不孕症中医诊治方药的古今文献研究

【作者】 吴贵娥；

【导师】 谢鸣；

【作者基本信息】 北京中医药大学 ， 中医方剂学， 2008， 博士

【摘要】 本课题拟以古、今医家诊疗经验作为切入点,通过较为全面地搜集历代有关治疗不孕症的文献,侧重从其辨证论治,特别是有关方药运用经验方面,给以系统整理、归纳、分析,总结古今有关不孕症治疗的方药经验,探讨其演变和递嬗关系,以为探索从病证角度整理方药规律提供方法学思路,为不孕症的现代临床治疗提供新思路,为探索高效方药提供经验依据。本文由两部分组成,第一部分为不孕症中医诊治方药的现代文献研究,第二部分为不孕症中医诊治方药的古代文献研究。本次研究查阅了有关不孕症报道的大量文献,其中收集现代中医及中西医临床报道等文献319篇,查阅了有关不孕症古籍161本,其中收集到不孕症治方有关条文共897条。现代文献调查发现,本病以子宫和内分泌功能失调为主因,临床以附件炎、闭经/稀发月经、黄体功能不全、输卵管阻塞、子宫发育不良为常见。中医认为该病主要由于湿热、寒凝、痰阻、瘀血等病理因素导致瘀阻胞络;脾肾两虚,肝气郁滞,冲任失调等引起脏腑经脉功能失调所致,其中肝肾精血不足尤为重要。中医治疗不孕症的基本大法可概括为补肾养肝健脾,祛瘀化痰除湿。无排卵性不孕症的主体用药涉及滋肾养肝疏肝;黄体不全性不孕症的主体用药涉及补肾温阳,养血健脾与疏肝;子宫内膜异位不孕症的主体用药涉及活血化瘀和补肾;免疫性不孕症的主体用药涉及滋补肝肾、健脾益气及清热活血;卵巢囊肿性不孕症的主体用药涉及滋阴养血和祛瘀除湿;输卵管阻塞不孕症的主体用药涉及祛瘀通络、软坚消癥、疏肝行气。中医周期疗法是根据月经周期的阴阳消长转化规律和现代医学关于月经和生殖生理的知识提出的按月分阶段干预的方案,即经后期因经后血海空虚,阴血不足,治以滋补肾阴、填精养血、调冲为主;排卵前期治以滋肾阴为主,稍佐活血之品,促使卵泡发育;排卵期治以补肾通络为主以促排卵;月经前期治以补肾养血、佐疏肝活血通络以助受孕;行经期以活血化瘀为主,以因势利导,祛瘀生新。对古代文献中病因考察发现,不孕症涉及到内伤、外感及不内外因等方面,“虚、损、寒”是引起不孕症的主因,气血不足和寒客胞宫为主要机理,寒客胞宫、胞宫虚寒、气血两虚是最常见的证候。不孕症伴见的症状涉及到妇科和内科病症范畴,其中月经不调、带下及崩漏是古代不孕症的主要伴随症状。不孕症所涉脉象达20种之多,其中以弱、细、涩、弦脉多见,且多为复合脉形式,其中以弱涩脉象最多见。对不孕症治疗的总体用药分析发现,古方配伍涉及补益、活血化瘀、解表、温里、清热、祛湿、理气、收涩几大类,主要集中在补益、活血化瘀、解表、温里、清热五类,提示古代不孕症治方的基本结构可以概括为“补益+温散/清热+活血化瘀”。从分证论治的组方用药涉类来看,各证组方主要是围绕健脾益气、养肝滋肾、温阳祛寒、解表散寒、活血祛瘀、理气行滞、化痰祛湿、清热等多法的选配,但配伍重心有所不同,其中“健脾养肝滋肾”的运用最为重要。古代治疗不孕症的方剂所涉及的剂型以丸剂为主,其中丸剂又以蜜丸为最多用;有关丸药则以食前或空心服为主,餐后服用较少;特别送服方法中以酒或米饮送下最多见。外用法中纳阴户和温脐法是古代治疗方药的特色性内容,所用方药大多以辛温芳香通散药为主,具有散寒暖胞、辟秽化浊、通畅气血助循环以及助药力透皮等作用有关。酒剂也比较常用,配方以滋补阴血为主,属于保健酒类。该剂型有效成分比较容易溶出且服用方便,酒也能祛寒活血,对于虚寒类患者可能是有益的。结合现代不孕症的发病类型和中医辨证分型的分析发现,西病的病因类型与中医病机证候之间存在一定的关联性:无排卵型和黄体功能不全不孕症均以肾虚为主;输卵管阻塞性和卵巢囊肿型不孕症则主在气滞血瘀;子宫内膜异位不孕症则主要在于肾虚,兼有肝郁和血瘀;免疫性不孕症主要是阴阳失调,也与肾虚与肝郁等密切相关。对古今不孕症中医治疗中涉及到的证候类型进行归并后可以发现:古代不孕症主要有寒客胞宫、胞宫虚寒、气血两虚、痰湿闭阻、寒凝血瘀、冲任虚损、寒湿闭阻、肾阴不足、精气不足、脾胃气虚、肝气郁结、冲任伏热等证,但以寒客胞宫、胞宫虚寒、气血两虚三证最多见;现代不孕证主要有湿热闭遏、痰湿阻滞、肝胆郁热、肝郁血瘀、脾肾虚衰、肝肾血虚、冲任不足、瘀阻胞络、寒凝血瘀基本证以及血瘀肾虚、肝郁脾虚、肾虚肝郁、痰凝血瘀等常见复合证;其中以脾肾虚衰、肝郁血瘀,痰湿阻滞证最为多见。古今关于本病证候的认识大体相近,但古今在常见基本证候上有气血两虚、寒客胞宫和肝肾不足、痰凝血瘀的偏颇。本文还对古今中医治疗不孕症的辨治方药经验进行了比较,提出关于不孕症的中医肾阳虚、肾阴虚、气血两虚、肝郁、痰湿、血瘀、寒凝、湿热八种证候类型及其相应的治疗方药;还对古今经验异同进行了分析,在总结不孕症中医古代治疗特色的基础上,提出其值得今人借鉴的经验。更多还原

【Abstract】 The problem intends to diagnose experience with the ancient times,the now medicine family as point of penetration,put particular emphasis on by collecting the past dynasties document in connection with curing barrenness comparatively all round,from whose diagnosis and treatment based on an overall analysis of the illness and the patient’s condition, medicine wields experience aspect especially in connection with method,give system arranging,is summed up as,analyse,sum up method of medicine experience treating in connection with barrenness at all time,discuss the person developing and passing changing relation,believe the exploration arranges method of medicine law from disease angle providing method learning a train of thought,modern times for barrenness clinical treat provide the new train of thought,Be an exploration high-effect method of medicine provides the experience basis.The main body of a book is composed of from two parts,PartⅠthe doctor of traditional Chinese medicine diagnoses the method of medicine modern times document for barrenness studying,PartⅡthe doctor of traditional Chinese medicine diagnoses the method of medicine ancient times document for barrenness studying.Capital is studied time having looked up the large amount of document reporting in connection with barrenness,319 documents such as collecting modern doctor of traditional Chinese medicine among them and being hit by clinical news report of Western medicine have looked up relevant barrenness 161 ancient books collect among them in connection with article 897 in total bringing method under control to barrenness.The modern document investigation is discovered,this disease gives first place to the womb and the endocrine functional disturbance because,menses,the metoarion function are incomplete,the fallopian tube blockage,womb maldevelopment are common clinically with accessories imflammation,sparse hair of amenorrhea.Doctor of traditional Chinese medicine thinks that disease is main since sticky,cold curdling,the sputum hinders a factor,the blood stasis waits for lead to stagnate to hinder compatriot net-like things;Yu stagnates sple en-kidney deficiency,irritability,is caused by functional disturbance according to let lack of proper care wait to arouse internal organs passages through which vital energy circu-lates, liver kidney essence among them blood is not worth being especially important.The doctor of traditional Chinese medicine cures fundamental barrenness fundamental law but summarization is to nourish kidney fostering liver tonifying spleen,drive away stagnating to spend sputum dehumidification.The main body there being no ovulation nature barrenness uses medicine to involve in growing the kidney fosters sparse liver of liver;Incomplete sex of metoarion barrenness main body uses medicine to involve in nourishing kidney warming up the sun,nourishing the blood tonifying spleen and dredging liver;Womb inner film ectopia barrenness main body uses medicine to relate to promoting blood circulation and removing blood stasis and nourishes kidney;Immune barrenness main body uses medicine to relate to nourishing liver and kidney,the tonifying spleen benefit gas and clears heat invigorating the circulation of blood;Ovary cyst barrenness main body uses medicine to relate to more overcast nourishing the blood compose in reply dehumidification driving away stagnating;Fallopian tube blockage barrenness main body is use medicine to involve in driving away stagnating to exchange net-like things,soft firm eliminate a disease,sparse liver does a gas.Doctor of traditional Chinese medicine period treatment is that the waxing and waning of yin and yang according to the menstrual cycle changes the scheme interfering with monthly by stages brought forward by law and modern medicine knowledge about menses and reproduction physiology,is that after later stage the queen sea of blood is void because of classics,overcast blood is insufficient,the back,fills intensive culture blood,the tune rushes to administer to growing to nourish kidney give first place to;Ovulate to administer to grow in the earlier stage kidney back give first place to,slightly,assist product of invigorating the circulation of blood,urge a follicle to develop;The period of ovulation administers to nourish kidney exchanging net-like things giving first place to urge ovulating; Menses administers to nourish kidney fostering blood in the earlier stage,sparse assistant liver promoting blood circulation and removing obstruction in channels already has helped fertilization;Passing by scheduled time giving first place to promoting blood circulation and removing blood stasis,to channel one’s actions according to circumstances,drive away stagnating to grow the new.Cause of disease examination discovers face to face ancient document middle, barrenness deals with aspect such as internal injury,diseases caused by external factors and block of wood inside and outside reason",false,mean,cold "be the major cause arousing barrenness,the insufficient and cold gas blood visitor compatriot palace is main mechanism, the cold visitor compatriot palace,compatriot palace are false cold,gas blood two emptiness is the most common syndrome.Barrenness accompanies the present symptom to deal with the department of gynaecology and the internal medicine illness category,abnormal menstruation,leukorrhagia and uterine bleeding among them are that the barrenness main part accompanied a symptom in the ancient times.What barrenness goes through the pulse elephant reaches more of 20 kinds,among them use weak,thin,unsmooth,spring pulse sees much,is a compound pulse form and much,the maximum sees among them with unsmooth weak pulse condition.The population treating barrenness is discovered with medicine analysis,Gufang making medicines compatible relates to benefit,promoting blood circulation and removing blood stasis,clearing heat and expelling damp,regulates the flow of vital energy and removes obstruction toit,collect unsmooth several major kinds in the diaphoresis,the temperature,five resembles mainly all together in clearing heat in benefit,promoting blood circulation and removing blood stasis,diaphoresis,the temperature,"promoting blood circulation and removing blood stasis pointing out that barrenness brought the square basic structure under control in the ancient times being able to clear heat+summarizing that the temperature falls apart for benefit +".From that the group that mark of certificate theory punishes uses medicine to wade across method resembling coming,that every certificate forms method is that the kidney,the temperature sun dispel cold,the diaphoresis falls apart about that tonifying spleen benifit a gas,fostering liver growing mainly cold,the selective breeding invigorating the circulation of blood driving away stagnating,regulating the flow of vital energy and removing obstruction toit doing much law such as stagnant,reducing phlegm clearing damp,clearing heat,but making medicines compatible the centre of gravity has applying of not fostered liver with "tonifying spleen among them,growing kidney" to be most important.The form of a drug related to by the prescription curing barrenness’s gave first place to the pill,pills among them took honeyed bolus as maximum using in the ancient times;Give first place to eating front or to be convinced on an empty stomach then in connection with the pill,after having meal take less;Give dose of method China-Israel a liquor or give water to drink meter specially to give to the most opinion down.That the outside accepts overcast family and temperature navel law in usage is the medicine characteristic content cured method in the ancient times,mostly,scattered medicine gives first place to Xinwen fragrance,have the warm scattered cold compatriot,open up dirty effects such as melting confused,unobstructed gas blood aiding to cycle and helping an efficacy of a drug to penetrate skin with method of medicine relevant.The vina can’t compare in common use, formula gives first place to nourishing overcast blood,belong to the health care liquor.That the form of a drug active constituent goes to the lavatory comparatively easy to dissolve out and take,the liquor also can dispel cold invigorating the circulation of blood;the patient may have benefit to false cold kind.The analysis discriminating mark of type combining with modern barrenness morbidity type and doctor of traditional Chinese medicine is discovered,existence is certain between west cause of disease type falling ill and doctor of traditional Chinese medicine pathogenesis syndrome relevance:There be no the ovulation type and incomplete barrenness of metoarion function without exception giving first place to deficiency of the kidney;That fallopian tube blocks nature and ovary cyst type barrenness is that the host stagnates blood in the gas stagnating;Womb inner film ectopia barrenness lies in deficiency of the kidney then mainly, annexes to have liver depression and blood to stagnate;Immune barrenness is imbalance between yin and yang mainly,goes hand in hand also with deficiency of the kidney and liver depression etc.The doctor of traditional Chinese medicine treats barrenness at all time middle after the syndrome type relating that to carries out conflation not bad find that:The ancient times barrenness had the cold visitor compatriot palace mainly,the compatriot palace was false cold,gas blood two is false,the sputum is wet shut hinder,cold curdle blood stagnates, according to allowing emptiness mean,cold-dampness shuts hinder,the kidney back is insufficient,vital essence is insufficient,taste is lacking in vital energy,liver-qi depression,fever of lying on according to Ren etc.proves,but the compatriot palace,the compatriot palace are false with cold visitor cold,gas blood two three false certificates maxima see;The modern dysgenesia certificate has mainly sticky shut hold back,the wet retardant of sputum,courage are sultry,liver stagnation of the blood stagnates,spleen deficiency of the kidney declines,liver kidney blood is false,hinder compatriot net-like things on the basis of that Ren is not worth stagnating,cold curdle blood stagnates fundamental certificate deficiency of the kidney,liver depression insufficiency of the spleen,deficiency of the kidney liver depression,sputum curdle as well as blood stagnates blood stagnates to wait for the common compound certificate;Among them,deficiency of the kidney declines,liver stagnation of the blood stagnates with spleen,the wet sputum retardant certificate sees much most.At all time cognition cardinal principle about disease syndrome is close,but blood stagnates in having the gas blood two weak,cold visitors compatriots palace to curdle with liver kidney deficiency,the sputum on common fundamental syndrome at all time biased.The medicine experience curing dysgenesia certificate distinguishing between bringing method under control has carried out the main body of a book or,doctor of traditional Chinese medicine at all time comparing,has suggested that two is false,liver depression, the sputum are wet,blood stagnates,curdle,sticky cold eight kinds syndromes type and their corresponding treating poisons method about barrenness doctor of traditional Chinese medicine kidney sun emptiness,sinister emptiness of kidney,gas blood;Experience similarities and differences had carried out analysis on at all time,the doctor of traditional Chinese medicine had cured the characteristic basis in summing up barrenness in the ancient times going ahead,experience suggesting that the person is worthy for contemporaries to draw lessons.更多还原