多囊卵巢综合征不孕的辨证论治和用药规律研究

发布时间：2019-06-21 18:00

【摘要】：目的:收集及整理近20年有关治疗多囊卵巢综合征(PCOS)不孕的中医文献,探讨现代医家治疗本病的主要证型、治法及其用药规律,为优化中医治疗本病提供理论依据。方法:搜索1996年1月至2015年12月刊登在中国知网、维普数据、中国万方数据库的关于PCOS不孕的中医临床研究文献。对其中的证型分布、治法及药物性味归经等进行统计建立数据库,采用频数统计和聚类分析,总结出PCOS不孕的主要证型、治法及用药规律。结果:经筛选后纳入符合标准文献106篇,共收纳病例4538例,方剂192首,中药136味,共使用1988次。归纳总结出本病的11种中医证型中3种较常见的为肾虚血瘀型38.8%,肾虚痰瘀型22.0%,肾虚痰湿型12.2%。13种不同的治疗方法中3种较常见的为补肾活血法39.3%,补肾祛痰、化瘀通络法18.4%,补肾化痰法10.8%。肾虚血瘀型高频药物为:当归、菟丝子、熟地黄、淫羊藿、丹参、枸杞子、川芎、山药、赤芍、香附、白芍、女贞子,药性以温、平、微温、微寒为主,药味以甘、辛、苦为主,药物归经以肝、肾、脾、心经为主,聚类药物组合为当归-熟地黄,附子-肉桂,红花-桃仁,菟丝子-淫羊藿。肾虚痰瘀型高频药物为:当归、熟地黄、丹参、香附、茯苓、菟丝子、山茱萸、淫羊藿、半夏、山药、赤芍、川芎,药性以温、平、微寒、微温为主,药味以甘、辛、苦为主,药物归经以肝、肾、脾为主,聚类药物组合为茯苓-半夏,桃仁-红花,枸杞子-菟丝子,赤芍-白芍,山药-山茱萸-当归-熟地黄-茯苓-半夏-川芎。肾虚痰湿型高频药物为:茯苓、菟丝子、苍术、陈皮、淫羊藿、续断、山药、半夏、当归、川芎、熟地黄,药性以温、平、微温为主,药物归经以肝、肾、脾为主,药味以辛、甘、苦为主,聚类药物组合为陈皮-半夏,熟地黄-山茱萸-山药,陈皮-半夏-苍术-茯苓。结论:整理文献发现,PCOS不孕的辨证以虚实夹杂为主,多数为在肾虚的基础上兼有血瘀或痰湿或痰瘀并存,其中肾虚血瘀型最常见,此外,单纯实证的患者以肝经郁热型、痰湿内阻型为主。治法以补肾活血为主,药性以温、平为主,药味以味甘、辛、苦为主,归经以肝、肾、脾为主。可见,本病的病机以虚为本,治疗上以补虚为主,兼顾活血化瘀,理气祛痰。
[Abstract]:Objective: to collect and collate the literature on the treatment of (PCOS) sterility in polycystic ovary syndrome (PCOS) in recent 20 years, and to explore the main syndrome types, treatment methods and medication rules of modern doctors in the treatment of PCOS, so as to provide theoretical basis for optimizing the treatment of PCOS. Methods: from January 1996 to December 2015, the Chinese medicine clinical research literature on PCOS sterility published on China knowledge Network, Weipu data and China Wanfang Database was searched. The distribution of syndrome types, treatment methods and drug flavor meridians were statistically established. The main syndrome types, treatment methods and drug use rules of PCOS sterility were summarized by frequency statistics and cluster analysis. Results: after screening, 106 articles in accordance with the standard were included. A total of 4538 cases, 192 prescriptions and 136 traditional Chinese medicines were collected. A total of 1988 times were used. Three of the 11 TCM syndromes of the disease were kidney deficiency and blood stasis type 38.8%, kidney deficiency phlegm stasis type 22.0%, kidney deficiency phlegm dampness type 12.2%. Among the 13 different treatment methods, the common treatment methods were tonifying kidney and activating blood circulation (39.3%), tonifying kidney and dispelling phlegm, removing blood stasis and dredging collaterals (18.4%) and tonifying kidney and removing phlegm (10.8%). The high frequency drugs of kidney deficiency and blood stasis type were Angelica sinensis, Cuscuta chinensis, Rehmannia glutinosa, Herba Epimedii, Salvia miltiorrhiza, Lycium barbarum, Ligusticum chuanxiong, Yam, Radix Paeoniae Rubra, Xiangfu, Paeonia lactiflora, Ligustrum lucidum, warm, flat, slightly warm, slightly cold, Gan, Xin and bitter, the drugs were mainly liver, kidney, spleen, heart meridians, and cluster drugs were Angelica-cooked Rehmannia glutinosa, aconite cinnamon, safflower peach kernel, dodder seed-Epimedium. The high frequency drugs of kidney deficiency and phlegm stasis type are: Angelica sinensis, Rehmannia glutinosa, Salvia miltiorrhiza, Xiangfu, Poria, dodder, Cornus officinalis, Herba Epimedii, Pinellia ternata, Chinese yam, Radix Paeoniae Rubra, Ligusticum chuanxiong, mainly warm, flat, slightly cold, slightly warm, Gan, Xin, bitter, drugs classified as liver, kidney, spleen, Poria paniculata, peach kernel safflower, Lycium barbarum Cuscuta, Radix Paeonia lactiflora, Radix Paeonia lactiflora, Yam, Cornus officinalis, Angelica sinensis, Rehmannia glutinosa, Poria, Pinellia ternata and Ligusticum chuanxiong. Kidney deficiency phlegm dampness type of high frequency drugs are: Poria, dodder, Atractylodes macrocephala, Herba Epimedii, Dioscorea opposita, Pinellia ternata, Angelica sinensis, Ligusticum chuanxiong, Rehmannia glutinosa, mainly warm, flat, slightly warm, drugs mainly belong to liver, kidney, spleen, medicine flavor is mainly Xin, sweet, bitter, cluster drug combination is Chenpi-Pinellia ternata, Rehmannia officinalis-Cornus officinalis-yam, Chen Pei-Pinellia ternata-Atractylodes macrocephala-Poria. Conclusion: it is found that the syndrome differentiation of PCOS sterility is mainly due to deficiency and excess, most of which have blood stasis or phlegm dampness or phlegm stasis on the basis of kidney deficiency, among which kidney deficiency and blood stasis type is the most common. In addition, the simple empirical patients are liver meridians stagnation heat type and phlegm dampness internal obstruction type. The treatment is mainly to tonify the kidney and activate blood, the medicine is warm and flat, the taste of medicine is sweet, Xin, bitter, and the meridians are mainly liver, kidney and spleen. It can be seen that the pathogenesis of this disease is based on deficiency, the treatment is mainly based on tonifying deficiency, taking into account promoting blood circulation and removing blood stasis, regulating qi and dispelling phlegm.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.9

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