本文選題：高泌乳素血癥 + 中藥頻次　； 參考：《廣州中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的:1.通過系統(tǒng)查閱中文數(shù)據(jù)庫,收集、篩選并整理近三十年有關(guān)高泌乳素血癥的臨床研究文獻(xiàn),挖掘其中藥處方用藥規(guī)律,為臨床治療高泌乳素血癥提供系統(tǒng)化的用藥思路。2.通過三年的跟師學(xué)習(xí),抄方并筆錄心得,系統(tǒng)總結(jié)出導(dǎo)師李坤寅教授治療高泌乳素血癥的用藥經(jīng)驗,以饗同道。方法:1.以"高泌乳素血癥"、"高催乳素血癥"、"閉經(jīng)溢乳"、"閉經(jīng)泌乳"為主題詞或關(guān)鍵詞,在相關(guān)期刊論文(CNKI)、維普數(shù)據(jù)庫(VIP)、中國萬方數(shù)據(jù)庫全面搜索1986年1月—2016年12月的文獻(xiàn)。按照設(shè)定的納入標(biāo)準(zhǔn)、剔除標(biāo)準(zhǔn),嚴(yán)格篩選文獻(xiàn),并把納入研究的文獻(xiàn)的數(shù)據(jù)進(jìn)行規(guī)范化:記錄文獻(xiàn)發(fā)表的年份、是否設(shè)置對照組、治療組的樣本量、治療療程數(shù)目、是否合并西藥治療或其他中醫(yī)特色療法;重點(diǎn)記錄治療高泌乳素血癥的方藥組成,對于高泌乳素血癥的兼證加減用藥,則不予記錄。關(guān)于中藥藥名的規(guī)范化,及中藥歸類、歸經(jīng)方法,則參照黃兆勝主編的《中藥學(xué)》教材(人民衛(wèi)生出版社,2002年第1版)。利用excel軟件建立基本資料數(shù)據(jù)庫、方劑及藥物數(shù)據(jù)庫,并按照中藥的歸類、歸經(jīng)、四氣五味等建立子數(shù)據(jù)庫,將所得信息量化錄入其中;將其導(dǎo)入至SPSS18.0統(tǒng)計分析軟件包中,對數(shù)據(jù)進(jìn)行頻數(shù)分析、聚類分析。2.在跟師學(xué)習(xí)的過程中,勤于抄方,思考總結(jié),并筆錄心得,及時與導(dǎo)師交流學(xué)習(xí),從病因病機(jī)、辨證思路、用藥特色等方面概括導(dǎo)師經(jīng)驗,并通過典型驗案,逐層分析其治療思路。結(jié)果:1.臨床用藥規(guī)律的中醫(yī)文獻(xiàn)研究1.1 一般資料本課題收集近三十年(1986年至2016年)的文獻(xiàn),符合納入標(biāo)準(zhǔn)的文獻(xiàn)共計61篇,最早發(fā)表于1993年,2016年的文獻(xiàn)數(shù)量最多,計六篇。其中有36篇在研究過程中設(shè)立了對照組,占59.0%。中藥治療組的樣本量最少為20例,最多者為366例,樣本量為30例者最多見(18%),36.07%的文獻(xiàn)樣本量在30例-39例之間。55篇文獻(xiàn)是采用單方治療的,其余6篇為辨證論治。所有文獻(xiàn)的治療組均以內(nèi)服中藥為主,65.6%的文獻(xiàn)治療組為純中藥治療。研究療程多為3個以內(nèi),研究多數(shù)以一個月為一療程,總療程長度幾乎都在6個月以內(nèi),以3個月的療程長度為多見。1.2用藥分析納入的61篇文獻(xiàn),共載有中藥107味,總藥物頻數(shù)為717味次,每味中藥平均使用6.7味次。每個方劑使用4-26味中藥,平均每個方劑使用中藥11.75味。1.2.1中藥的歸類及頻次分析107味中藥歸屬到16個類別中,其中歸屬于補(bǔ)虛藥的中藥最多味(29味中藥,使用頻數(shù)累計達(dá)284次,占總藥物頻數(shù)的39.61%);其次為活血化瘀藥(13味中藥,頻數(shù)達(dá)75次)。中藥種類數(shù)排名前五的,還有理氣藥、清熱藥、化痰止咳平喘藥,分別包括11、10、10味中藥,頻數(shù)依次為55次、58次、29次。中藥種類數(shù)排名第七、第八、第九的利水滲濕藥、消食藥、解表藥,其使用頻數(shù)均較高(44次、65次、53次),平均每味中藥的使用頻數(shù)分別為8.8次、16.25次、13.25次。以中藥平均使用頻數(shù)做標(biāo)準(zhǔn),對比各大類別,平均頻數(shù)從高到低分別為:消食藥、解表藥、補(bǔ)虛藥、利水滲濕藥、清熱藥、活血化瘀藥、理氣藥、開竅藥、收澀藥、平肝息風(fēng)藥、化痰止咳平喘藥、安神藥與化濕藥、瀉下藥與祛風(fēng)濕藥、溫里藥。1.2.2各類別的高頻中藥分析分別建立每個類別中藥的子數(shù)據(jù)庫,按照使用頻次,將該類別的中藥從高到低地排序,累積頻率超過50%的藥物則納為該類別的高頻中藥。對于中藥總頻數(shù)少于10次的類別,則不作高頻中藥分析。最終得出各類別的高頻中藥統(tǒng)一列出:白芍、當(dāng)歸、甘草、白術(shù)、枸杞子、牛膝、郁金、丹參、香附、枳殼、牡丹皮、赤芍、桅子、半夏、山茱萸、茯苓、麥芽、柴胡。補(bǔ)血藥的總頻數(shù)占補(bǔ)虛藥這一大類的近半數(shù)(41.55%),其次為補(bǔ)氣藥。1.2.3中藥的性味歸經(jīng)分析中藥的四氣歸屬,以溫性藥最多(43味中藥,累計頻次248),寒性藥次之(34味中藥,累計頻次238),平性藥再次之(23味中藥,累計頻次213)。熱性藥(4味中藥,累計頻次9)、涼性藥(3味中藥,累計頻次9)的數(shù)量較少。中藥的五味歸屬,以甘味藥最多(61味中藥,累計頻次484),苦味藥次之(45味中藥,累計頻次326),辛味藥再次之(40味中藥,累計頻次275),此三味藥累計頻次1085次,占85.5%。而酸味藥雖僅有8味,其頻次卻有106次,頻數(shù)亦不少。淡味藥、咸味藥、澀味藥的種類及頻次則較少。中藥的歸經(jīng),以肝經(jīng)藥最多(66味中藥,頻次534,占總頻次61.68%)。其次則為脾經(jīng)(34味中藥,頻次342)、腎經(jīng)(44味中藥,頻次259),脾經(jīng)藥雖然味數(shù)不及腎經(jīng)藥,但使用頻次較之高,位居眾經(jīng)第二。再次之為心經(jīng)(29味中藥,頻次209)、胃經(jīng)(32味中藥,頻次183)。入肝經(jīng)、脾經(jīng)、腎經(jīng)、心經(jīng)、胃經(jīng)的藥物總頻次合計1527,占總數(shù)的83.99%。余歸經(jīng)藥物的頻次則較低。1.2.4整體藥物中的高頻中藥分析按頻數(shù)從高到低排序,中藥頻次高于7次(即該種藥物的使用頻率不低于1%)者,便納為整體藥物中的高頻中藥:白芍(53味次)、麥芽(49味次)、柴胡(49味次)、當(dāng)歸(47味次)、茯苓(35味次)、甘草(26味次)、香附(25味次)、白術(shù)(18味次)、枸杞子(18味次)、牛膝(18味次)、淫羊藿(17味次)、熟地黃(16味次)、牡丹皮(16味次)、菟絲子(15味次)、山茱萸(15味次)、山藥(14味次)、山楂(12味次)、郁金(11味次)、丹參(10味次)、赤芍(10味次)、半夏(10味次)、梔子(9味次)、生地黃(8味次)。其中有9味為補(bǔ)虛藥,4味清熱藥,3味活血化瘀藥,2味消食藥,而補(bǔ)虛藥囊括補(bǔ)血藥3味、補(bǔ)氣藥3味。23味高頻藥物集中在寒性、溫性、平性;其味集中于甘、苦、辛、酸,以甘味最多見;主要入肝經(jīng)、腎經(jīng)、脾經(jīng)、心經(jīng)、胃經(jīng),側(cè)重于肝經(jīng)。將23味高頻中藥單獨(dú)制一頻次表,按頻次從高到低排序,將累計頻率達(dá)50%的高頻中藥單獨(dú)列出,所得組合即成一核心方劑:白芍、麥芽、柴胡、當(dāng)歸、茯苓、甘草。此核心方劑含補(bǔ)血藥2味。1.2.5治療高泌乳素血癥中藥的聚類分析根據(jù)聚類樹狀圖,可得出四個組合:C1:白芍、柴胡、當(dāng)歸、麥芽。C2:白術(shù)、甘草、香附、茯苓。C3:淫羊藿、枸杞子、菟絲子、郁金、半夏、山楂、丹參、赤芍、牛膝。C4:牡丹皮、梔子、生地黃、山茱萸、山藥、熟地黃。四個聚類組合可分別概括為中醫(yī)藥治療高泌乳素血癥的基本方、肝脾同調(diào)之方、補(bǔ)腎活血之方、滋陰下火之方。2.導(dǎo)師李坤寅教授治驗總結(jié)導(dǎo)師李坤寅教授認(rèn)為,高泌乳素血癥的重要病機(jī)是肝腎不調(diào),腎虛而肝郁,在遣方用藥時,秉承肝腎同調(diào)的大旨,據(jù)其兼證,加減化裁;用藥常選麥芽、郁金、陳皮、柴胡、白芍、浙貝母、貓爪草、蒲公英等;根據(jù)女子所處階段,循時而用藥,分期而調(diào)理;不拘泥于一法,伍以西藥甲磺酸溴隱亭、維生素B6片等,衷中參西,以期降低病人血清泌乳素水平。結(jié)論:1.治療高泌乳素血癥的用藥思路及規(guī)律:疏肝解郁以治本,結(jié)合補(bǔ)腎健脾之法,再配合化濕祛瘀之藥以治標(biāo),適當(dāng)添加回乳通經(jīng)之品。臨床上治療高泌乳素血癥,可參考運(yùn)用基本方(白芍、麥芽、柴胡、當(dāng)歸、茯苓、甘草),并據(jù)其證候特點(diǎn),酌用上述聚類組合的方劑。2.導(dǎo)師李坤寅教授在治療高泌乳素血癥時,謹(jǐn)守病機(jī),肝腎同調(diào),巧用麥芽、郁金、柴胡、白芍、浙貝、蒲公英等特色藥,分期調(diào)理,衷中貫西,身心同治。
[Abstract]:Objective: 1. through systematic consulting Chinese database, collecting, screening and sorting out the clinical literature about hyperprolactinemia in the last thirty years, excavating the rule of drug use in the prescription of traditional Chinese medicine, providing a systematic way of thinking for the clinical treatment of hyperprolactinemia,.2. through three years of learning from the teacher, copy and record his mind, and systematically sum up the Tutor LI. Professor Kun Yin's experience in the treatment of hyperprolactinemia in the same way. Methods: 1. "hyperprolactinemia", "hyperprolactinemia", "amenorrhea milk", "amenorrhea milk" as the theme or key words, in the Chinese journal full text database (CNKI), VP number base (VIP), the Chinese Wanfang database comprehensive search for January 1986 - December 2016 literature According to the set criteria, eliminate the standard, select the literature strictly, and standardize the data of the literature included in the study: record the year of the published literature, whether the control group is set up, the sample size of the treatment group, the number of treatment courses, the combination of Western medicine treatment or other traditional Chinese medicine treatment, and the prescription for the treatment of hyperprolactinemia. The composition of the medicine will not be recorded for the combination of hyperprolactinemia, the normalization of the name of the Chinese medicine, the classification of Chinese medicine, the classification of traditional Chinese medicine and the method of returning to meridian, refer to the textbook of Chinese pharmacy, compiled by Huang Zhaosheng (people's Health Press, first edition 2002). The basic data database, prescription and drug database are established by using the Excel software, and according to the Chinese medicine database. The classification of the drugs, return to meridian, four Qi and five flavors and so on, set up a sub database to quantify the information and import the information into the SPSS18.0 statistical analysis software package and analyze the data frequency. In the process of learning with the teacher,.2. is diligent in copying, thinking and summarizing and communicating with the tutor in time, from etiology and pathogenesis and syndrome differentiation. Ideas, drug characteristics and other aspects summarized the tutor experience, and through typical cases, analyze the treatment ideas by layer by layer. Results: 1. the 1.1 general data of TCM literature study on the law of clinical medication collected in the literature of nearly thirty years (1986 to 2016), which were in line with the inclusion criteria of 61 articles, the earliest published in 1993, the number of 2016 literature. The maximum amount was six. 36 of them set up a control group in the study process, which accounted for 20 cases in the 59.0%. Chinese medicine treatment group, with the maximum number of 366 cases, the sample size of 30 cases (18%), 36.07% literature sample in the 30 cases between the.55 literature and the other 6 articles for the treatment of syndrome differentiation. All the literatures were treated with syndrome differentiation. The treatment group was given mainly traditional Chinese medicine, and 65.6% of the literature treatment group was treated with pure Chinese medicine. The course of the study was more than 3. Most of the studies were treated with one month, the length of the total course of treatment was almost 6 months, and the length of the course of treatment was more than 61 literature, which included 107 flavors of traditional Chinese medicine, and the frequency of total medicine was 717, with the length of 3 months of treatment. The average use of traditional Chinese medicine is 6.7 times. Each prescription uses 4-26 flavors of traditional Chinese medicine. The average prescription is classified into 16 categories by the classification and frequency analysis of 11.75 flavors of traditional Chinese medicine, 11.75 flavors of traditional Chinese medicine and frequency analysis. Among them, the most flavors belong to the traditional Chinese medicine (29 flavors, 284 times, 39.61% of the total drug frequency). The second is the medicine for activating blood and removing blood stasis (13 traditional Chinese medicine, frequency of 75 times). The number of kinds of Chinese medicine ranks the top five, and there are physical drugs, antipyretic drugs, expectorant antitussive antiasthmatic drugs, including 11,10,10 flavored Chinese medicine respectively, respectively 55 times, 58 times, 29 times. The number of kinds of Chinese medicine ranks seventh, eighth, ninth of the leuditic wetting medicine, digestion and digestion medicine, its frequency of use is higher (44 Times, 65 times, 53 times), the average use frequency of traditional Chinese medicine was 8.8 times, 16.25 times, 13.25 times. The average frequency of traditional Chinese medicine was used as the standard, and the average frequency was compared to the major categories. The average frequency was from high to low. The average frequency of the Chinese medicine was as follows: the digestion medicine, the antipyretic medicine, the antipyretic medicine, the antipyretic medicine, the blood activating medicine, the medicine, the astringent medicine, the relieving medicine, the phlegm and the phlegm. Antitussive and antiasthmatic drugs, anantiotic and humidifying drugs, purging drugs and dispelling wind dampness drugs, the high frequency traditional Chinese medicine analysis of each category of warm medicine.1.2.2 respectively set up the sub database of each category of Chinese medicine. According to the frequency of use, the traditional Chinese medicine of this category is sorted from high to low, and the cumulative frequency of more than 50% is used as the high frequency traditional Chinese medicine of this category. The high frequency traditional Chinese medicine was not analyzed in the category of less than 10 times. Finally, it was concluded that the high frequency traditional Chinese medicine of various categories was listed in the same list: Paeonia lactiflora, angelica, licorice, Alba, Chinese wolfberry, tulip, Salvia miltiorrhiza, Radix Paeoniae, peony root, peony, Pinellia ternata, Fructus Corni, Poria, malt, bupleurum. In addition, the sexual flavor of Chinese medicine.1.2.3 was followed by the four Qi attribution of traditional Chinese medicine, with the most warm medicine (43 flavors of traditional Chinese medicine, 248), the second of the cold sex medicine (34 flavors of traditional Chinese medicine, 238 of the cumulative frequency), the third of the traditional Chinese medicine (23 flavors of traditional Chinese medicine, 213). The number of hot drugs (4 traditional Chinese medicine, 9), and the quantity of cold sex medicine (3 Chinese traditional medicine, 9 frequency 9) Less. The five flavor of traditional Chinese medicine, with the most sweet medicine (61 flavors of traditional Chinese medicine, the cumulative frequency of 484), bitter medicine the second (45 flavors of traditional Chinese medicine, 326), again (40 flavors of traditional Chinese medicine, 275), the cumulative frequency of three drugs 1085 times, and the acid medicine, although only 8, its frequency is 106, a lot of frequency. Mild taste medicine, salty medicine, astringent The type and frequency of the herbal medicine were less. The Chinese medicine was treated with the most medicine (66 flavors, 534, 61.68%). The second was the spleen meridian (34 traditional Chinese medicine, 342), the kidney meridian (44 traditional Chinese medicine, 259), while the spleen meridian was less than the kidney meridian, but the frequency was higher and the number was second. The second was the heart meridian (29 flavors of traditional Chinese medicine, frequency). 209), stomach meridian (32 flavors of traditional Chinese medicine, frequency 183). The total frequency of the drugs into the liver, the spleen meridian, the kidney meridian, the heart meridian and the stomach meridian total the total frequency of 1527, and the frequency of the 83.99%. of the total drugs in the total medicine of the lower.1.2.4 is sorted from high to low by frequency, and the frequency of traditional Chinese medicine is higher than 7 times (that is, the use frequency of this kind of drug is not less than 1%). The high frequency traditional Chinese medicine in the whole medicine: Paeonia lactiflora (53 flavor times), malt (49 flavor), Chinese Angelica (47 times), tuckahoe (35 taste), licorice (26 times), Rhizoma Atractylodes (18 times), Chinese wolfberry (18 times), Achyranthes (18 flavour), epimedium (17 times), Radix Rehmanniae (16), peony (16 taste), dodder (15 taste times), Cornus officinalis, Cornus officinalis (15 times), yam (14 flavor), hawthorn (12 flavors), tulips (11 times), Salvia miltiorrhiza (10 flavors), red peony (10 flavors), pinellia (10 flavors), gardenia (9 times), and Rehmannia (8 flavors). Among them, 9 is supplemental medicine, 4 taste medicine, 3 flavor activating blood stasis medicine, 2 taste elimination medicine, and supplemental medicine including supplementing blood drugs,.23 flavor high frequency medicine concentrated in cold Sexual, warm, flat; its taste is concentrated in Gansu, bitter, symplectic, acid, most common; mainly into the liver, the kidney meridian, the spleen meridian, the heart meridian, the stomach meridian, and focus on the liver meridian. The 23 flavors of high frequency traditional Chinese medicine alone made a frequency list, according to the frequency from high to low, the accumulative frequency of high frequency Chinese medicine is listed separately, the combination is a core prescription: Paeonia lactiflora, malt, Chai This core prescription contains 2 flavors of.1.2.5 for hyperprolactinemia in the cluster analysis of Chinese medicine for hyperprolactinemia, according to the cluster tree chart, we can get four combinations: C1: Paeonia lactiflora, Radix Bupleuri, Radix Angelicae, malt.C2: albai, Glycyrrhiza, Fuling.C3: epimedium, Lycium chinensis, dodder, tulip, pinellia, haw, Radix Salviae, Radix Paeoniae,.C4: Peony Skin, gardenia, rehmannia, Cornus, yam, yam. Four cluster combinations can be summed up as the basic prescription of Chinese medicine for hyperprolactinemia, the prescription of the liver and spleen, the recipe for invigorating the kidney and activating blood, and Professor Li Kunyin, the tutor of Professor Li Hun Yin, the instructor of the fire of Nourishing Yin, that the important pathogenesis of hyperprolactinemia is that the liver and kidney are not adjusted, Kidney deficiency and liver depression, according to the main purpose of the liver and kidney concurrently, according to the essence of the liver and kidney, according to its syndrome, adding and subtraction, the drugs often choose malt, tulips, tangerine, bupleurum, Paeonia, Fritillaria thunbergii, cat claw grass, dandelion, etc. Conclusion: 1. in order to reduce the level of serum prolactin in patients. Conclusion: the thought and law of treating hyperprolactinemia by treating hyperprolactinemia, combining the treatment of stagnation of liver and strengthening the kidney and invigorating the spleen, combined with the medicine of dampness and removing stasis to treat the standard, and appropriately add the medicine to the menstruation of hyperprolactinemia. Hu, angelica, tuckahoe, licorice), and according to the characteristics of its syndrome, Professor Li Kaiyin, the.2. tutor of the combination of the above clustering combination, is in the treatment of hyperprolactinemia, keeping the disease machine, liver and kidney with the same tune, using malt, tulip, bupleurum, Radix Paeoniae, Thunbergi, dandelion and other characteristic drugs.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R249;R271.9

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