妇人腹痛中医文献的回顾性研究

【作者】 李小萍；

【导师】 刘雁峰；

【作者基本信息】 北京中医药大学 ， 中医妇科， 2012， 硕士

【摘要】 目的收集古代及近代2002年至2012年有关中医治疗妇人腹痛之文献,对其症状、辨证、治法及用药进行分析统计、总结归纳,拟发掘其辨证、治法及用药规律,从而为优化妇人腹痛的中医药治疗提供依据。方法(1)以中国知识资源总库(CNKI)对近10年,即2002-2012年文献,以“妇人腹痛”为检索词,对所有相关症状、证候、治则、治法及用药进行检索,归纳、总结,并用EXCEL软件对入选文献进行数据统计分析。(2)以北京中医药大学基础医学院中医信息研究室中医方剂数据库,以“腹痛”、“腹胀”、“小腹坠胀”、“妇人腹痛”为检索词,对古代文献进行症状、证候、治则、治法及用药检索,归纳、总结,并用EXCEL软件对入选文献进行数据统计分析。(3)回顾性总结肖承惊教授治疗妇人腹痛的辨证思路、经验及用药特色。结果古代文献共275篇,收纳古籍共26本,记录妇人腹痛的症状描述共291项,累计频次为764次,经过计算,统计出每项出现之频次及频率(频率=频次／合计累积频次)。在前14个症状中,除与腹部疼痛有关的症状描述,其他伴随症状,例如与经带有关的占32.94%,与胃纳有关的有11.88%,与全身症状有关的占9.00%。古代文献证候类型共见75种,累计频次263次,最高频次证候依次为血气不调、血气攻刺、血气虚劳、冲任虚损、血海虚冷、荣卫不足等；古代文献中治疗妇人腹痛证候以本虚受寒为主,治疗用药以温里药占比例最大,共见287种中药,累计频次有2286次,按频次排序位于前20味的中药为当归、肉桂、白芍药、干姜、炙甘草。说明古代认识妇人腹痛牵连甚广,除腹部痛症,也影响到妇女的腰部、月经及带下,于古时已经为妇人带来身体与精神上的折磨及痛苦。现代文献共93篇,记录妇人腹痛的症状描述共202项,累计频次为20940次。在前14个症状中,除与腹部疼痛有关的症状描述,其他伴随症状,例如与白带有关的占28.61%；与下腹部有关的占17.48%；与月经有关的占13.24%,与腰部有关的有9.60%,影响怀孕的,如不孕、继发不孕等占8.91%。现代文献共见76种证候类型,累计频次3973次,最高频次证候依次为湿热瘀阻、气滞血瘀、湿热蕴结、瘀血阻络、湿热下注等；现代文献治疗妇人腹痛的方法共有20种,累计频次有5126次。目前仍以中药内服为主共2299例,占44.85%,中药灌肠的有1376例,占26.84%,累计治疗频次为20940次。按频次排序位于前20味的内服中药有当归、茯苓、白芍、败酱草、黄芪、延胡索、赤芍、红藤。说明妇人腹痛牵连广甚,其影响与古人对妇人腹痛的认识相同,且能影响怀孕、后续子嗣,古今皆为妇人带来身体与精神上的折磨及痛苦。通过整理及分析肖承惊教授对妇人腹痛之辨证思路、治疗用药及果效,肖教授提出肾虚肝郁为妇人腹痛的重要病因病机之一,并提出补肾疏肝为治疗法则,临床取得很好的疗效。结论(1)古今文献对妇人腹痛之症状描述前后一致,主要症状妇人腹部疼痛,有刺痛、胀痛、冷痛、绞痛等,伴随症状可包括白带增多、腰胁腿痛、月经不调、不孕、恶寒、潮热等,古今文献均对以上症状有不同描述,但内容前后一致。(2)妇人腹痛之病因、病机随时代更替而有所改变。古代文献以虚、寒为主要病因病机,现今文献则以湿、热、瘀、气滞等为主要病因病机,盖现今人文风俗、生活习惯与古代迥然不同所致。古代妇女多因生活失摄、起居不慎,伤于风寒湿冷而发为本病,现代妇女除因生活起居,亦可因数坠胎、妇科术后耗损肾精肾气、而致湿热邪留。古今医家以本虚为本病重要病机之一,本质观点一致。(3)用药方面,因古代文献以虚、寒为主要病因病机,按出现频次,用药以温里药、补气、补血药为主,现代文献则以湿热瘀多见,故用药亦以活血化瘀、清热利湿为最高出现频次。从个别中药出现频次,古今皆以当归、白芍为高,从药特点、以药测证来看,古今医家皆认同本虚标实为本病重要病机之一,而现今妇女除本虚易致本病,亦因工作压力、多产数坠胎等妇科手术易致湿热瘀互结,故现代临床亦多见以标实为主之妇人腹痛。(4)肖承惊教授提出以肾虚肝郁为本病之重要病机之一,并提出补肾疏肝为治疗法则,临床疗效可观。更多还原

【Abstract】 ObjectiveAncient literatures and contemporary journals related to feminine pelvic pain were retrieved so as to analyze its symptoms, syndrome differentiation, Chinese medicine treatment and prescription hence optimize its clinical effect and theoretical basis.MethodMajor databases, namely CKNI, was searched by using specific terms to retrieve Chinese journals published in recent decade and Fang Ji database devised by School of Basic Medical Sciences, Beijing University of Chinese Medicine was used to retrieve ancient literatures related to those specific terms regarding to feminine pelvic pain. All the titles and abstracts were screened to identify relevant studies. Studies containing symptoms, syndrome differentiation, Chinese medicine treatment and prescription were included. Studies related to menstruation, pregnancy and postnatal period were not included. Data extracted was analysed with Excel(2007). The experience of Professor Xiao Cheng Chong treating sequelae of pelvic inflammatory diseases was concluded retrospectively.Results275ancient descriptions were found within26ancient literatures, in which291symptom descriptions of feminine pelvic pain were retrieved and accumulative frequency was764times. In the most-frequent14symptoms,40.75%of them related to abdominal tension or pain,32.94%related to menstruation and abnormal vaginal discharges,11.88%related to abnormal diet,9.00%related to overall symptoms.75types of different syndrome differentiations were seen with accumulative frequency of263times. The most frequent syndrome differentiation is disharmony of blood&Qi, deficiency of blood&Qi, etc.93studies in recent decade were found related, in which2299cases of studies were prescriptions for internal use and1376cases were using Chinese medicine for enema. Total accumulated treatment frequency is20940times.ConclusionFor2,000years Chinese medicine has worked wonderfully by following the Chinese medical guidelines and treatment principles. Not only the symptoms, treatments and prescriptions in ancient literatures were consistent with those in nowadays, but also the adjustment in accordance with syndrome differentiation is still practically applied. Kidney Yin-Yang deficiency with liver Qi stagnation was advocated by Professor Xiao Cheng-Chong. The theory was well-supported by ancient literatures and elaborated in this study.更多还原