【作者】 陈江美丽；

【导师】 樊巧玲；

【作者基本信息】 南京中医药大学 ， 方剂学， 2012， 博士

【摘要】 外除阴道假絲酵母菌病以前称为黴菌性阴道炎,或念珠菌性阴道炎,属于中医的“带下病”、“阴养”范畴,是妇科的常兄病和多发病,敷據显示,约有75%妇女一生中至少患遇1次外阴阴道假絲酵母菌病,其中45%妇女经历过2次或2次以上的发作。发作时外阴瘙养难忍,严重影响她们的生活和工作。西药如氟康唑、伊曲康唑、克黴唑、硝酸咪康唑等治疗虽然有一定的疗效,却有肝臀功能损害及易反复发作等同题,近年来发现加用益生菌治疗,可以提高疗效、减少再次发作。可临床仍有部分患者疗效不理想,如何充分发挥中医药在治疗外阴阴道假蒜酵母菌病的优势,探讨外阴阴道假絲酵母菌病的中医病因病机,总结中医药治疗外阴阴道假蒜酵母菌病的方法,提高临床疗效,是本次研究的重点。本文從理输及临床雨个方面进行如下研究。在理输研究方面,系统总结了外阴阴道假絲酵母菌病的中医病因病机,参考了现代医家在治疗外除除道假絲酵母菌病方面的临床经验,在此基础上,提出外阴阴道假絲酵母菌病的基本病机是本虚标实。本虚是指脾臀亏虚,脾虚则湿渴内生,臀虚则带脉不固,均是带下生成的重要原因。标实虽有湿熟、血瘀、气滞之不同,但以湿熟蕴毒为主,也是血瘀、气滞形成的原因。據此,本文提出外阴阴道假絲酵母菌病的应以扶正解毒为基本大法。扶正重在補脾益臀,解毒著眼祛除湿毒。在临床研究方面,靓察了扶正解毒法在治疗外阴除道假絲酵母菌病中的作用,通遇本人在台湾新竹江美丽妇产科诊所所收集的30例外阴除道假絲酵母菌病病人为观察封象,共分属3组,第一组：纯西药治疗组,参舆者10人：第二组：西药+益生菌治疗组参舆者11;第三组：西菜+益生菌+中药治疗组：参舆者9人。治疗方法：所有患者皆以西药Fastin (中文名：克黴唑)阴道外用,一日1次,每次1粒于睡前将本剂置入阴道深处,连续使用5日;第二组患者同时加服益生菌治疗；第三组患者在第二组治疗的基础上,再加用中药内服和外洗。中药内服外用方均为导师经验方。内服处方：黄柏10g、苍白术各10g、生苡仁10g、川牛膝10g、赤芍10g、车前子15g(包煎)、土茯苓15g、败醤草15g、连翘15g、黄耆10g、生甘草4g,水煎温服,每日一次。外洗处方：蛇床子、土茯苓、苦参、黄柏各30g,丁香20g、黄连6g、薄荷12g、枯凡6g,每日阴道冲洗1次,7天为一疗程,治疗1-2个疗程。疗程结束一周复白带培养阴性者转培其本,服用知柏地黄丸加捕中益氟汤1侗月,间隔1周再服知柏地黄丸及補中益气汤1个月以鞏固治疗。疗效标准：以症状消失,培养阴性连续达3个月以上无复发为治愈：培养阴性未达3个月以上属无效。结果,第一粗：参舆者10人,治愈0人,煞效者10人。第二组：西药+益生菌治疗组：参舆者11,治愈11人,无效0人。第三组：西药+益生菌+中药治疗组：参舆者9人,治愈者8人。说明：第三组(西药+益生菌+中药)中有4人是先在第二组(西药+益生菌)治疗,复因治疗无效,本人要求蒋到第三组。加用中药治疗复,结果其中3人治愈,1人燕效。在复发率方面,第一组的复发率为100%;第二组15例治疗者中有4例复发,复发率为26.7%,而第三组再加用中药内服和外洗复,复发率仅为11.1%。研究表明,扶正解毒法配合常规西药加益生菌治疗,可以提高外阴阴道假丝酵母菌治愈率,降低复发率,提示中药封于治疗该病的应用价值得深入研究。更多还原

【Abstract】 Vulvovaginal candidiasis belong to Chinese "fIuor","YinYang"category, it is cornmom diseases and frequently-occurring disease in women, the data show that the life of about75%of women suffered from VVC at least1time,of which45%of women experienced the onset of more than2or2times, severe genital itching impact on their lives and work. Although western medicine has some effect, it lead to the shortcomings of liver and kidney dysfunction and recurrent attacts. Lately found that addition of probiotic therapy can improve efficacy and reduce recurrence. But the curative effect isn’t ideal to some patient at the clinic.how to give full play to the advantages of Chinese medicine in the treatment of VVC, investigate the cause and pathogenesis of VVC bacteriad disease, and improve clinical outcomes is the focus of this study. In this paper, both theoretical and clinical aspects the foil owing study.Theoretical research summed up the cause and pathogenesis of VVC with reference to the clinical experience of the modern physicians in the treatment of VVC on this basis we raised that the fundamental pathogenesis of VVC is asthenia in origin and sthenia in superficiality. Asthenia in origin is spleen and kidney deficiency. Spleen asthenia create endogenous wet and kidney asthenia DAI meridian is not solid. Above all are the important causes of fluor. Although the sthenia in superficiality has difference of humid heat blood stasis and qi stagnation>the damp and hot toxin is main-it also lead to blood stasis and qi stagnation. Accordingly this thesis raise that the TCM treatment of VVC method is mainly strengthening body resistance and detoxication. The strengthening body resistance refers to the spleen and kidney, detoxification method also includes clearing the damp toxin.In clinical studies, observe the effection of Fuzheng Toxin in curing Vulvovaginal candidiasis’by observing30peoplethat suffering vulvovagingal Candidiasis in Hsinchu,Taiwan Jiang Meili Obstetrics and Gynecology Clinic, and divid they into three groups, first group:10people by pure western medicine; second group:11people by western medicine and probiotics; third group:9people by western medicine, probiotics and traditional Chinese medicine. Treat method: all sufferers continuoutly put Fasti n i nto the vagina for5days,1time every day,1pill every time;on the same time take probiotics in the second group; on the second group basis, take traditional Chinese medicine and wash the vagina by it in the third group. The using method of the traditional Chinese medicine depend on tutor’s experience. Oral prescription: Huang Bo10g,white patients10g, raw yi,10g,Schuan bidentata10g,red peony root10g,Plantago15g(including fry),soil Fuling15g,Patrinia15g,forsythia 15g,Astragalus10g,raw licorice4g. take it after boilling1time every day. Washing Prescription:Cnidium,soil Fuling,matrine,Treats30g,cloves20g,Coptis6g,mint12g dry where6g, wash the vagina1time every day for1-2periods,7days as a period. take the ZDP plus Buzhongyiqi soup for a month, after a week, take it for a month again to strongly treat. Efficacy standard:symbtom disappeared, culture negative continuously for more than3months which is looked as cure, culture negative for less than3months which is in vain.On outcom, first group:participant10, cure0, nonresponder10. second group: participant11, cure11people, nonresponder0. third group:participant9, cure8people. Explanation:in the third group,4people of them in the second group are put into the third group after treated by the western medcine and probiotics. By traditiona chinese medcine, three of them is cured, nonsponder1. On recurernce rate, it is100%in first group, it is26.7%,4of15patientsappear symptom again in second group; it isonly11.1%in third group.Studies have shown that the righting detoxification method with the conventional western medicine can improve VVC cure rate and decrease the relapse rate suggesting that TCM for treatment of the disease value worthy of further study.更多还原