【作者】 雷磊；

【导师】 尤昭玲；

【作者基本信息】 湖南中医学院 ， 中医诊断学， 2002， 博士

【摘要】 为了探讨宫环出血病的证候规律和血瘀病机特征，我们运用流行病学的调查方法及聚类分析的统计学方法，在安徽、湖南等地对1210例宫环出血病患者的证候进行了调查分析，结果显示： 1．肝郁血瘀证的主症为胸胁胀痛或刺痛、乳房胀痛或刺痛、脉弦或弦涩、精神郁闷、腰骶胀痛或刺痛、面淡而晦黯、小腹胀痛或刺痛；气虚血瘀证的主症为神疲乏力、少气懒言、脉虚弱、舌质淡红、苔薄白、经色鲜红或深红或黯红质稠粘；阴虚血瘀证的主症为咽燥口干、口苦、腰膝酸软、经质粘稠如痰、经血有块、经色黯红如酱洗杂粘液、苔黄、经色淡红、质清稀或紫黑、脉细涩；血热证和痰湿证的主症分别为舌质红、心烦口渴和苔腻、脉滑数、胸腹痞满、恶心呕吐、形体肥胖、白带量多；血瘀症状在血热证和痰湿证中表现不明显，可能因为通过聚类后血瘀症状都集中到第1亚型有关。 2．宫环出血病的证型主要以肝郁血瘀证、气虚血瘀证和阴虚血瘀证最为多见，主要证类为经量增多和经期延长。 3．血色素和肝郁血瘀证、气虚血瘀证和阴虚血瘀证中相关，差异有显著性；血小板和各证型无相关性。 4．血瘀的主症为舌质黯红，舌有瘀点或有瘀斑，认为血瘀是本病的主要病机，贯穿着疾病的始终。其成因主要为气滞、气虚、出血、寒邪、热邪等，发病机理与瘀血内结及离经之血有关。 根据流行病学的调查结果及对血瘀病机特征的探讨，我们研制了针对肝郁血瘀证、气虚血瘀证及阴虚血瘀证的化瘀止血方98-C、98-B、98-D。通过置IUD家兔动物模型，观察了上述药物对模型动物的影响，结果显示： — — 问而N甘院 傅士磅位伶或 仑 是 1．置器家兔动物模型病理改变与中医血瘀病机特征相紊合，表现为子 宫内膜形态学的改变，生化指标的变化及血液流变学的异常。 2．化瘀止血方的作用机理：中医认为三方均能积极消除各种病理因 素，协助机体适应置器后新的生理环境而止血。西医认为其主要机理是 对置器家兔子宫内膜具有一定的保护和修复作用；能调整子宫内膜匀浆 液生化指标，影响置环后导致出血的主要病理环节而止血；改善血液流 变性而止血。更多还原

【Abstract】 To make chear the law of syndrome and character of the syndrome of stagnancy of blood and stasis of blood of endometrorrhagia which is caused by lUD-wearing, 1210 cases with endometrorrhagia which is caused by lUD-wearing were investigated and analysed on Anhui and Hunan by epidemiology method and statistical method of system cluster analysis. The results showed:l.The chief symptoms of stagnancy of liver and blood are the smarting, distending pain in the gastric and hypochondriac regions , breast ,lumbosacra land and lower abdomen,a wiry and unsmooth pulse, morose mood ,grey-dull complexion.The chief symptoms of deficiency of Qi and stagnancy of blood are lassitude ,lack of strength,lack of strength to breathe and speak a weak pluse ,lightly red tongue with thin white coating,weakness of the low back amd knees,bright red or deep or gloomy and viscous menses in blood .The chief symptoms of deficiency of yin and stagnancy of blood are drynes in the mouth,bitter,viscous menses in blood like sputum and mixed with clots,gloomy blood like sauce mingle with mucus,a yellow tongue coating ,light red and thin discharge indicates blood deficiency or violet black,a thready and unsmooth pulse .The symptoms of head in blood and sputum are reddened,upset and thirsty,sticky coating on the tongue ,a smooth and rapid pulse,a suffocating feeling in the chest and abdomen ,fullness in the gastric region,nausea ,Obesity,a large amount of leucorrhea .The symptom of stagnancy of blood and stasis of blood is not transparent relating to the symptoms’ concentration to the first Isoforms.2. Stagnancy of liver and blood , deficiency of Qi and stagnancy of blood , deficiency of yin and stagnancy of blood are cardinal syndromes of endometrorrhagia which is caused by IUD-wearing,and the main symptom is menostaxis and menorrhagia.3. Hematochrme and stagnancy of liver and blood .deficiency of Qi and stagnancy of blood , deficiency of yin and stagnancy of blood are closely related .The difference is significance ; Blood platelet is not correlated to the syndromes o4. The chief symptom of stagnancy of blood and stasis of blood is a dark red tongue with purplish spots or patches ,and the syndrome of stagnancy of blood and stasis of blood transfixes the disease as the committed role o The main reasons are stangnacy of Qi,deficiency of Qi , bleeding,cold,heat, the mechanism of onset of illness is the stasis because of blood stasis with constipation and blood of apomeridian .On the basis of the survey of epidemiology, 98-B, 98-C, 98-D ,which are series of complex prescription eliminating stasis to stop bleeding ,are set up to be directed against syndromes of stagnancy of liver and blood , deficiency of Qi and stagnancy of blood , deficiency of yin and stagnancy of blood.By means of the animal model of rabbit with IUD,the animal models influenced by the aforementioned series of complex prescription are investigated ,the results showed:1. Alteration of pathologic of the animal model of rabbit with IUD is consistent with character of cause of disease of stangnancy of blood ,which?all manifestates the alteration of endometrium morpholo ,the biochemical marker and hemorrheologic abnormality.2. The mechanism of series of complex prescription eliminating stasis to stop bleeding is : Chinese medical science thinks that three prescription eliminating stasis to stop bleeding could preclud various kinds of pathologic factor actively ,assist the body to adaptate new physiological enviroment.Medical doctor thinks that the series of complex prescription eliminating stasis to stop bleeding could protect and repair the rabbit endometrium with IUD; adjust the biochemical marker of endometrium homogenate;affect the chief pathologic link of bleeding with IUD; improve the hemorheology.更多还原