金匮温经汤治疗不孕不育现代文献研究

【作者】 吕佳憓；

【导师】 尉中民；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2011， 硕士

【摘要】 本课题拟以现代医家的诊疗经验作为切入点,对不孕不育的认识、治疗进行系统的整理、归纳,并针对1949年至2010年有关金匮温经汤治疗不孕不育的文献,使用Microsoft Excel2007统计软件,采用频数分布分析方法,侧重其辨证论治与方药运用经验,总结金匮温经汤治疗不孕不育现代临床应用的相关资料,呈现金匮温经汤治疗不孕不育的病种、症状、体征、舌诊、脉象、药物加减变化、用药特点、服用方法、疗程、疗效及对男性不育的应用。金匮温经汤治疗不孕不育临床疗效良好,本研究统计结果为病例年龄23～43岁,病程1～16年,原发性不孕为多。女性病种分布以月经病为最多,其中又以月经后期为多。另外无排卵性不孕居次；子宫发育不良又次之。男性病种分布为精索静脉曲张30例,阳萎1例,精少1例。女性案例的月经史方面,初潮年龄较晚,17～19岁多见,经量以量少描述为最多,经色描述共可归纳为淡红、黯红、紫黑三种,以淡红为最多。经质的描述仅夹血块、质稀两种。经期伴随症状以少腹痛为主,其他为腰酸或痛、乳房胀痛、胸胁胀痛,且病案多有痛经经验,两者可相互参照。其它症状描述,多见面色(无华、晦暗、萎黄)、体形消瘦或肥胖两类居多、形寒肢冷(手足、腰腹)、腰膝酸软、神疲体倦、白带量多质稀、偶见手掌时有烦热,伴口唇干燥等。舌质方面,舌色常见淡白舌,偶有瘀斑。舌形仅见嫩、胖大、齿痕三种。舌苔以薄白为主。苔质薄最多。苔色仅见白色描述。脉诊描述脉位皆属沉,脉形多细、弦,脉势多涩、弱、无力,脉律多缓、迟。方药加减方面,原方12种药物使用,以麦冬、牡丹皮、半夏最常被减去不用。阿胶与姜次之不用。并对原方12种药物所使用最少、最大及常用剂量作完整归纳统计。加入药味最常见有菟丝子、香附、淫羊藿,其次为巴戟天、小茴香、艾叶、乌药、川断、玄胡、杜仲、丹参、桃仁、红花、仙茅、熟地等。加入药味分类中,以补虚药为最多,其中又以补阳药为主；活血祛瘀药居次;理气药又次之；温里药再次之。服药时间方面,以经期用药最多。有效疗程统计分两种情况,一种是有效疗程以月计者,最短1个半月,最长8个月。一种是有效疗程以月经周期计者,最短1个月经周期,最长10个月经周期。治愈率统计方面,女性病案(1)单用温经汤,总孕率80.36%。(2)温经汤合用氯米芬,总孕率21.87%。男性病案配偶总孕率40.63%。中医辨证分型,总治愈率86.11%,以肾阳虚型病例数最多；血瘀型病例数居次；痰湿型病例又次之。现代对金匮温经汤专门针对不孕不育上的临床研究还很有限,国内金匮温经汤的实验研究文献方面数量亦相对稀少,且多为日本、美国之翻译期刊文献资料。本课题有其现实意义,明确本方治疗不孕不育的使用指征,全面系统地分析总结金匮温经汤治疗不孕不育现代临床应用的相关资料,并对方药中吴茱萸、桂枝、人参、姜的应用、药味加减、疗效、服药时间予以探讨,充实中医妇科学治疗不孕不育症的方法,达到古方今用的目的。女性不孕症使用温经汤可诱发排卵,则产生副作用的情况是可以减少的,从机体体质的调整后,全面增加受孕的机率及改善胞宫内环境以利于滋养胚胎成长生出健康的下一代。因此本课题能为临床治疗不孕不育提供有益参考。从文献中发现已有零星医家将金匮温经汤运用于男性不育的领域,如精索静脉曲张不育、精少不育、阳萎不育,获得一定的疗效,希望本研究能作为一抛砖引玉之作用,俟有志于不孕不育治疗的临床及实验研究工作者选择以金匮温经汤为研究对象,增加本方临床运用的机会,能促使针对金匮温经汤展开多项研究计划,深刻挖掘其方中的奥妙,用来指导我们未来治疗与研究。此外对其他不孕不育病种或可以考虑将其纳入治疗用的临床处方用药,为现代不孕症临床治疗提供新的思路。更多还原

【Abstract】 This study is intended to cut to the chase of the knowledge and treatment about infertility and sterility by analyzing and concluding the clinic experience of modern physicians, and to focus on the literature of 1949-2010 about the "Jingui Wenjing Decoction" on treating infertility and sterile, by using the Microsoft Excel 2007 statistical software for the frequency distribution analysis, focusing on the experience of treatment based on syndrome differentiation, and the application of prescription. By summarizing all the correlation data, we can conclude the disease, symptoms, signs, tongue diagnosis, pulse, drug addition and subtraction changes, medication characteristics, drug taking method, course of treatment, curative effect about treating the infertility and sterility.Jingui Wenjing·Decoction achieves good results of clinical treatment for infertility and sterility. The case of this study aged 23 to 43 years, duration of 1 to 16 years, primary infertility is the major. Most distribution of women is menstrual disease which the late period is the major. Second place is anovulatory infertility; uterine hypoplasia is next. In the distribution of male diseases, there are 30 cases of varicocele,1 case of impotence,1 case of few semen capacity.Menstrual history of female cases, the late menarche 17 to 19 years old are more common, the volume is less, and the colors are summarized as pale red (the most), dark red, dark purple. The qualities are thin or with the blood clots. Menstrual symptoms associated with pain in the lower abdomen, lower back, swollen breast, chest and upper side body. And the experience of dysmenorrhea is common. The symptoms and dysmenorrhea can be cross-referencing.Other symptoms descriptions are, more colorless, dim, or sallow complexion, body weight loss or obesity, cold limbs (hand, foot, waist), waist and knees worn out and aching, mind and body tired, plenty but thin leucorrhea, sometimes palm burning and lips drying.Pale tongue is common, occasional petechiae. Tongue shape only see the tender, fat and large, scalloped. Tongue coating is thin white fur, mainly the thin coating quality, and only see the white fur color. Pulse manifestations are deep, thin, string, hesitant, weak, weakness, slow, late.Recipe addition and subtraction:the original 12 medicines used to subtract Radix, Paeonia suffruticosa, and Pinellia, followed by donkey-hide gelatin and ginger, the addition are the seed of Chinese dodder, Cyperus rotundus, epimedium, followed by Morinda, fennel, Chinese mugwort, aggregata, Sonchus asper, Xuan Hu, Eucommia, Salvia, peach kernel, safflower, Curculigo, Rehmannia and so on. Most of them are tonic medicines(especially tonifying yang), than the drugs used to activate blood flow, regulating qi, and warming interior. Medication timing is mainly the menstrual period.Effective course of treatments are two cases, one is effective course of treatment in months by the shortest one and a half months up to 8 months. Another effective course of treatment is in menstrual cycle, the shortest is one menstrual cycle, up to 10 menstrual cycles.Cure rate statistics, women medical record (1) Only taking the Wenjing Decoction, the total pregnancy rate is 80.36%. (2) Wenjing Decoction combined with clomiphene, the total pregnancy rate is 21.87%. Spouses of male medical record 40.63% of total pregnancy rate. TCM syndrome differentiation, overall cure rate was 86.11% , the largest number of cases is deficiency of kidney yang; than the blood stasis subordination; and than the phlegmatic hygrosis.Nowaday, Jingui Wenjing Decoction to infertility-specific clinical research is still very limited. In this country, the number of experimental research literature is also relatively scarce, and mostly is translated journal literature of Japan and the United States. Has its practical significance of this issue, clear the use of infertility indications, comprehensively and systematically analyzed and summarized by the Jingui Wenjing Decoction treating infertility clinical application of modern information, and herbs in Evodia, Guizhi, ginseng, ginger applications, addition and subtraction, curative effect of TCM syndrome differentiation, the time of taking medicine. Enrich TCM gynecology infertility treatment methods. Female infertility by using Wenjing Decoction can induce ovulation, the side effects can be reduced, adjusted from the physical body, an overall increase in the probability of pregnancy and improve fetal trophoblast cells to facilitate the growth of intrauterine environment give birth to healthy children. Therefore, this issue for the clinical treatment of infertility to provide useful information.Found in the literature have been isolated from the physicians Jingui Wenjing Decoction area of male sterility such as varicocele sterility, low sperm sterility, impotence sterility, obtained a significant effect,Ⅰhope this study can serve as The role of an initiate, as soon as the treatment of sterility interested in clinical and experimental research workers choose to Jingui Wenjing Decoction as the research object, increase the clinical application of this side the opportunity to make Jingui Wenjing Decoction launched by a number of research project, to dig deep secret of their prescription, to guide our future treatment and research. In addition to other disease or infertility can be considered for inclusion in the clinical treatment of prescription drug use for the modern clinical treatment of infertility to provide new ideas.更多还原