【摘要】：目的:通過(guò)對(duì)名老中醫(yī)李維賢治療痛經(jīng)的病案進(jìn)行回顧性臨床研究,以中醫(yī)藥理論為指導(dǎo),采用觀察法、比較法及數(shù)理統(tǒng)計(jì)等法來(lái)完成此文,從而探析和歸納李維賢治療痛經(jīng)的臨床經(jīng)驗(yàn);同時(shí)通過(guò)前瞻性臨床研究,采用自身前后對(duì)照試驗(yàn)方法,觀察分析李老自擬驗(yàn)方虛寒痛經(jīng)方治療虛寒型痛經(jīng)的臨床療效,以進(jìn)一步為中醫(yī)藥治療痛經(jīng)提供指導(dǎo)。方法:通過(guò)痛經(jīng)文獻(xiàn)學(xué)研究,歸納古代中醫(yī)家對(duì)痛經(jīng)的病名、病因病機(jī)、辨證論治等方面的認(rèn)識(shí),整理現(xiàn)代中醫(yī)家對(duì)痛經(jīng)的中醫(yī)藥內(nèi)、外治療方法的研究,概括現(xiàn)代西醫(yī)學(xué)對(duì)痛經(jīng)的病因病機(jī)、分型及治療手段的研究及進(jìn)展,為整理和研究李維賢治療痛經(jīng)的辨證治法及用藥規(guī)律打好理論基礎(chǔ)。通過(guò)分析李老門(mén)診62例痛經(jīng)患者病案的辨證及論治方法,并對(duì)李老治療各證型痛經(jīng)的25首處方進(jìn)行分類(lèi)及頻次統(tǒng)計(jì)、歸納比較與分析討論,將常用的117味中藥進(jìn)行功效分類(lèi)、歸經(jīng)及性味統(tǒng)計(jì)分析,以了解其用藥規(guī)律,最后概括總結(jié)李維賢診治痛經(jīng)的臨床經(jīng)驗(yàn)及一般特點(diǎn)。同時(shí)收集納入2015年12月至2017年1月在廣東省中醫(yī)院婦科門(mén)診就診診斷為虛寒型痛經(jīng)的49例患者,予以李老自擬驗(yàn)方虛寒痛經(jīng)方加減,患者經(jīng)期服藥5天,治療3個(gè)月經(jīng)周期,觀察記錄治療前后痛經(jīng)癥狀評(píng)分及VAS評(píng)分,分析對(duì)比治療前后各評(píng)分的差異,分析年齡、病程、病情與療效的相關(guān)性,觀察虛寒痛經(jīng)方的整體臨床療效。結(jié)果:李老辨證治療痛經(jīng)處方情況比較分析:肝氣郁滯型:調(diào)經(jīng)種玉湯加味主治肝郁血虛夾有氣滯之痛經(jīng);開(kāi)郁種子湯加味主治肝郁兼肝脾不調(diào)型痛經(jīng);宣郁通經(jīng)湯加味主治肝郁夾瘀熱之痛經(jīng);解肝煎加味主治肝郁兼脾胃郁滯之痛經(jīng);當(dāng)歸芍藥散加味主治肝郁脾虛兼有血水郁滯之痛經(jīng)。寒凝血瘀型:通卵種育丹加味主治少腹寒凝血瘀兼氣滯型痛經(jīng);溫臍化濕湯加味主治下焦寒濕型痛經(jīng);金匱之溫經(jīng)湯加味主治沖任血虛、寒凝血瘀型痛經(jīng)。氣血虧虛型:人參養(yǎng)榮湯加味主治氣血俱虛型痛經(jīng)。脾胃虛弱型:七味白術(shù)散加味活血調(diào)經(jīng)之藥主治脾胃虛弱型痛經(jīng)。腎氣不足型:調(diào)肝湯加味主治腎精虛少、肝血不足之痛經(jīng)。常用中藥分類(lèi)統(tǒng)計(jì)結(jié)果顯示前五類(lèi)依次為補(bǔ)氣藥、補(bǔ)血藥、活血化瘀藥、理氣藥、助陽(yáng)藥;中藥歸經(jīng)排在前三位的依次為歸脾經(jīng)、肝經(jīng)、心經(jīng)。常用中藥的藥性前兩位依次為溫性、平性;藥味前兩位依次為辛味、甘味。李老驗(yàn)方虛寒痛經(jīng)方治療虛寒型痛經(jīng)療效觀察:治愈6例,顯效16例,有效18例,無(wú)效9例,總有效率為81.63%。患者治療前后痛經(jīng)癥狀評(píng)分及VAS評(píng)分對(duì)比,治療后明顯下降,差異有統(tǒng)計(jì)學(xué)意義。患者各年齡組間比較有統(tǒng)計(jì)學(xué)意義,患者各病程組間、各病情組間療效療效比較均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:李維賢教授臨床常見(jiàn)痛經(jīng)辨證分型:肝氣郁滯型、寒凝血瘀型、氣血虧虛型、脾胃虛弱型、腎氣不足型。經(jīng)驗(yàn)特點(diǎn):推崇古方,辨證施治;善理臟腑,重調(diào)肝脾;氣血為要,通補(bǔ)兼施;溫散寒邪,通化血瘀。李老經(jīng)驗(yàn)方—虛寒痛經(jīng)方加減對(duì)虛寒型痛經(jīng)具有較好的治療作用,可溫經(jīng)散寒止痛,有效緩解患者的痛經(jīng)癥狀,且對(duì)年輕痛經(jīng)患者療效相對(duì)較好。
[Abstract]:Objective: to carry out a retrospective clinical study on the case of dysmenorrhea treated by Li Weixian, an old Chinese medicine, with the guidance of the theory of traditional Chinese medicine, with the methods of observation, comparison and mathematical statistics to complete this article, so as to explore and summarize the clinical experience of Li Weixian in the treatment of dysmenorrhea. Methods: To observe and analyze the clinical effect of Li Lao's own prescription of deficiency cold and dysmenorrhea in treating dysmenorrhea of deficiency cold type, and to provide guidance for the treatment of dysmenorrhea by traditional Chinese medicine. Methods: through the study of dysmenorrhea literature, summarize the understanding of the name of the dysmenorrhea, the pathogenesis, the syndrome differentiation and treatment of the ancient Chinese medicine family, and collate the traditional Chinese medicine for the dysmenorrhea. The study of internal and external treatment methods summarized the research and progress of modern western medicine on the etiology, pathogenesis, classification and treatment of dysmenorrhea, and made a theoretical basis for sorting out and studying Li Weixian's treatment of dysmenorrhea and the rule of drug use. Through analysis of the syndrome differentiation and treatment methods of 62 cases of dysmenorrhea in Li Lao outpatient clinic, and the treatment of Li Lao's various syndromes, the treatment of dysmenorrhea in Li Lao clinic was analyzed. The 25 prescriptions of type dysmenorrhea were classified and analyzed, compared with the analysis and discussion. The commonly used 117 herbs were classified, classified and analyzed in order to understand the rule of drug use. Finally, the clinical experience and general characteristics of Li Weixian's treatment and treatment of dysmenorrhea were summarized and summarized in Guangdong from December 2015 to January 2017. 49 cases of deficiency cold type dysmenorrhea were diagnosed in the gynecologic outpatient clinic of the provincial hospital of traditional Chinese medicine. The patients were treated with Li Lao's own prescription for deficiency cold and pain. The patients were treated with medicine for 5 days and 3 menstrual cycles. The scores of dysmenorrhea and VAS scores before and after treatment were observed, and the differences of the scores before and after the treatment were analyzed, and the age, course, condition and curative effect were analyzed. Correlation, observe the overall clinical effect of deficiency cold and pain menstrual prescription. Results: Li Lao syndrome differentiation and treatment of dysmenorrhea prescription comparison analysis: liver qi stagnation type: regulating meridian seed jade soup supplemented with liver qi stagnation and stagnation of qi stagnation of dysmenorrhea; Kai Yu seed soup to treat liver qi stagnation and liver spleen non adjustable dysmenorrhea; Xuan Yu Tong Jing Decoction for liver qi stagnation and stasis heat menstruation; solution The liver decoction is used to treat the dysmenorrhea of liver depression and spleen and stomach stagnation; the decoction of Angelica peony is used to treat liver depression and spleen deficiency with blood stasis of dysmenorrhea. Blood stasis type dysmenorrhea and deficiency of Qi and blood deficiency type: the ginseng nourishing and Rong Rong decoction is the main treatment of Qi and blood deficiency type dysmenorrhea. Spleen and stomach weak type: the medicine of seven flavour of Baizhu powder is used to treat the spleen and stomach weak type of dysmenorrhea. The kidney qi deficiency type is the kidney essence deficiency and the deficiency of the liver blood. The classification statistics of common Chinese medicine show that the first five categories are the Qi supplementing medicine in turn, Blood enriching medicine, activating blood and removing blood stasis medicine, regulating qi medicine and helping Yang medicine; the first three cases of traditional Chinese medicine are the order of the spleen meridian, the liver meridian and the heart meridian. The first two places of the traditional Chinese medicine are warm and flat in turn; the two places in the front of the medicine are successively bitter and sweet. 6 cases are cured, 16 cases are cured and 18 cases are effective. Effect of 9 cases, the total effective rate of 81.63%. patients before and after the treatment of dysmenorrhea symptom score and VAS score comparison, after treatment significantly decreased, the difference is statistically significant. The patients of all age groups have statistical significance, the patient's various course groups, the curative effect of each disease group has no statistical significance. Conclusion: Professor Li Weixian's clinical common dysmenorrhea differentiation Syndrome classification: liver qi stagnation type, cold coagulation and stasis type, Qi and blood deficiency deficiency type, spleen and stomach weak type, kidney qi deficiency type. Experience characteristics: admired ancient recipe, syndrome differentiation and treatment; good reason viscera, resetting liver and spleen; Qi and blood to be used; Qi and blood stasis, Tonghua blood stasis. The experience prescription of deficiency cold pain has good therapeutic effect on deficiency cold type dysmenorrhea, can warm the temperature. It is effective to relieve dysmenorrhea symptoms and relieve dysmenorrhea in young patients with dysmenorrhea.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R249;R271.113
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本文編號(hào)：2150462