【摘要】：目的：對(duì)于男科疾病陽(yáng)痿,境外中醫(yī)內(nèi)科學(xué)教材中的證型,與我們?cè)谂R床上觀察到的證型有較大區(qū)別,大部分教材把命門(mén)火衰列為第一位,亦無(wú)提到各證型的發(fā)病比例,而且很多證型沒(méi)有涉及。筆者于2011至2013年,在徐福松教授指導(dǎo)下,在江蘇省中醫(yī)院名醫(yī)堂的男科專家門(mén)診收集40例陽(yáng)痿病患,并整理數(shù)據(jù),分析陽(yáng)痿主要臨床證型,與主要的5本當(dāng)代中醫(yī)內(nèi)科學(xué)教材(境外英語(yǔ)版)做對(duì)照比較分析,找出區(qū)別及發(fā)現(xiàn)需要改進(jìn)之處,繼而探討國(guó)際中醫(yī)教育。方法：教材與臨床的兩組數(shù)據(jù)使用兩種方法。第一階段：1.系統(tǒng)的收集及記錄5本中醫(yī)內(nèi)科學(xué)(境外生用)中對(duì)于陽(yáng)痿的分型。辨證分型方法遵循書(shū)中辨證方法。2.系統(tǒng)的整理陽(yáng)痿的40例臨床病例數(shù)據(jù),在徐福松老師指導(dǎo)下完成。納入標(biāo)準(zhǔn)：病人主訴無(wú)法維持勃起或勃起困難。納入標(biāo)準(zhǔn)后的病人以中醫(yī)四診舌、脈及主訴癥狀等區(qū)分證型。第二階段：把數(shù)據(jù)標(biāo)準(zhǔn)化,整理,統(tǒng)計(jì),分析,比較。結(jié)果：通過(guò)統(tǒng)計(jì)后,發(fā)現(xiàn)在5本境外中醫(yī)內(nèi)科學(xué)教材中,共有10種陽(yáng)痿證型,最常見(jiàn)的教科書(shū)證型為腎陽(yáng)虛(命門(mén)火衰),出現(xiàn)率為100%,及肝氣郁滯(100%),濕熱下注(100%),其次是心脾兩虛(80%),驚恐傷腎(60%),心膽氣虛(20%),腎陰虛(陰虛火旺)20%,腎精虧虛(20%),寒凝血滯(20%),以及寒滯肝脈占20%。從臨床收集的40組病例數(shù)據(jù)分析來(lái)看,總見(jiàn)8種證型,最常見(jiàn)的臨床證型是腎陰虛(陰虛火旺),約70%,其次是肝郁氣滯,約32.5%,濕熱下注患者占27.5%,痰濁阻滯者為12.5%,命門(mén)火衰為12.5%,心脾兩虛為10%,驚恐傷腎為7.5%,血脈瘀滯者為2.5%。還有許多患者是兩種及兩種以上的復(fù)合證型。40例病患中14例為單一證型,26例為復(fù)合證型。平均每個(gè)患者患有1.75個(gè)證型。在復(fù)合證型中統(tǒng)計(jì),陰虛火旺+肝郁氣滯組合最多,約占20%,陰虛火旺+濕熱下注組合占15%,陰虛火旺+命門(mén)火衰組合占7.5%,痰濕阻滯+心脾兩虛占7.5%,陰虛火旺+命門(mén)火衰+濕熱下注組合占5%,濕熱下注+驚恐傷腎組合5%,濕熱下注+肝氣郁滯組合占2.5%,濕熱下注+血脈瘀滯組合占2.5%。結(jié)論：分析比較了教材與臨床的數(shù)據(jù),我們發(fā)現(xiàn)臨床中確有一些證型并沒(méi)有被大多數(shù)教材包含在內(nèi),如陰虛火旺,痰濕阻滯,血脈瘀滯,而這三種證型(所占比例分別為70%、12.5%及2.5%)。而臨床收集的40例陽(yáng)痿病患中未見(jiàn)心膽氣虛,寒滯肝脈,寒凝血滯,腎精虧虛這幾種教科書(shū)中提到的證型,可能與樣本較小有關(guān),但在另一方而也說(shuō)明了這幾種證型在臨床中不太常見(jiàn)。通過(guò)分析教科書(shū)證型,我們發(fā)現(xiàn)肝氣郁滯,濕熱下注,心脾兩虛,驚恐傷腎這幾種證型為多數(shù)教材的重要證型,特別是命門(mén)火衰,是多數(shù)中醫(yī)內(nèi)科學(xué)教材提及的首要證型,但卻不是臨床的主要證型。值得一提的是,腎陰虛在臨床中占主導(dǎo)地位,不管是單一證型還是復(fù)合證型。但僅在一本教材中內(nèi)科學(xué)教材中有所涉及。
[Abstract]:Objective: for impotence in andrology, the syndromes in the textbooks of Chinese medicine abroad are quite different from those we have observed in clinic. And many card types are not involved. From 2011 to 2013, under the guidance of Professor Xu Fusong, 40 patients with impotence were collected from the Department of andrology in the famous Hospital of traditional Chinese Medicine of Jiangsu Province, and the main clinical syndrome types of impotence were analyzed. This paper compares and analyses with 5 main textbooks of contemporary Chinese medicine (foreign English version), finds out the differences and finds out the points that need to be improved, and then probes into the international education of traditional Chinese medicine. Methods: two methods were used for teaching materials and two groups of clinical data. The first stage: 1. Systematic collection and recording of 5 TCM internal medicine (foreign raw use) for impotence classification. The method of syndrome differentiation and classification follows the method of syndrome differentiation in the book. 2. Systematic collation of 40 cases of impotence data, under the guidance of Xu Fusong. Inclusion criteria: the patient's main complaint is unable to maintain an erection or erectile difficulty. The patients included in the standard were divided into syndromes by TCM four-diagnosis tongue, pulse and main complaint symptoms. The second stage: data standardization, collation, statistics, analysis, comparison. Results: after statistics, 10 types of impotence syndrome were found in 5 foreign textbooks of traditional Chinese medicine. The most common type of textbook syndrome is deficiency of kidney yang (senility of Shengmen fire), occurrence rate of 100, stagnation of liver qi (100%), betting on dampness and heat (100%), deficiency of heart and spleen (80%), panic injury of kidney (60%), deficiency of heart and gallbladder qi (20%), deficiency of kidney yin (fire of yin deficiency) (20%), deficiency of kidney essence (20%), deficiency of cold and blood coagulation (20%). Stagnation (20%) and cold stagnation of the liver accounted for 20%. According to the data analysis of 40 groups of cases collected in clinic, there are 8 syndrome types. The most common clinical syndrome type is kidney yin deficiency (Yin deficiency and fire flourishing), about 70 cases, followed by liver stagnation and qi stagnation. About 32.5, the patients with dampness and heat were 27.5am, those with phlegm and turbid block were 12.5, those with dampness and spleen were 12.5, the patients with deficiency of heart and spleen were 10, the patients with panic injury and kidney were 7.5 and those with blood stasis were 2.5. There were also many patients with two or more types of complex syndrome, 14 of 40 patients with single syndrome type and 26 with complex syndrome type. The average patient had 1.75 syndrome types. According to statistics, the combination of Yin deficiency, fire, liver depression and qi stagnation is the most. About 20%, 15% of Yin deficiency Fire, 15% of Yin deficiency Fire, 7.5 of Yin-deficiency Fire, 7.5 of Fire failure, 7.5 of phlegm and dampness Block, 7.5 of deficiency of Heart and spleen, 5 of Yin deficiency of Fire, 5 of Dish and Heat, and 5 of panic injury Kidney. The combination of damp-heat injection and stagnation of liver qi accounted for 2.5%, and the combination of damp-heat injection and blood stasis accounted for 2.5%. Conclusion: by analyzing and comparing the data of teaching materials with clinical data, we find that there are some syndrome types in clinic that are not included in most textbooks, such as Yin deficiency and fire, phlegm dampness block, blood stasis, and these three syndromes (70% 12.5% and 2.5% respectively). However, in the 40 cases of impotence collected clinically, the syndrome types mentioned in the textbooks, such as deficiency of heart and gallbladder qi, cold stagnation of liver vein, cold coagulation and blood stagnation, deficiency of kidney essence, may be related to the smaller sample. But in the other side it also shows that these syndrome types are not very common in clinical practice. Through the analysis of textbook syndrome types, we found that liver qi stagnation, damp-heat betting, deficiency of heart and spleen, and panic injury and kidney are the most important syndromes in most teaching materials, especially the failure of the fire in Shengmen, which are the primary syndromes mentioned in most teaching materials of traditional Chinese medicine. But it is not the main type of clinical syndrome. It is worth mentioning that kidney yin deficiency plays a dominant role in clinical practice, regardless of single syndrome or complex syndrome. However, only one textbook in the teaching of internal medicine has been involved.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.5

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