【摘要】：目的:1絕經前后諸證是婦科常見病,也屬疑難雜癥。近年來本病發(fā)病率逐年上升,不僅嚴重危害婦女身心健康,同時也給家庭和社會造成極大影響。王希浩導師是國家級第五批名老中醫(yī)藥專家?guī)煶兄笇Ю蠋?碩士生導師,主要從事中醫(yī)婦科臨床與科研工作。導師在中醫(yī)藥治療女性內分泌與生殖免疫調節(jié)方面有深入研究,尤其對絕經前后諸證的辨證和治療,經驗獨到,但其許多寶貴經驗未能及時整理歸納。本文通過對導師的講課內容、論文集著、門診病例跟蹤觀察,結合個人臨床體會,全面系統(tǒng)地進行歸納整理,進而探討導師辨治絕經前后諸證的學術思想,以期為祖國醫(yī)學事業(yè)的發(fā)展略盡綿力。2絕經前后諸證臨床表現(xiàn)紛繁,如烘熱汗出、煩躁易怒、心悸失眠、潮熱面紅、眩暈耳鳴、面浮肢腫、腰背酸楚、皮膚蟻行感、情志不寧等癥狀,中醫(yī)藥治療絕經前后諸證雖然療效確切,副作用少,但在病因病機、辨證分型、療效評定等方面尚缺乏統(tǒng)一標準。本文旨在通過對王希浩導師治療絕經前后諸證的學術思想的探討總結,以期獲得絕經前后諸證的病因病機、辨證分型、療效評定等方面的量化指標,以便臨床推廣應用。方法:1通過匯總王希浩導師學術論文30余篇,研析導師講課資料、學術論著等,對導師辨治絕經前后諸證的方法和用藥特點進行探討分析和歸納總結。2整理其臨證醫(yī)案150余例,自擬方、經驗方100余首,對方內隨癥加減藥物及使用頻次進行統(tǒng)計分析。3查閱文獻,深度分析導師學術思想和現(xiàn)有治療婦科疾病理論框架之間的關系。4結合個人臨床體會和學術交流,對導師學術思想進行實踐學習和反復驗證。5系統(tǒng)總結出導師辨治絕經前后諸證的學術思想,書寫專業(yè)論文。成果:跟師過程中,搜集匯總導師學術論文30余篇,整理其臨證醫(yī)案150余例,自擬方、經驗方100余首,研析其講課資料、學術論著等,對導師辨治絕經前后諸證的方法和用藥特點進行探討分析和歸納總結,并結合個人臨床體會,初步整理總結出導師對絕經前后諸證的辨證思路及診療規(guī)律。具體歸納為以下幾方面:1導師對絕經前后諸證病因病機的認識1.1“腎陰虧虛是其本”。祖國醫(yī)學認為,婦女“七七”之年,腎氣漸衰,天癸將竭,沖任二脈虧損,精血不足,月經逐漸減少而至絕經,生殖能力逐漸下降而至消失。導師認為,女子屬陰,婦女一生歷經“經、孕、產、乳”,數(shù)次耗傷陰血,機體處于“陰常不足,陽常有余”的生理狀態(tài),又因“年逾四十而陰氣自半”,若素體陰虛或房勞多產;或情志內傷,氣火傷陰;或大病久病,窮必及腎等,腎陰就會更加虧虛,不能灌溉五臟,滋養(yǎng)諸經,進而變生諸癥。所以腎陰虧損是本病的發(fā)病之本。1.2“陽亢火炎是其標”。中醫(yī)認為,心腎屬水火既濟關系,腎肝屬于精血同源關系。絕經前后腎陰虧虛不能上濟于心,可使心火獨亢,出現(xiàn)心腎不交、水火失濟,臨床常見面部烘熱、心悸、心慌以及失眠、煩躁、焦慮、抑郁等心火上炎癥狀;腎陰虧虛,腎水不足以涵養(yǎng)肝木,肝失柔養(yǎng),臨床常見眩暈耳鳴、腰膝酸軟、心煩急躁、咽干口苦、心悸健忘、失眠多夢等一系列肝腎陰虛、肝陽上亢癥狀�？梢�,絕經前后諸證以腎陰虧虛為本,由腎陰虧虛所致的陽亢火炎是其常見表象。1.3“病情涉及心肝脾”。婦女絕經前后,腎氣虛衰、陰陽失調為本,又常常波及心肝脾三臟。波及于心,可見心陰虧虛,心腎不交證;波及于肝,常出現(xiàn)肝陰不足、肝陽上亢和肝經郁熱化火的癥狀表現(xiàn);波及于脾,常見脾腎陽虛、脾胃虛弱等證。2導師辨治絕經前后諸證的臨床經驗2.1“補腎為主,兼調心肝脾”2.1.1“治病求本,補腎養(yǎng)陰是關鍵”。絕經前后的婦女由于體質差異,疾病、產育、營養(yǎng)等因素,再加上家庭問題、社會環(huán)境、工作壓力等方面的原因,使得機體處于“陰常不足,陽常有余”的病理狀態(tài)。腎陰虧虛,臟腑失養(yǎng),繼而出現(xiàn)絕經前后諸證如潮熱、盜汗以及情緒障礙如抑郁、焦慮等。因此腎陰虧虛是絕經前后諸證的基本病機。治療應以滋補腎陰、填精益髓為基本大法。2.1.2“兼顧他臟,心肝脾各有側重”。絕經前后諸證的基本病機是“其本在腎,涉及心肝脾”,在本證中,除腎陰虧虛的主要臨床表現(xiàn)外,�？梢娖�、偏心、偏脾的不同癥候。所以,導師在臨證中,十分重視“審查病機”,嚴格做到“有是癥用是藥”。治療上,除滋補腎陰為主外,又根據(jù)臨床所出現(xiàn)的偏于心、肝、脾的不同癥狀,用藥各有側重。2.2“平調陰陽,善于陰中求陽、陽中求陰”。導師辨證治療絕經前后諸證,從腎虛入手,平調腎中陰陽。雖然本病腎陰虧虛證居多數(shù),但也不忽視腎陽虛和腎陰陽兩虛證。治療上注意溫腎陽和陰陽雙補,并善于陽中求陰,陰中求陽,滋陰之中不忘助陽。2.3“心理疏導,重視人文關懷”。絕經前后諸證作為一種身心疾病已被大家公認,因此心理療法本病的治療具有重要的作用。中醫(yī)認為情志是五臟功能的外在表現(xiàn),只有臟腑功能正常,情志才會正常,反過來五志過極及七情失常又可影響臟腑的功能。導師在臨證時尤其重視人文關懷,在藥物治療的基礎上,常常給予患者必要的心理疏導及健康教育,以幫助患者順利渡過絕經期。2.4“標本兼顧,從虛、熱、瘀辨治絕經期功血”。絕經期功血,是指婦女絕經前后因卵巢機能減退,卵泡幾乎耗竭,不能正常排卵引起的月經周期、經期、經量紊亂。此病是婦科臨床常見病、多發(fā)病,也是疑難急重病癥,屬中醫(yī)學崩漏范疇。導師繼《內經》之理論,承傅青主之學說,結合數(shù)十年臨床實踐,認為絕經前后崩漏的病因病機主要是陰虛內熱,熱迫血行,兼有瘀血瘀毒。治療以固腎、調肝、健脾為主,輔以清熱涼血止血、化瘀解毒。3導師治療絕經前后諸證的用藥規(guī)律收集2012年9月至2015年5月導師治療絕經前后諸證病例56份,處方172張,并統(tǒng)計出其中常用藥物的使用頻次和頻率。結果顯示,處方中藥物出現(xiàn)頻率具有統(tǒng)計學意義的有28味,占統(tǒng)計處方中藥物頻率的71.44%,而這些藥物正是組成治療本病的基本方(黃柏、知母、生熟地、生山藥、山萸肉、當歸、白芍、川楝子、生龍骨、生牡蠣、丹參、雞內金、白術)及兼證常用方的主要藥物,可以看出導師治療絕經前后諸證主要從滋補腎陰、兼調心肝脾入手,在本證本方的基礎上隨證加減。結論:絕經前后諸證是由于婦女“七七”之年腎氣漸衰,天癸將竭,沖任虛損,精血不足,進而導致機體陰陽失調,臟腑功能紊亂。導師從事婦科臨床與科研三十余載,對本病的辨證施治積累了極其豐厚的臨床經驗,認為本病的基本病機是“其本在腎,涉及心肝脾”,治療以滋補腎陰為主,兼調心肝脾,同時注意平衡陰陽,標本兼顧。臨床辨證準確,用藥精當,療效顯著。
[Abstract]:Objective: 1 postmenopausal syndrome is a common disease of gynecology and is a difficult and complicated disease. In recent years, the incidence of this disease is rising year by year. It not only seriously endangers the health of women, but also has a great influence on family and society. Wang Xihao's tutor is the fifth batch of national experts of traditional Chinese medicine, the teacher of the master of Chinese medicine and the master of the master of Chinese medicine, mainly engaged in Chinese medicine women. Department of clinical and scientific research work. Tutors have a deep study on the treatment of female endocrine and reproductive immunity in traditional Chinese medicine, especially for the syndrome differentiation and treatment of postmenopausal and postmenopausal syndrome, but their experience is unique, but many valuable experiences have not been arranged and summarized in time. Human clinical experience, comprehensive and systematic induction, and then discuss the academic thoughts of the tutor before and after the menopause, in order to make the development of the medical cause of the motherland a little bit.2, such as hot sweat, irritability, palpitation, insomnia, red tide, vertigo and tinnitus, surface floating limb swelling, low back and back, skin ants. In the treatment of menopause, traditional Chinese medicine has a definite curative effect and less side effects in the treatment of menopause, but there is still a lack of unified standard in the etiology, pathogenesis, syndrome differentiation and evaluation of curative effect. The aim of this paper is to summarize the academic thoughts and thoughts of Wang Xihao's tutor before and after the menopause, in order to obtain the cause of the menopause. The quantitative index of disease machine, syndrome differentiation and curative effect evaluation in order to be applied in clinical application. Method: 1 through summarizing more than 30 articles of Wang Xihao's academic thesis, studying and analyzing tutor's lecture materials, academic treatise and so on, the methods and characteristics of the Advisors' treatment and treatment of postmenopausal syndrome were analyzed and summarized by.2. An example, a self-made party, more than 100 experienced parties, a statistical analysis of the medication and frequency of use in the other side,.3 consulted the literature, and the relationship between the academic thought of the tutor and the existing theoretical framework for the treatment of gynecologic diseases was deeply analyzed..4 combined with personal clinical experience and academic exchange, and the academic thought of the tutor was studied in practice and repeated to verify the general.5 system. In the course of the teacher, we collected more than 30 academic papers and collected more than 150 cases of medical cases, made up their own prescription and more than 100 experience. To discuss and summarize the analysis and summary, and combined with personal clinical experience, preliminarily collate and summarize the syndrome differentiation and diagnosis and treatment rules of the postmenopausal and postmenopausal syndrome. 1 the following aspects are summed up as follows: 1.1 "kidney yin deficiency" is the basis for the understanding of the etiology and pathogenesis of the menopause before and after the menopause. The Chinese medicine thinks that the year of the "77" of women, the gradual decline of kidney qi "Tian Kui will be exhausted, the two pulse loss, lack of blood, menstruation gradually decrease to menopause, the reproductive capacity gradually decline to disappear. The tutor thinks, women belong to the Yin, women's life through" meridian, pregnancy, production, milk ", several times consumption of Yin blood, the body is in" Yin often insufficient, Yang often surplus "physiological state, and because" over forty and Yin Qi from the half ", If the body of the body is Yin deficiency or labor and labor, or emotional internal injury, air fire injury Yin, or a long illness, poor and kidney, the kidney and so on, the kidney Yin will be more deficient, can not irrigate the five zang organs, nourish all the meridians, and then change the disease. Therefore, the kidney Yin loss is the disease of the pathogenesis of.1.2 "Yang Hyperactivity fire is its standard". Chinese medicine thinks that the heart and kidney are water and fire to the relationship, kidney and liver belong to essence The kidney yin deficiency before and after menopause can not be put on the heart, can make the heart fire hyperactivity, the heart and kidney disjoint, water and fire loss, the clinical common facial heat, palpitation, panic and insomnia, irritability, anxiety, depression and other symptoms of heart fire, kidney yin deficiency, kidney water is not sufficient to maintain liver wood, liver softness and support, clinical common vertigo tinnitus, the waist knee soft, heart Irritable, dry throat, palpitation, forgetfulness of heart palpitations, insomnia and many other symptoms of liver and kidney yin deficiency, liver yang hyperactivity symptoms. It can be seen that the syndrome of kidney yin deficiency is the common manifestation of kidney yin deficiency caused by deficiency of kidney yin, the common expression.1.3 "the disease involves the heart and the spleen". Spleen three dirty. Wave in the heart, visible deficiency of the heart Yin deficiency, the heart and kidney do not pass the syndrome; wave in the liver, often appear liver yin deficiency, liver yang hyperactivity and liver meridian heat of the symptoms of the symptoms; wave in the spleen, common spleen and kidney yang deficiency, spleen and stomach weakness,.2 tutor's clinical experience of syndrome differentiation and treatment of menopause, 2.1 "kidney tonifying, also regulating the heart liver spleen" 2.1.1 "cure the disease and seek the basis, The key to nourishing the kidney and nourishing Yin is the key. The factors such as physical difference, disease, birth and nutrition, and other factors, such as family problems, social environment and work pressure, make the body in the pathological state of "Yin deficiency, Yang often surplus", kidney yin deficiency and viscera loss, and then the occurrence of menopause, such as hot tide and night sweats. And emotional disorders such as depression, anxiety and so on. Therefore kidney yin deficiency is the basic pathogenesis of postmenopausal syndrome. Treatment should be to nourish the kidney yin, fill the lean pulp as the basic.2.1.2 "to give consideration to his dirty, both heart and liver and spleen". The basic pathogenesis of the menopause syndrome is "the kidney, the heart and the liver and the spleen", in this evidence, in addition to the kidney yin deficiency of the owner of the main syndrome, in this certificate, the main deficiency of kidney yin deficiency of the main owner of the master In addition to clinical manifestations, liver, eccentric, partial spleen are often seen in different symptoms. Therefore, the tutor attaches great importance to "examining the pathogenesis" and strictly "is a medicine". In the treatment, in addition to nourishing the kidney Yin mainly, and according to the clinical symptoms of heart, liver, spleen, the drug each has a particular emphasis on.2.2 "Ping Yin and Yang, good at Yin and Yang, good at Ping Yin and Yang, adept at regulating yin and Yang." The treatment of kidney yang deficiency and Yin and yang two deficiency syndrome is not neglecting the kidney yang deficiency and Yin and yang deficiency syndrome. The treatment of yin and Yang and Yin and Yang double supplement, and good at Yang in Yin, yin and Yang, and nourishing yin.2.3 "psychological sparse" It has been recognized as a kind of physical and mental illness before and after the menopause. Therefore, the treatment of psychotherapy has an important role. Traditional Chinese medicine believes that emotion is the external manifestation of the function of the five zang organs. Only the function of the viscera is normal and the emotion is normal, in turn, the five aspiration and seven disorders can affect the function of the viscera. On the basis of drug treatment, tutors pay special attention to humanistic care. On the basis of drug treatment, they often give patients the necessary psychological guidance and health education to help patients successfully cross the menopause.2.4 "both from deficiency, heat, and blood stasis to treat menopause." menopause dysfunctional blood, refers to women's ovarian dysfunction before and after menopause, follicles almost consumed. Exhaustion, the menstrual cycle, menstrual period, menstrual disorder caused by normal ovulation. This disease is a common gynecologic disease, it is a common disease of Gynecology, and it is also a difficult and severe disease. It belongs to the category of Chinese medicine. Blood stasis, blood stasis and blood stasis poison. Treatment of kidney, liver, spleen, supplemented with clearing heat, blood stasis, removing blood stasis and detoxifying.3 tutors for the treatment of menopause before and after the treatment of 56 cases of postmenopausal and 172 cases, prescription 172, and statistics the frequency and frequency of common drugs used. The results showed that the frequency and frequency. The results showed that the frequency and frequency. Results showed the frequency and frequency of common drugs. Results showed the frequency and frequency. Results showed the frequency and frequency of drugs. Results showed the frequency and frequency. Results showed frequency and frequency. Results showed There are 28 flavors of statistical significance in the prescription of the prescription, accounting for 71.44% of the frequency of the drug in the statistical prescription, and these drugs are the main drugs that constitute the basic prescription for the treatment of the disease (cortex phellodendron, Anemarrhena, raw land, raw yam, Cornus, angelica, Paeonia, Kawa Ko, raw oysters, Salvia miltiorrhiza, chicken inner gold, Atractylodes macrocephala), It can be seen that tutor's treatment of menopause mainly from the nourishing kidney yin, and regulating heart and liver and spleen, on the basis of this prescription. Conclusion: the syndrome of the menopause is due to the gradual decline of the kidney qi in the year of "77", the exhaustion of Tian Kui, the deficiency of the blood, the deficiency of the blood, the dysfunction of the body Yin and Yang, the dysfunction of the viscera and the function of the viscera. Gynecologic clinical and scientific research for more than 30 years, the syndrome differentiation and treatment of the disease accumulated extremely rich clinical experience, the basic pathogenesis of this disease is "the kidney, involving the heart and the spleen", the treatment to nourish the kidney Yin mainly, and adjust the heart and liver and spleen, while paying attention to balance yin and Yang, the clinical syndrome differentiation accurate, drug intensive, curative effect is significant.
【學位授予單位】：河南中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R249;R271.116

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