【作者】 李乾；

【导师】 乔明琦；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2012， 博士

【摘要】 目的：1.探索近30年来中医文献中经前期综合征（重度，PMDD）证型及症状分布特点，为编制调查表提供参考依据；2.初步探讨PMDD的中医临床证候分布规律，为临床研究提供参考依据。方法本研究共分为三部分：1.理论探讨：从祖国医学对本病的历代文献研究，近现代中医药对本病的病因病机、治疗、动物实验等方面，现代医学对本病的流行病学调查、发病机制及治疗进展等方面，对经前烦躁症（PMDD）、经前期综合征（PMS）的中西医研究近况进行了系统阐述。2.文献梳理：检索近3O年来本病的文献资料，选取符合纳入标准的文献，对其证候、症状进行及相关条目进行统计、分析。3.临床流行病学调查：调查不同群体、年龄18-45岁的女性共计750人，初步筛查出符合PMDD诊断标准的受试者。对所筛选的受试者，进行一般情况及病史的调查，并进行《PMDD中医症状调查表》、《PMDD舌脉调查表》、《PMDD证候调查表》的填写，通过PMDD相关调查表的分析，探讨本病的证候分布规律。结果：1.经过规范化地提取所研究文献，本病证型以肝郁证、肝郁化火证、肝郁脾虚证、肝肾阴虚证、脾肾阳虚证和血瘀气滞证为主。本病病位主要在肝，并涉及脾、肾等脏腑。病理性质属虚实夹杂。实证，以气滞为主；虚证，以气虚为主。2.按照PMDD诊断标准，现况调查的750人中，符合PMDD诊断为44人，患病率为5.87%，年龄多集中于31-45岁。3.临床流行病学调查：通过对44例PMDD患者《PMDD中医症状调查表》、《PMDD证候调查表》的分析，发现PMDD患者主证以肝郁化火证和肝气逆证为主，次证以脾肾阳虚证、肝郁肾虚证和肝郁血瘀证为主；总体症状以急躁易怒、口干咽燥、心烦和腰膝酸软为主。结论：从文献梳理和临床流行病学研究的结果可知，PMDD的主证和病因病机与肝关系密切，这为PMDD从肝论治提供了理论和临床依据。更多还原

【Abstract】 Objective1.In research of the distribution law of symptoms and syndromes ofPremenstrual Syndrome(severe,PMDD),summarized from Traditional ChineseMedicine literature in recent30years,we are aimed to provide references formaking scientific questionnaires.2. Discuss preliminarily the distribution rules of symptoms and syndromes ofPMDD in the view of Traditional Chinese Medicine, to find more references forthe clinical research.Methods the study is divided into three parts:1.Theoretical study:from the disease in ancient medical literatureresearch,modern medicine in the etiology and pathogenesis of thedisease,treatment methods,animal experiments,to the West Medicine on theepidemiology research,the pathogenesis and treatment progress in respect ofthe PMDD and PMS,the recent research on Chineses and Western Medicine wasdescribed systematically.2.Literature review: We analysed the correlative items in the literature ofPMDD and PMS symptoms in recent30years.3.Clinical epidemiology: Investigation of different groups,aged from18to45,750women, the patients with PMDD who were screened preliminarily began to complete the general circumstances and medical history enquiry,“PMDDsymptoms of TCM questionnaire”,“coating on the tongue and pulse conditionof PMDD questionnaire”and “PMDD syndrome questionnaire”.Based on theanalysis of questionnaires,we discussed the distribution law of PMDD.Results:1.After abstracting,the common syndrome types of the disease were based onsyndrome of liver-qi stagnation, syndrome of liver-qi stagnation transforminginto fire, syndrome of liver stagnation and spleen deficiency, syndrome ofyin deficiency of liver and kidney, syndrome of yang deficiency of spleen andkidney, syndrome of qi stagnation and blood stasis.The disease locations werebased on liver and related to spleen,kidney and other apparatuses.Thepathological nature was mixture of asthenia and sthenia.The sthenic syndromewas mainly on syndrome of qi stagnation; the asthenic syndrome was mainly onsyndrome of qi deficiency.2.The diagnosis of PMDD was confirmed in44of750women (5.87%) who completedthe spot investigation,and age of onset was between31and45years old.3.Clinical epidemiology：based on the analysis of “PMDD symptoms of TCMquestionnaire”, and “PMDD syndrome questionnaire”,it was found that theprincipal syndrome type of PMDD were based on syndrome of liver depressionof the fire,syndrome of liver qi invasion; the secondary syndrome type of PMDDwere based on syndrome of yang deficiency of spleen and kidney, syndrome ofliver stagnation and spleen deficiency and syndrome of liver stagnation andblood stasis. The general symptoms were chiefly on irritable,dry throat,vexation and weakness in loin and knees.Conclusion:According to the results of literature review and clinical epidemiology,themain symptoms,syndrome types,etiology and pathogenesis of PMDD are tied upwith liver,which provides theoretical and clinical evidence for treatmentwith liver.更多还原