄风药(2%)、驱虫药(1%)、开窍药(1%)。5、所有涉及到的不孕症中药累计使用的频率,按照中药类别来统计,可得到如下结果,补虚药(38%)、活血化瘀药(12%)、理气药(12%)、清热药(9%)、解表药(5%)、利水渗湿药(4%)、安神药(4%)、温里药(3%)、化痰止咳平喘药(3%)、消食药(3%)、化湿药(2%)、收涩药(2%)、止血药(2%)、祛风湿药(1%)。6、聚类分析结果在距离标尺为24的情况下,录入中药大体被聚为5类,具体为:c1(橘核、荔枝核、青皮、小茴香、延胡索、丹参、香附、麦芽、山楂、益母草);c2(牛膝、桃仁、柴胡、枳壳、赤芍、红花);c3(北沙参、川楝子、当归、麦冬、枸杞子、生地黄、枳实);c4(阿胶、吴茱萸、杜仲、淫羊藿、砂仁、熟地黄、桂枝、牡丹皮、半夏、太子参、陈皮、白术、甘草、白芍、茯苓、川芎);c5(酸枣仁、远志、龙眼肉、木香、茯神、黄芪、党参、山药)。7、因子分析结果(1)肝郁气滞证,可抽取3个主成分进行分析,分别为:f1:橘核、荔枝核、青皮、小茴香、延胡索、香附f2:香附、麦芽、山楂f3:延胡索、丹参、益母草(2)血瘀气滞证,可抽取2个主成分进行分析,分别为:f1:牛膝、桃仁、赤芍、红花f2:柴胡、枳壳(3)肝肾阴虚证,可抽取2个主成分进行分析,分别为:f1:北沙参、当归、麦冬、枸杞子、生地黄f2:川楝子、枳实(4)冲任虚寒证,可抽取5个主成分进行分析,分别为:f1:砂仁、半夏、太子参、陈皮、白术、甘草、茯苓f2:阿胶、吴茱萸、桂枝、牡丹皮、半夏、太子参、甘草、白芍、茯苓、川芎f3:桂枝、牡丹皮、白芍、茯苓f4:杜仲、淫羊藿、熟地黄f5:熟地黄、白芍、川芎(5)肝阴不足、心脾两虚证,可抽取5个主成分进行分析,分别为:f1:酸枣仁、山药f2:酸枣仁、远志、龙眼肉、茯神f3:木香、黄芪、党参、山药。研究结论1、虚乃不孕之本,瘀乃不孕之标。不孕症病机主要还是“虚”、“瘀”。2、在临床诊治不孕症时,大体将其分为五个证型从冲任与肝脾肾的调理方面着手,五证型分别为:肝郁气滞证、血瘀气滞证、肝肾阴虚证、冲任虚寒证、肝阴不足心脾两虚证。3、在临床诊疗过程中,要多注重药物的合理搭配,注意药对的搭配使用,要做到旧药搭配出新用。
[Abstract]:The purpose of this study is to study the main symptoms, syndrome types and prescriptions in the medical case, and to carry out the standardized treatment according to the requirements, and carry out frequency analysis, cluster analysis and factor analysis. In order to see the whole thought and law of the treatment of infertility by Professor Tian Yumei, it can provide some reference and reference for later generations to better inherit the academic thought of Professor Tian. The frequency and frequency of the tongue, vein, meridian, Chinese traditional Chinese medicine four-gas, five-flavor, the return and the syndrome type were calculated by using the excel form, and the statistical analysis was carried out by using the SPSS21.0 statistical software to carry out cluster analysis, factor analysis and other descriptive statistics on the entered Chinese medicine. According to the study result 1,9 kinds of Chinese medicinal properties related to the infertility are described, and according to the size of the frequency of occurrence, the medicinal properties of the traditional Chinese medicine are as follows: the temperature (50), the flat (37), the cold (32), the micro-cold (26), the micro-temperature (12), the cooling (7), the heat (4), the large heat (2) and the large-cold (1). 7 kinds of Chinese medicinal materials for treating the infertility, according to the size of the frequency of occurrence, are bitter (90), sweet (82), symplectic (68), acid (15), astringent (11), salt (10) and light (9) in turn, according to the frequency of occurrence, the liver (94), the spleen (65), the kidney (58), the lung (58) and the heart (50) are arranged in turn from big to small, The invention has the advantages of promoting blood circulation to remove blood stasis (12%), regulating the flow of qi (7%), the hemostatic (6%), the solution (6%), the diuresis and the dampness (6%), the astringent (5%), the phlegm and the cough and the asthma (5%), the tranquillizing agent (4%), the digestion promoting agent (4%), the wind-dispelling and dampness-removing medicine (4%), The frequency of the cumulative use of the traditional Chinese medicine for infertility, which is related to the total use of the traditional Chinese medicine for infertility, can be obtained according to the traditional Chinese medicine category, and the following results can be obtained (38%), Has the effects of promoting blood circulation, removing blood stasis (12%), regulating qi-flowing (12%), clearing away heat, clearing away heat (9%), relieving exterior syndrome (5%), eliminating dampness (4%), tranquilizing, (4%), warming and (3%), resolving phlegm, relieving cough and asthma (3%), promoting digestion (3%), and removing dampness (2%). In the case of 24 cases of distance scale, the results of cluster analysis are as follows: c1 (orange, lychee, green, small, fragrant, corydalis, red-rooted, cyperus, malt, and mountain). (Herba Leonuri); c2 (Achyranthis Radix, Semen Persicae, Bupleuri Radix, Fructus Aurantii, Radix Paeoniae Rubra, and Carthami Flos); c3 (Radix Glehniae, Radix Dipsaci, Radix Angelicae Sinensis, Radix Ophiopogonis, Fructus Lycii, Radix Rehmanniae, and Fructus Aurantii); c4 (Colla Corii Asini, Radix Rehmanniae, Ramulus Cinnamomi, Cortex Moutan, and Rhizoma Pinelliae, Radix Pseudostellariae, Pericarpium Citri Tangerinae, Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae, Radix Paeoniae Alba, Poria, and Radix Dipsaci, and c5 (Semen Ziziphi Spinosae, Radix Polygalae, Arillus Longan, Radix Aucklandiae, Poria, Radix Polygalae, Radix Codonopsis, and Rhizoma Dioscoreae). Semen Litchi, Pericarpium Citri Reticulatae, Fructus Hordei Germinatus, Rhizoma Corydalis, Rhizoma Cyperi, Fructus Hordei Germinatus, and Fructus Hordei Germinatus f3: Rhizoma Corydalis, Saviae Miltiorrhizae Radix, and Herba Leonuri (2) for blood stasis and qi stagnation, and extracting two main components for analysis, respectively: f1: Achyranthis Radix, Semen Persicae, Radix Paeoniae Rubra, and Carthami Flos, and Radix Bupleuri. The liver and kidney yin deficiency syndrome of the bitter orange shell (3) can be analyzed by extracting two main components, namely: f1: radix glehniae, angelica, dwarf lilyturf root, wolfberry fruit, radix rehmanniae f2, and immature bitter orange (4), and 5 main components can be extracted for analysis, respectively: f1: fructus amomi and pinellia ternata, Radix Pseudostellariae, Pericarpium Citri Tangerinae, Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae, Poria, Colla Corii Asini, Radix Pseudostellariae, Ramulus Cinnamomi, Cortex Moutan, Rhizoma Pinelliae, Radix Pseudostellariae, Radix Glycyrrhizae, Radix Paeoniae Alba, Poria, and Bulbus Fritillariae Cirrhosae f3: Ramulus Cinnamomi, Cortex Moutan, Radix Paeoniae Alba, Poria, and Radix Paeoniae Alba, and Radix Rehmanniae Preparata, Radix Rehmanniae Preparata, and Radix Paeoniae Alba, (5) Deficiency of liver yin and deficiency of heart and spleen, and analysis of 5 main components, respectively: f1: Semen Ziziphi Spinosae, Rhizoma Dioscoreae, Semen Ziziphi Spinosae, Radix Polygalae, Arillus Longan, and Poria f3: Radix Aucklandiae, Radix Polygalae, Radix Codonopsis, and Rhizoma Dioscoreae. The conclusion is that the deficiency is the root of the infertility, and the blood stasis is the standard of the infertility. The pathogenesis of the infertility is mainly the "virtual" and the "blood stasis". In the clinical diagnosis and treatment of the infertility, it is divided into five types, namely, the liver-qi stagnation syndrome, the blood stasis and qi stagnation syndrome, the liver and kidney yin deficiency syndrome, and the deficiency cold syndrome. In the course of clinical diagnosis and treatment, we should pay more attention to the rational collocation of the drugs and the combination of the drugs, so that the old medicine should be matched with the new ones.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R271.14

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