【作者】 陈晓航；

【导师】 黎小斌；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2009， 硕士

【摘要】 理论背景:李丽芸教授是全国名老中医,也是“广东省名中医”,从医从教五十余年,其学术思想体系及临证经验是中医学非常宝贵的财富,这些理论及经验急待总结。此项工作以前已总结了一部分,但多局限于某一经验、某一观点、或知识比较零散的经验汇集,缺少特色,缺乏系统,同时,未就李丽芸教授的大量成功病例中整理出富于岭南中医妇科特色的中医医案,难以展示李丽芸教授在中医妇科领域的突破性成果和形成理论上的升华。因此,全面系统地总结李丽芸教授的理论及临床经验,从典型病例中分析挖掘其辨证思路及用药特点是迫切需要的。研究目的:本课题通过系统采集及整理李教授在妇科学临床积累的丰富经验,进行全面收集归纳,分析研究其典型医案、临证经验、学术思想,总结其思辨特点及用药规律,并运用中医辨证对其临证的典型个案进行剖析,形成中医医案形式并记录成册,一方面可将李丽芸教授的学术思想及临床经验较完善地保留及继承下来,同时也对中医妇科临证具有更实用的指导意义。研究方法:系统收集李丽芸教授多年来发表的论文、专著及对李教授进行个人访谈,仔细分析整理后,总结出李教授对女性生理及妇科疾病的一套中医理论体系。系统收集李教授治疗妇科常见病的病例及常用内服外治法,分析并总结李教授辨证思路及治疗思路。全面收集李教授常用方剂,分析其组方思想并交李教授点评。研究结果:1、李教授主要学术思想集中在:调经方面,李教授常用补肾调周法。此法强调补肾精以育卵,补肾阳以促排卵,肝脾肾同调以促黄体。孕期亦以补肾为主,并提出“育儿求端庄”理论。带下病从湿热论治,主张多途径用药。输卵管阻塞者,李教授主张利湿通络、活血化瘀。癓瘕方面,关键病机是气滞与血瘀,气滞可导致血瘀,血瘀又可加重气滞,两者相互影响;此外,痛经也与癓瘕密切相关。崩漏方面,认为肾阴虚、脾气虚是致病之本,血热、血瘀只是其中某一阶段的病理因素。常用方剂方解:1方补肾阳;2方滋阴清热;3方补精血;4方能清热利湿;5方能消癥结、活血化瘀;6方健脾益气生血;7方养肝阴肝血以疏肝;8方补肾健脾养肝;9方健脾益气摄血;10方活血化瘀;11方利湿清热;12方消癥化痰瘀;13方化湿利水通络健脾;14方滋补肝肾之阴血;15方清泄肝胆湿热;16健脾化痰燥湿;17方疏肝理气止痛;18方活血消癥化痰瘀;19方气血双补;20方凉血止血;21方疏肝解郁;中药包1、2号活血利湿通络。2、临床应用:(1)补肾调周法:月经后期需辨清肾阴、肾阳还是肾精不足,肾阳虚者用1方以补肾阳;肾阴虚用2方以滋阴降火同时加用洋藿叶、巴戟等补阳之品以促使卵泡发育;肾精亏虚者用3方调理。另外,如为PCOS证属痰湿内蕴者,多用16方。排卵期强调补肾阳以促排卵,用1方及梅花针叩击冲任督脉、神阙、双肾腧。但对于PCOS卵巢上皮增厚阻碍排卵者,也可用18方化痰瘀以促排卵。对于气虚的患者,也可用6号方加洋藿叶、桑寄生等以促排卵。黄体期用药特点:李教授指出黄体功能健全,必须肝脾肾三脏并调,以补肾为主,调肝脾为次,李教授多用8方。行经期以通为用。若考虑患者经行不畅,应用10方通经。如患者月经量多,可根据辨证,阴虚血热迫血妄行者可用20方;如为脾气虚统摄无权者可选用9方。(2)李教授治疗生殖器炎症多从湿论治。根据辨证以热象为主的,选用4方;以湿重为主的,选用11方。对于输卵管阻塞者,李教授主张利湿通络、活血化瘀,内服主要以13方及通瘀1号为主。并根据病情轻重及有无合并盆腔炎,选用中药包、四黄水蜜或毛冬青灌肠等。治疗宫颈炎方面,在内服药基础上也主张宫颈上药。(3)李教授治疗癓瘕经验总结:李教授一般分期而治,非经期时当辨单纯的血瘀还是痰瘀互结,如为前者用5号方;如为后者用18方或12方。月经期时当辨以气滞为主还是以血瘀为主,前者用17方,后者用18方。(4)对于李教授治疗崩漏的经验总结:在暴崩久漏之际,塞流止血多用20方,并适当加补气药。如崩漏并出现气血两亏之象可用9方。崩漏下血缓解后,李教授多用19方调理气血。更多还原

【Abstract】 Background of theoryProfessor Li Liyun is the famous doctor of traditional Chinese medicine all over China, and also is the Famous doctor of TCM in Guangdong Province. She has been engaging in teaching, doctoring for over fifty years. Her academic theory and clinical experience are the very precious fortune for TCM that needs to be collected immediately. Some part of the collecting job has been worked, but limited. Most of them are just one single theory, or spreading experience in many books, which is deficient in characteristic and systematization. At the same time, it is lack of huge successful cases of Professor Li, which are full of South China character in gynecology of TCM, so that it’ s hard to reveal the breakthrough achievement in the field of gynecology of TCM and the sublimation in the academic theory. So it is very urgent to collect the academic theory and clinical experience of Professor Li comprehensively and systematically, and so are the dialectical thinking and characteristic of using Chinese medicine that are dug out from the typical cases.ObjectiveThis subject’s objective has four points. First is to collect and systematize the academic theory and clinical experience of Professor Li in the field of gynecology of TCM, through the successful cases. Second is to study the typical cases, academic theory and the clinical experience by using the logic of TCM science. Third is to summarize the dialectical thinking and regulation of using Chinese medicine. At last, it comes out with a Professor Li’s Chinese medicine case set. Then we can completely reserve and inherit her academic theory and clinical experience. It is more practical to guide the clinical of gynecology of TCM. MethodsSystematically collecting the theses, works, interview of Professor Li all these years. And then analyzing and arranging them carefully, so that we can systematize the theory of female physiology and the disease of gynecology. Systematically collecting the usual cases of gynecology disease and the oral and external therapies. Then analyzing and arranging the dialectical thinking and ways of treatments. Totally collecting the formulations Professor Li usually using, and analyzing the components of them, and handing to Professor Li to correct them.Resaults1、The academic theory of Professor Li is concentrating in regulating menstrual function, which Professor Li often uses to regulate the menstrual cycle by supplementing kidney. And this emphasizes that supplementarity of essence in kidney can grow the ovarian follicles, promotability of Yang in kidney can help ovulate, adjusting the liver, spleen and kidney at the same time can mature the Corpus luteum. Also in the pregnant period, supplementing the kidney is very important. Professor Li then comes out with the theory of ’having a good baby needs to act elegantly’ . Her treatment of cureing leukorragia depends on the moist heat theory. And she advocates using different therapies. Such as tubal obstruction, she is willing to remove dampness, relax vein and promote blood circulation by removing blood stasis. In the field of lump, the key to the pathogenesis is about the stagnation of the circulation of vital energy and the blood stasis. The stagnation of the circulation of vital energy can lead to the blood stasis, while the blood stasis can also strengthen the stagnation of the circulation of vital energy. Both of them can affect each other. Besides, dysmenorrheal has very close relationship with the lump. The nature of uterine bleeding is the deficiency of the kidney yin and the spleen qi. The blood heat and stasis are just the pathological factors in some period.2、The function of formulations: No.1 is for supplementing the kidney yang; No. 2 nourishing Yin and clearing heat; No. 3 supplementing essence and blood; No. 4 clearing heat and removing dampness; No.5 promoting blood circulation by removing blood stasis and clearing the lump; No. 6 strengthening the spleen and replenishing qi; No. 7 completing the liver yin and blood in order to sooth it; No. 8 supplementing kidney, strengthening the spleen and completing the liver; No. 9 strengthening the spleen qi to hold blood; No.10 promoting blood circulation by removing blood stasis; No. 11 removing dampness and clearing heat; No. 12 clearing the lump and phlegmy; No. 13 removing dampness, relaxing vein and strengthening spleen qi; No. 14 supplementing yin and blood of kidney and liver; No. 15 clearing the heat and moist in liver and gall; No. 16 strengthening spleen qi in order to clean phlegmy and dampness; No. 17 soothing the liver qi and curing the pain; No. 18 promoting blood circulation by removing blood stasis, clearing lump and phlegmy; No. 19 supplementing qi and blood; No. 20 cooling blood and stopping bleeding; No. 21 soothing the liver qi to relax the sullen; Chinese medicine bag one and two promoting blood circulation, removing dampness and relaxing vein.3、Supplementing kidney to regulate the menstrual cycle: after the menstrual period we need to analyze that which is missed, the kidney yin, yang or essence. Deficiency of kidney yang is going to use No. 1 formulation to complete yang. Deficiency of kidney yin can use No. 2 formulation to supply yin and clear heat, but it must add epimedium Herba Epimedii and Morinda officinal is to promote the growth of ovarian follicles. Deficiency of kidney essence must use No. 3 formulation. Besides, if it is the patients who suffer PCOS and full of the phlegmy and dampness in the body, No. 16 formulation will be useful. At ovulation time, Professor Li emphasizes that strengthen the kidney yang can promote to ovulate. And this time it must use No. 1 formulation. Plum-blossom needle rapping the Chong, Ren, Du, Dai channel, Shenque and Shenxue meridians also help. But for the patients of PCOS can also use No. 18 formulation to ovulate because of the thick albuginea of ovarians. For the patients who is efficiency of spleen qi, it can use No. 6 formulation adding epimedium Herba Epimedii or Viscum albummistletoe to ovulate the follicles. In the period of Corpus luteum, adjusting liver, spleen and kidney is the key to promote the robustness of corpus luteum. But the most important thing is to supplement kidney, second is the liver and spleen. So this time Professor Li use No. 8 formulation. At the menstrual bleeding period, it is very important that the menses must be unobstructed. If you consider the menses is obstructed, you can use No.10 formulation to smooth it. If the blood is blocked by the lump or the phlegmy, you can use No.18 or No.12 formulation. But if the patient is menorrhagia, you should analyze which is the main reason, the deficiency of yin causing the heat or shortage of spleen qi hold blood. The former can use No. 20 formulation, the last can use No.9. 4、The moist cause the Genital inflammation. According to the dialectical analysis, you can use No. 4 formulation to clear the heat and moist; and No. 11 to remove the dampness. For the tubal obstruction, you can use No. 13 formulation together with Tongyu No. 1 capsule for oral therapy in order to remove dampness and relax vein. And according to the condition level and with the PID or not, you can choose Chinese medicine bag, Sihuangshuimi or Maodongqing clyster liquid for external therapy. For the cervicitis, you can put some Chinese medicine on the cervix base on the oral medicine.5、The theory of cure lump: Professor Li usually treat the lump disease in several parts. In the dismenstrual period, it must distinguish the lump alone or with the phlegmy. The former can use No. 5 formulation; while the last can use No.18 or No.12 formulation. At the menses bleeding time, it must distinguish the stagnation of the circulation of vital energy or just the lump. The former can use No. 17 formulation, while the last can use No. 18 formulation.6、The theory of curing uterine bleeding: While in the period of bleeding, stopping the bleeding is urgent, and you can use No. 20 formulation. And add some supplement medicine of qi. If the bleeding lasts a long time and appears the deficiency of qi and blood, it can use No. 9 formulation. If the bleeding has been stopped, you can use No. 19 formulation to complete the qi and blood.更多还原