【作者】 温琇文；

【导师】 罗颂平；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2010， 硕士

【摘要】 盆腔炎性疾病(Pelvic inflammatory disease, PID)是常见的妇科疾病且迁延难愈,是指女性生殖器及其周围组织、盆腔腹膜的炎症,包括子宫体、卵巢、输卵管炎症,范围较广,可局限于某一部位,也可几个部位同时发生,是育龄期妇女常见病。急性炎症缓解以后,往往还有盆腔组织的增生、粘连、瘢痕形成,容易发生再次感染。亦会引起一系列临床症状,许多文献称之为慢性盆腔炎,最近的教科书则称为“盆腔炎性疾病后遗症”。除了长期慢性疼痛、月经不调、盆腔炎性疾病反复发作外,严重的还会影响女性的生育功能,导致不孕症或异位妊娠。女性内生殖器官慢性炎症,包括输卵管炎与输卵管积水、输卵管卵巢炎、输卵管卵巢囊肿、盆腔结缔组织炎、子宫内膜炎,主要改变为组织破坏、广泛粘连、增生及瘢痕形成,常为急性盆腔炎未能彻底治疗,或患者体质较差,病程迁延所致,具有病程长、病情缠绵。病情顽固者,当机体抵抗力较差时,可反复感染,若不能有效控制,又可引起月经异常,甚至导致不孕、异位妊娠、慢性盆腔痛、盆腔炎反复发作等。因此对盆腔炎治疗尤其急性期必须正确、有效、彻底。目的：分析慢性盆腔炎的中医证候分布规律,并对其发病因素、症状特点进行探讨。通过前瞻性研究,观察岭南地区患者的临床证候特征,为中医药治疗本病提供循证医学依据。方法：参照卫生部2002年的《中药新药临床指导原则》和2005年《妇产科学》教材(人民卫生出版社)的PID诊断标准以及慢性盆腔炎的中医辨证标准,随机收集439例慢性盆腔炎患者作为研究对象,进行中医辨证分型,并对其症状分类统计。结果：本组患者的中医证候以湿热证常见(19.4%),其次是气虚、气滞、湿热瘀结、气虚血瘀、气滞血瘀证(分别为18.0%、17.5%、15.3%、11.6%和8.9%)。经聚类分析归纳为5种证候类型,依次为湿热瘀结型、气滞血瘀型、寒湿凝滞型、气虚血瘀型和肾虚血瘀。中医病机与湿、瘀、虚关系密切。带下黄稠,舌红,苔黄厚腻为湿热瘀结证的代表性征象；经前乳房胀痛,情志抑郁,烦躁易怒,舌黯红、脉弦为气滞血瘀证的代表性征象；腰腹冷痛,得热痛减,形寒肢冷为寒湿凝滞证的代表性征象；体倦乏力、纳差、舌淡、脉细为气虚证的代表性征象；腰酸耳鸣、婚久不孕为肾虚证的代表性征象。结论：1.慢性盆腔炎(盆腔炎性疾病后遗症)多发生于育龄期妇女,尤其是多次流产者。2.慢性盆腔炎(盆腔炎性疾病后遗症)以湿、瘀、虚为其主要病机,中医证候以湿热瘀结型、气虚血瘀型、气滞血瘀型较常见,肾虚血瘀型、寒湿凝滞型次之。多为虚实夹杂,本虚标实。3.经聚类分析,慢性盆腔炎(盆腔炎性疾病后遗症)湿热瘀结证的主要症状是下腹胀刺痛、带下增多色黄、身体低热、舌质红、苔黄厚腻；气虚血瘀证的代表性症状是下腹隐痛、带下增多、色白、质稀、体倦乏力、舌淡黯、脉细弦；气滞血瘀证的代表性症状是下腹胀痛、经期下腹痛加重、血块多、经前乳胀、情志抑郁、烦躁易怒、舌黯红有瘀点；寒湿凝滞证的代表性症状是下腹冷痛、得热痛减、形寒肢冷、舌淡苔白腻、脉沉细；肾虚血瘀证的代表性症状是下腹绵绵作痛、劳累后加重、腰膝酸软、婚久不孕、舌淡黯、脉细涩。更多还原

【Abstract】 Pelvic Inflammatory Disease (PID) is a common gynaecological disorder with long-term implications in women of reproductive age. PID refers to the inflammation of the female internal reproductive organs and the peritoneum, this includes the uterus, ovaries and the fallopian tubes, the affected region may be localised to one area or may affect several anatomical structures simultaneously. After the acute inflammation, and often ease of pelvic organizations, adhesion, scarring, easy to occur again. Also can cause a series of clinical symptoms, many documents called the chronic pelvic inflammation, recent schoolbooks called "pelvic inflammatory disease sequela.". Except for chronic pelvic pain, irregular menstruation, recursive pelvic inflammation, and may even affect fertility causing infertility or ectopic pregnancy.Within the female reproductive organs, including chronic inflammation with fallopian tube water salpingitis ovarian inflammation, oviduct tubes, ovarian cyst, pelvic inflammatory disease, endometritis connective tissue, major change for organizing sabotage, extensive adhesion, proliferation and scarring, often for treatment of acute pelvic inflammation, or fails to complete the patient’s constitution, course in the course of a long, lingering illness, has. When the body resistance, but poor recurrent infections, if cannot be effectively controlled, and can cause menstrual abnormalities, and even cause infertility, ectopic pregnancy, chronic pelvic pain repeated attacks of pelvic infection, etc. Therefore for pelvic inflammatory disease treatment especially acute period must be correct and effective, thoroughly. Objective:The etiological factors of chronic PID, their corresponding Traditional Chinese Medicine (TCM) syndromes and the key for syndrome differentiation are investigated through randomised trials in this prospective study. This paper aims to analyse the distribution of TCM syndromes of PID in Lingnan area of China and explore its possible implementation as a reference in TCM gynaecology.Methods:According to the ministry in 2002, the Chinese herbal medicine new medicine clinical guidelines and 2005 the textbooks of obstetrics and gynecology. People’s medical publishing house (PID) diagnostic criteria and the chronic pelvic inflammation of TCM syndrome differentiation standard, random collect 439 patients with chronic pelvic inflammatory disease patients as the research object, the TCM syndrome differentiation of symptoms, and classification of statistics.Results:Group of patients with dampness syndromes syndrome common (19.4%), second is the deficiency of qi, blood stasis, dampness, qi difficiency and blood stasis, qi and blood stasis syndrome (18.0%, respectively,、11.6%、15.3%、17.5%、8.9%). By clustering analysis to 5 kinds of syndrome type, dampness and order, qi stagnation and blood stasis, dampness, freeze and blood stasis and kidney blood stasis. TCM pathogenesis and wet, blood stasis, virtual close relationship. Bring yellow viscous, red tongue, moss HuangHou greasy for heat and blood stasis syndrome of representative signs, The breast before flatulence, emotions, irritability, depression and red tongue ageless and blood stasis string for signs of representative, Lumbar abdomen pain, pain reduction, hot, cold limbs cold dampness syndromes rickshaw for signs of representative, Body tired, tongue, light, pulse of the typical signs; deficiency The waist sour tinnitus, marriage long for testis-removed representative of infertility.Conclusions:1.The chronic pelvic inflammation (pelvic inflammatory disease sequela) are born in women of reproductive age, especially many pregnancies.2. The chronic pelvic inflammation (pelvic inflammatory disease sequela) to wet, blood stasis and virtual as its main pathogenesis, dampness syndromes and blood stasis, with qi and blood stasis, blood stasis syndrome is common, kidney blood stasis syndrome, the second type snow-drift dampness. For many, this healthy qi.3. By clustering analysis, the chronic pelvic inflammation (pelvic inflammatory disease sequela) and hot blood stasis syndrome is the main symptom of abdominal distention tingling, down under increased body color yellow, red, thermal, tongue HuangHou moss oily, Qi difficiency and blood stasis syndrome is the typical symptom, and brought home, abdomen, thin, white body roll fatigue, loose stools, blue-black tongue weak pulse, fine, string, Qi and blood stasis syndrome is the typical symptoms of abdominal pain, menstrual blood, abdominal pain, the breast before the sentiment, irritability, depression, blue-black tongue is red, petechiae, The typical symptom snow-drift cold-warm abdomen pain is hot, cold and pain reduction cold limbs and cold, pale moss BaiHou greasy, tongue pulse sink fine, Kidney blood stasis syndrome is the typical symptoms of fatigue, abdomen after continuous became, lumbar debility, marriage long tongue light sudpratanaa infertility, and fine.更多还原