【摘要】：經(jīng)斷前后諸癥是指婦人經(jīng)斷之年,因腎精虛衰、天癸枯竭而出現(xiàn)的一系列癥狀,其臨床表現(xiàn)主要為：經(jīng)水不調(diào)(經(jīng)期或提前或推后、量或多或少、色質(zhì)或粘稠鮮紅或清稀暗淡)、烘熱汗出、心悸失眠、煩躁易怒等�，F(xiàn)代醫(yī)學稱其稱為圍絕經(jīng)期綜合征(perimenopausal syndrome, MPS),認為此病與女性激素水平降低有關(guān),激素替代療法是其主要的治療方法。激素替代療法雖然在臨床上有一定的療效,卻伴有許多副作用,如出血、子宮內(nèi)膜癌等,故而應(yīng)用受到限制。中藥因在臨床治療經(jīng)斷前后諸癥中呈現(xiàn)出良好的療效,進入人們的眼線,備受關(guān)注。本文研究補腎精、益天癸中藥治療經(jīng)斷前后諸癥作用機制。系統(tǒng)整理中醫(yī)藥學文獻為其提供立論依據(jù)；從傳統(tǒng)中醫(yī)藥學理論、現(xiàn)代藥學研究等領(lǐng)域闡述其作用機制；并從運用指征、配伍特色等方面探討其臨床運用規(guī)律。綜合古代醫(yī)籍文獻、現(xiàn)代臨床報道及現(xiàn)代藥理實驗及中醫(yī)藥學理論等研究表明：腎精虛衰、天癸枯竭是經(jīng)斷前后諸癥發(fā)病的根本原因,腎虛累及心肝脾是其重要的病理傳變,治法上補腎精、益天癸,兼顧他臟。補腎精、益天癸中藥在藥性方面,性寒涼能滋陰、溫可益陽、平無偏忌,甘味補虛,主入腎經(jīng),趨向下焦、質(zhì)潤主靜的特點是治療婦人經(jīng)斷前后諸癥的藥學基礎(chǔ)；補而益精,補而滋陰,補而溫陽,補而平衡是治療婦人經(jīng)斷前后諸癥的主要作用機理。從臨床運用規(guī)律研究表明：經(jīng)水不調(diào),烘熱盜汗或心悸失眠或煩躁易怒是婦人經(jīng)斷前后諸癥的臨床運用指征；動靜結(jié)合、陰陽平補、兼顧脾胃是治療婦人經(jīng)斷前后諸癥藥物配伍特色。通過對寧心紅杞膠囊(補腎精、益天癸代表復方中藥)的藥理作用機制研究表明：寧心紅杞膠囊通過抗卵泡顆粒細胞(granulosa cells, GC)凋亡,延緩卵巢功能衰退,從而治療經(jīng)斷前后諸癥。為闡釋寧心紅杞膠囊抗GC凋亡的作用機制,本研究在體外原代培養(yǎng)的GC氯化鎘致凋亡損傷模型上,進行了實驗研究。采用MTT比色法,測定給藥前后大鼠GC增殖率的變化；采用放射免疫分析法,檢測大鼠GC培養(yǎng)液中雌二醇(estradiol, E2)、孕酮(progesterone, P)分泌量,觀察寧心紅杞膠囊對女性激素分泌能力的影響；采用酶聯(lián)免疫吸附實驗法,檢測培養(yǎng)液中Bcl-2、Bax及Caspase-3蛋白表達,觀察寧心紅杞膠囊對大鼠GC凋亡相關(guān)因子的影響。結(jié)果表明：寧心紅杞膠囊可促進大鼠GC增殖,提高E2、P分泌量,上調(diào)抑凋亡因子Bcl-2蛋白表達、下調(diào)促凋亡因子Bax和Caspase-3蛋白表達。結(jié)論：寧心紅杞膠囊能夠促進GC的增殖,提高GC女性激素分泌能力,調(diào)節(jié)GC凋亡相關(guān)因子,從而抗GC凋亡,進而改善卵巢功能,治療經(jīng)斷前后諸癥。本文研究的成果,闡釋了補腎精、益天癸中藥治療經(jīng)斷前后諸癥的作用機制,為臨床治療經(jīng)斷前后諸癥提供了科學依裾。
[Abstract]:The symptoms before and after menstruation are a series of symptoms that occur in women due to deficiency of kidney essence and exhaustion of Tiangui in the year of menstrual failure. Their clinical manifestations are mainly as follows: no regulation of water (menstrual period, early or delayed, more or less), Color or thick red or dark), drying hot sweat, palpitations insomnia, irritability, etc. Modern medicine calls it perimenopausal syndrome (perimenopausal syndrome, MPS), which is mainly treated by hormone replacement therapy, which is associated with lower hormone levels in women. Although hormone replacement therapy has a certain clinical efficacy, it has many side effects, such as bleeding, endometrial carcinoma and so on, so its application is restricted. Traditional Chinese medicine has attracted much attention because of its good curative effect in clinical treatment before and after meridian break. This paper studies the mechanism of tonifying kidney essence and Yitiangui traditional Chinese medicine in treating symptoms before and after meridian break. Systematic collation of traditional Chinese medicine literature to provide theoretical basis, from the traditional Chinese medicine theory, modern pharmaceutical research and other fields of its action mechanism, and from the use of indications, compatibility characteristics and other aspects of its clinical application. According to the literature of ancient medical literature, modern clinical reports, modern pharmacological experiments and the theory of traditional Chinese medicine, it is shown that deficiency of kidney essence and exhaustion of Tiangui are the fundamental causes of the disease, and kidney deficiency involving heart, liver and spleen is an important pathological transmission. On the treatment of kidney essence, Yi Tiangui, taking into account his dirty. Tonifying kidney essence, Yitiangui traditional Chinese medicine in the aspect of medicine, sexual cold can nourish yin, warm can benefit yang, flat no bias bogey, sweet taste tonify deficiency, main enter kidney meridian, tend to lower coke, quality moisten the characteristic of body static is the pharmacological foundation of treating the disease before and after the woman's meridian break; The main mechanism of treating women's syndrome before and after menstruation is to supplement and nourish essence, nourish yin, replenish and warm yang, and supplement and balance. The study of clinical application law shows that the symptoms of women before and after transection are as follows: unregulation of water, burning heat, night sweating, palpitations, insomnia or irritability and irritability; Combination of static and dynamic, yin-yang flat tonifying, taking into account the spleen-stomach is the treatment of women before and after the break of the symptoms of drugs compatibility characteristics. The pharmacological mechanism of Ningxin Hongqi capsule (tonifying kidney essence and Yitiangui compound Chinese medicine) was studied. The results showed that Ningxin Hongqi capsule delayed the decline of ovarian function by inhibiting the apoptosis of follicular granulosa cells (granulosa cells, GC). In order to treat before and after meridian break of the disease. In order to elucidate the anti-apoptosis mechanism of Ningxin Hongqi capsule (NXH), an experimental study was carried out on the model of apoptosis induced by cadmium chloride of GC in vitro. MTT colorimetric assay was used to determine the proliferation rate of GC in rats before and after administration. Radioimmunoassay (RIA) was used to detect the secretion of estradiol, E2 and progesterone (progesterone, P) in rat GC culture medium and to observe the effect of Ningxin Hongqi capsule on female hormone secretion. Enzyme linked immunosorbent assay (Elisa) was used to detect the expression of Bcl-2,Bax and Caspase-3 protein in culture medium and to observe the effect of Ningxin Hongqi capsule on apoptosis related factors of GC in rats. The results showed that Ningxin Hongqi capsule could promote the proliferation of rat GC, increase the secretion of E2P, up-regulate the expression of Bcl-2, and down-regulate the expression of Bax and Caspase-3. Conclusion: Ningxin Hongqi capsule can promote the proliferation of GC, improve the hormone secretion ability of GC women, regulate the apoptosis related factors of GC, so as to resist the apoptosis of GC, and then improve the ovarian function. The results of this study explain the mechanism of tonifying kidney essence and Yitiangui traditional Chinese medicine in treating the symptoms before and after meridian break, and provide a scientific basis for clinical treatment of the symptoms before and after meridian break.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R271.116

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本文編號：2302697