【作者】 沈劼；

【导师】 王旭东；

【作者基本信息】 南京中医药大学 ， 中医医史文献， 2013， 博士

【摘要】 目的：在系统整理卵巢早衰古代文献和现代文献的基础上,采用文献研究法,结合现代数据挖掘技术,对中医治疗卵巢早衰用药规律进行研究分析,探讨古代中医和现代中医治疗卵巢早衰的临证特点,为中医优势病种的理论创新及临床研究提供依据和指导。方法：①文献研究法：对于古代文献,确定包含有相关中医卵巢早衰辨治内容的中医古籍,并选择较佳版本,作为研究的基本文献资料；同时使用《中华医典》光盘版,以“血枯”“不孕”“经水早断”“闭经”“血隔”“经水不通”“年未老经水断”等为检索词,检索与卵巢早衰相关的中医文献资料,从中筛选与治疗卵巢早衰相关的方药,并将相关内容检索摘录。对于现代文献,使用中国期刊全文数据库(CNKI),以主题为检索项,以卵巢早衰为检索词,全面收集与中医药诊治卵巢早衰相关的全部文献资料,并从中筛选出有关治疗卵巢早衰的方药。②数据挖掘法：选用数据挖掘中的关联规则。先将文献研究法收集而来的治疗卵巢早衰的古代方药和现代方药进行数据的规范化处理,主要是中药名的规范统一。其次将文献研究整理并规范处理的数据资料按要求录入计算机,对相关内容进行标引,并制定相应的表单(包括卵巢早衰古代方药表和卵巢早衰现代方药表)。最后运用关联规则进行数据挖掘,本次研究运用PASW18进行相关的数据处理和分析。结果：①本次研究梳理了古代中医对卵巢早衰相似病证病因病机的认识；归纳了现代中医对卵巢早衰病因病机的认识。②本次研究共整理出412首卵巢早衰古代用方和191首卵巢早衰现代用方。③古代中医治疗卵巢早衰的核心药物是当归、川芎、白芍、茯苓、熟地黄、人参等,核心药对是当归-川芎、当归-白芍、当归-熟地黄、川芎-白芍、当归-甘草等。提示古代中医治疗卵巢早衰,主要还是立足于补益气血。④现代中医治疗卵巢早衰的核心药物是当归、熟地黄、菟丝子、枸杞子、山药、淫羊藿等,核心药对是当归-熟地黄、熟地黄-菟丝子、枸杞子-菟丝子、当归-菟丝子、山药-熟地黄等。提示现代中医治疗卵巢早衰,以滋补肝肾阴血为主。⑤古代中医和现代中医治疗卵巢早衰共同选择的核心药物为：当归、熟地黄、白芍、茯苓,核心药对为当归-熟地黄。提示古代中医和现代中医都认为阴血亏虚是本病的一个病理基础。⑥对于药物的选择,现代中医比古代中医更集中些,主要体现在补肾药物的使用上。说明现代中医认为卵巢早衰主要以肾虚为本,强调以补肾为主的治疗思想。古代中医用药范围更宽些,在治疗上并非一味补肾,而更注重人体脏腑功能间的相互联系,特别是心、肝、脾与肾之间的关系。⑦古代中医用药中常会配伍附子、肉桂等温里药,一方面温通经脉,鼓舞气血生长,另一方面可以引火归原,用于虚阳上浮,为现代中医治疗卵巢早衰提供新思路。结论：用文献研究法结合现代数据挖掘方法研究卵巢早衰古代和现代中医用药规律,可以发现古代医家与现代医家临床用药既有共同之处,又各有特点。提示现代医家在以补肾为主治疗卵巢早衰的同时,也可进一步探讨病因病机并拓展治疗思路。此方法研究结果清晰具体,指向明确,且有较好的可行性。在今后的研究工作中可以继续运用这种方法,对方剂的配伍规律作更深层次的探索和研究,并将研究对象从方剂的药物组成扩展到用量、用法,以及卵巢早衰的病因病机、证候、治法治则等方面,使研究更加全面、系统。更多还原

【Abstract】 ObjectiveBased on systematical arrangement of ancient literature and modem literature on premature ovarian failure, the literature research method, combined with modern data mining technology, is adopted to study the drug using regularity of traditional Chinese medicine treatment of premature ovarian failure, discuss the clinical features of ancient and modern Chinese medicine treatment of premature ovarian failure, and provide basis and guidance for the theoretical innovation and clinical study of diseases for which traditional Chinese medicine is advantageous.Methods①Literature research method:For the ancient literature, determine which Chinese medical books contain content related to traditional Chinese medicine syndrome differentiation and treatment of premature ovarian failure, and choose a better version as the basic literature material for the study; At the same time, use Traditional Chinese Medicine CD ROM to search "blood dry","infertility","the menses off early","amenorrhea","blood separation","absence of menses","not old by the menses off’, etc. as the index words; search traditional Chinese medicine literature associated with premature ovarian failure, screen out the prescriptions for premature ovarian failure treatment, and extract the relevant contents. For modern literature, use Chinese Journal Full-Text Database (CNKI) as the search term in the theme, with premature ovarian failure as the index words, collect all references related to traditional Chinese medicine diagnosis and treatment of premature ovarian failure, and screen out the prescriptions for treatment of premature ovarian failure.②Data mining method:The association rules in data mining are adopted. Firstly, the ancient prescriptions and modern prescriptions for treatment of premature ovarian failure collected by the means of literature research method are subject to data standardization processing, and it is mainly about the unity of Chinese medicine name. Secondly, enter the data material obtained by means of literature research and arrangement as well as standardized processing into the computer, index the relevant content, and make corresponding form (including list of ancient prescriptions for premature ovarian failure and list of modern prescriptions for premature ovarian failure). Finally use association rules to conduct data mining. PASW18is adopted for relevant data processing and analysis for this research.Results①This research combs the understanding of ancient traditional Chinese medicine towards the similar disease, etiology and pathogenesis of premature ovarian failure; summarizes the understanding of modern Chinese medicine towards etiology and pathogenesis of premature ovarian failure.②This research sorts out412ancient prescriptions for premature ovarian failure and191modern prescriptions for premature ovarian failure.③The core drugs used in ancient traditional Chinese medicine treatment of premature ovarian failure are angelica, rhizoma chuanxiong, radix paeoniae alba, poria, prepared rehmannia root, ginseng, etc. Angelica-rhizoma chuanxiong, angelica-radix paeoniae alba, angelica-prepared rehmannia root, rhizoma chuanxiong-radix paeoniae alba, angelica-radix glycyrrhizae, etc. are the core drug pairs. It points out that the ancient traditional Chinese medicine treatment of premature ovarian failure mainly bases on replenishing qi and blood.④The core drugs used in modern Chinese medicine treatment of premature ovarian failure are angelica, prepared rehmannia root, dodder seed, wolfberry fruit, Chinese yam, epimedium, etc. Angelica-prepared rehmannia root, prepared rehmannia root-dodder seed, wolfberry fruit-dodder seed, angelica-dodder seed, Chinese yam-prepared rehmannia root are the core drug pairs. It points out that the modern Chinese medicine treatment of premature ovarian failure mainly bases on nourishing the blood in liver and kidney.⑤The core drugs selected by both ancient and modern Chinese medicine treatment of premature ovarian failure are:Angelica, prepared rehmannia root, radix paeoniae alba and poria. Angelica-prepared rehmannia root is the core drug pair. It points out that both the ancient and modern Chinese medicine suggest that deficiency of blood is a pathological basis of the disease.⑥For the choice of drugs, modern Chinese medicine is more centralized compared to ancient traditional Chinese medicine, which is mainly reflected in the use of drugs tonifying kidney. And this demonstrates that modern Chinese medicine considers premature ovarian failure is mainly caused by kidney deficiency, and it emphasizes on treatment thought of tonifying the kidney. While the drugs range of ancient traditional Chinese medicine is wider, not focusing on tonifying kidney only in treatment, and it pays more attention to the relationship between the function of the human body organs, especially the relationship between heart, liver, spleen and kidney.⑦The ancient traditional Chinese medicine often combines interior-warming drugs such as aconite and cinnamon for the treatment. On the one hand, they can warm and smooth the passages through which vital energy circulates, and help the growth of Qi and blood, on the other hand they can conduct the fire back to its origin, which is used for deficient yang with upper manifestation. This provides new ideas for modern Chinese medicine treatment of premature ovarian failure.ConclusionLiterature research method combined with modern data mining method are adopted to study the drug using regularity in ancient and modern Chinese medicine for premature ovarian failure and this reveals the common ground and unique features of ancient and modern clinical medicine doctors. It points out that modern doctors, who mainly give priority to tonifying kidney in treatment of premature ovarian failure can also further discuss the etiology and pathogenesis and expand their treatment thoughts. The results of this method are clear and specific with definite direction, and it has good feasibility. In the future research work, people can continue to use this method for deeper exploration and research of the prescription compatibility regularity, and the object of study shall be expanded from drug composition to drug dosage and usage of the prescriptions, as well as the aspects such as etiology and pathogenesis, syndrome, therapy, rules of treatment, etc. for premature ovarian failure in order to make the study more comprehensive and systematical.更多还原