【作者】 陈曰黄；

【导师】 张玉珍；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2005， 博士

【摘要】 胎漏、胎动不安及滑胎相当于西医所说的先兆流产和习惯性流产,是妇产科的常见病。流产,特别是习惯性流产,不仅损害妇女的身心健康,甚至还可能会引发一系列家庭问题,给社会带来不稳定因素。所以寻找一种防止流产的有效方法具有积极的临床意义和社会意义。 本文系统回顾了古今文献对胎漏、胎动不安及滑胎病因病机及治疗的论述,总结了近20年来中西医对发病机理和治疗的认识和经验,在此基础上认为其主要病机是脾肾两虚,故安胎当以补肾健脾为要。目前中医药治疗疗效常在90%左右,暂未发现明显副作用。而西医在这方面的治疗手段比较单一,且疗效未如理想,与之相比,中医药治疗有着较大的优势和广阔的前景。 目前认为先兆流产、习惯性流产多为脾肾两虚型,因此在导师张玉珍教授的指导下提出设想,认为加减寿胎丸应该对所有脾肾虚证的胎漏、胎动不安及滑胎患者都有效。本课题观察了符合诊断与辨证标准的45例患者,其中30例用加减寿胎丸治疗,另外15例用安胎中成药滋肾育胎丸治疗作对照。结果表明加减寿胎丸对脾肾虚证的胎漏、胎动不安及滑胎患者疗效达90%,与滋肾育胎丸疗效接近。在消除阴道流血、腰痛、腹痛、下腹坠胀方面两组作用差异无显著性。另外,既往流产次数、自然流产次数与疗效均无明显关系。加减寿胎丸组和滋肾育胎丸组治疗前与治疗后HCG均有显著性差异,提示用药后改善了妊娠黄体功能,使HCG分泌增多。加减寿胎丸组治疗前与治疗后β—内啡肽均有显著性差异,提示用药后使β—内啡肽分泌减少。因此认为加减寿胎丸治疗肾脾虚弱型先兆流产、习惯性流产有很好的疗效,推测加减寿胎丸可能通过调整β—内啡肽和GnRH、HCG和孕酮之间的关系,降低过度应激,胎盘功能恢复正常,使妊娠继续。更多还原

【Abstract】 The terms TAI LOU, TAI DONG BU AN refer to threatened abortion (TA), and HUA TAI means to habitual abortion , which also call recurrent spontaneous abortion (HA). They are common diseases in the specialty of obstectrics and gynecology. Abortion, especially habitual abortion, not only injure the women’s mind and body health, even may cause a series of family problem and bring unsteady factor for society. So, looking for a kind of valid method that prevent from have a abortion to have the actively clinical meaning and social meanings.In this paper, the discussion about the pathogeny , pathogenetic mechanism and treatment of TAI LOU , TAI DONG BU AN and HUA TAI. That disperse plentiful documents of Traditional Chinese Medicine (TCM) in different dynasties are reviewed. And the knowledge and experience of both TCM and Western medicine about pathogenetic mechanism and curative effect which has developed during the past twenty years is summarized. Having studied these literature, we consider that "Deficiency of spleen and kidney " must be the most important way to survice a fetus. As matters stand, the effective rate of treatment with TCM is simple, and the curative effect is not good enough. In comparison with Western medicine, TCM have an advantage in treatment and a bright future.According to the former research, patients who had suffered from immune abortion were considered to be "Deficiency of spleen and kindey" , after an overall analysis of their condition. For this reason, we conjecture that "JIA更多还原