【作者】 关富健；

【导师】 薛博瑜；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2013， 博士

【摘要】 背景：功能性下丘脑性闭经(FHA)是继发性闭经的最重要类型,许多女性为该病所困扰,中医治疗闭经有着几千年的历史,挖掘中医药治疗方法对本病的治疗具有重要意义。目的：分析功能性下丘脑性闭经之肝郁证在其证侯分布中的地位,观察调肝法治疗本病的疗效与优势。研究方法：1、选择香港存德堂中医诊所就诊的闭经患者,同时符合纳入标准及排除标准的患者76例。采用回顾性研究方法,将功能性下丘脑闭经患者的临床症状表现进行采集、归纳、整理,以分析和探讨功能性下丘脑闭经的病机和中医证候主证及相兼证分布规律,并探讨不同主证证型的相关因素。2、采用自身治疗前后对照法,对香港存德堂诊所28例符合证型的患者进行前瞻性研究,选用柴胡疏肝散加减以调肝养血为主,并配合针灸治疗(选穴：期门穴,太冲穴,气海穴、关元穴,肝俞穴、肾俞穴),观察临床疗效2个疗程(3个月为1疗程)。研究结果：1、肝郁证是功能性下丘脑闭经的重要证型。其中肾虚证21例,占27.6%；肝郁证19例,占25%；是功能性下丘脑闭经的主要证型,其余依次是血瘀证、脾虚证和痰湿证,分别占21.1%、14.5%和11.8%。肝郁证不仅以主证形式表现,而且也存在于功能性下丘脑闭经其他证型兼证中,是各种兼证中最为常见的兼证。肝郁证是最容易兼有其他证型的主证,而肝郁证也是其他各种证型中最常见的兼证。2、从证侯分布相关因素分析,年轻患者表现为肾虚证、肝郁证、脾虚证的可能多于年龄较大的患者,年龄较大的患者痰湿证、血瘀证的情况可能多于年轻患者；病程较短的患者可能以肝郁证为主,而病程较长的患者可能表现以痰湿证、血瘀证为主；发病诱因中的情志因素作为功能性下丘脑闭经的发病因素,与肝郁证关系更加密切。3、调肝法针药结合治疗本病疗效总有效率为71.43%。对于疗效相关因素分析发现,兼证不同及年龄的差异可能会影响疗效。相比而言,调肝法对单纯肝郁证患者效果最佳,总有效率为77.78%,若同时兼有肾虚或血瘀证疗效率相对下降；对年轻患者效果最佳,总有效率为75%,对年龄较长的患者则疗效相对较差,总有效率为66.67%；而病程的差异对于调肝法针药结合治疗本病疗效则影响显著,病程小于1年的患者治疗效果明显优于病程大于1年的患者,总有效率为80%。4、调肝法针药结合治疗对于改善肝郁主证症状疗效明显。调肝法针药结合治疗可明显提高FSH和LH水平,疗效明显(P<0.05)。调肝法针药结合治疗可促使功能性下丘脑闭经基础体温(BBT)由单相向双相转化,治疗后单相转为不典型双向者8例、改善率为28.57%,转为典型双向者12例、改善率为42.86%,总有效率为71.43%。提高BBT高低温相平均差及BBT上升速度,疗效明显(P<0.05)。结论：肝郁证是功能性下丘脑闭经的重要证型;其证候的分布与年龄、病程、情绪相关；调肝法针药结合治疗肝郁证型功能性下丘脑闭经疗效肯定。更多还原

【Abstract】 Background:Functional hypothalamic amenorrhea (FHA) is the most important secondary amenorrhea type of disease plagued by many women; The Chinese Medicine treatment of amenorrhea has thousands of years of history, to discover the treatment of Chinese Medical on this disease with significance.Objective:To analyze the Functional Hypothalamic Amenorrhea (FHA) with depression syndrome (Stagnation of the Liver on TCM) and its distribution. Observe Liver treatment efficacy and its advantages of this disease。Methods:1.76patients selected by Chuen Tak Tong Chinese Medicine Clinic (Hong Kong), A retrospective research methods summing up the clinical cases of Functional Hypothalamic Amenorrhea (FHA) on Chuen Tak Tong Chinese Medicine Clinic (Hong Kong), To acquisition, induction, consolidation with the clinical symptoms to analyze and explore Functional Hypothalamic Amenorrhea (FHA) mechanisms on Chinese Medicine with the main and relatived symptoms. Investigate and discuss the different factors related syndromes on this disease.2. The before and after treatment were prospectively evaluated of28patients by use of regulating Liver acupuncture combined Chinese Medicine treatment. Using "Chaihu Shugan Powder" plus related herbs with regulating liver and blood nourishing methods, selected six of acupunture points for the treatment, The clinical cases were selected by Chuen Tak Tong Chinese Medicine Clinc (Hong Kong). Observation on two courses (three months for one course).Results:1. Stagnation of the Liver on TCM is important syndromes on Functional Hypothalamic Amenorrhea (FHA). Which Kidney deficiency syndrome on TCM (21Cases,27.6%) and Stagnation of the Liver on TCM (19cases,25%) are the main syndromes and second syndromes followed by Stasis syndrome on TCM, Spleen deficiency syndrome and Phlegm damp syndrome (21.1%,14.5%and11.8%). Stagnation of the Liver on TCM not only the main syndrome, but also in other related syndromes of functional hypothalamic amenorrhea and is a variety of the most common and related syndromes in all types on Functional Hypothalamic Amenorrhea (FHA).2. In the analysis of distribution and related factors, younger patients showed Kidney deficiency syndrome on TCM, Stagnation of the Liver on TCM and Spleen deficiency syndrome on TCM more than the older patients, older patients with Phlegm damp syndrome on TCM and Stasis syndeome on TCM more than younger patients; Patients shown shorter durarion of Functional Hypothalamic Amenorrhea (FHA) most likely with Stagnation of the Liver on TCM, while patients with longer duration of Functional Hypothalamic Amenorrhea (FHA) that manifestations of Phlegm damp syndrome on TCM and Stasis syndeome on TCM. Predisposing factors of emotional factors as Functional Hypothalamic Amenorrhea (FHA) and the relationship of Stagnation of the Liver on TCM was closer.3. Regulating liver with acupuncture combined Chinese Medicine treatment of Functional Hypothalamic Amenorrhea (FHA) total effective rate was71.43%. Efficacy factors analysis found that different syndrome types and age differences may affect the efficacy. In comparison, patients with pure Stagnation of the Liver on TCM shown the best results on TCM treatment, total effective rate was71.43%. The treatment Relative decline with syndeome of Kidney deficiency syndrome on TCM and Stasis syndeome on TCM, for the young patients group with best result, the total effective rate was75%, older patients with relatively poor efficacy, total effective rate was66.67%; the differences in the course of the disease Regulating liver with acupuncture combined with Chinese Medicine treatment shown significantly on efficacy, the duration less than one year with received treatments patients is better than the course of the disease is over than1year patients, the total effective rate was80%.4. Regulating liver with acupuncture combined with Chinese Medicine treatment of Functional Hypothalamic Amenorrhea (FHA) therapy is improving the efficacy of obvious symptoms of Stagnation of the Liver on TCM, the result was significant (P<0.05). The above methods improve the level of FSH and LH, the result also significant. Regulating liver with acupuncture combined with Chinese Medicine treatment promoted the Basic Body Temperature (BBT) into a single phase after treatment with atypical way in8cases, improvement rate28.57%,12cases into a typical way improvement rate42.86%, the total effective rate was71.43%. The mean of temperature difference and the rate of increase was shown significantly (P<0.05). Conclusion:Stagnation of the Liver on TCM is important syndromes on Functional Hypothalamic Amenorrhea (FHA).The distribution of syndromes is relationed of the age, the course of the disease and the emotion.Regulating liver with acupuncture combined Chinese Medicine treatment of Functional Hypothalamic Amenorrhea (FHA) was effective.更多还原