【摘要】：研究目的本文試從田玉美教授臨床多年的驗(yàn)案著手,將搜集得到的醫(yī)案中的主要癥狀、證型、處方進(jìn)行整理,按照要求進(jìn)行規(guī)范化處理,對(duì)其進(jìn)行頻數(shù)分析、聚類(lèi)分析、因子分析,以求窺得田玉美教授治療不孕癥的整體思路及用藥規(guī)律,為后人能夠更好地繼承田教授的學(xué)術(shù)思想提供一定的參考與借鑒。研究方法運(yùn)用excel表格計(jì)算舌、脈、經(jīng),中藥四氣、五味、歸經(jīng)以及證型的頻數(shù)、頻率,并運(yùn)用SPSS21.0統(tǒng)計(jì)軟件對(duì)錄入的中藥進(jìn)行聚類(lèi)分析、因子分析等描述性統(tǒng)計(jì)分析。研究結(jié)果1、所涉及不孕癥的中藥藥性描述有9種,按照其出現(xiàn)頻數(shù)的大小,由大到小依次為溫(50)、平(37)、寒(32)、微寒(26)、微溫(12)、涼(7)、熱(4)、大熱(2)、大寒(1)。2、所涉及不孕癥的中藥藥味描述有7種,按照其出現(xiàn)頻數(shù)的大小,由大到小依次為苦(90)、甘(82)、辛(68)、酸(15)、澀(11)、咸(10)、淡(9)。3、將所涉及到的不孕癥中藥歸經(jīng)整理后,按照其出現(xiàn)頻數(shù)的大小,由大到小依次為肝(94)、脾(65)、腎(58)、肺(58)、心(50)。4、所涉及到的不孕癥中藥可分為10類(lèi),其占比由大到小依次為補(bǔ)虛藥(18%)、清熱藥(15%)、活血化瘀藥(12%)、理氣藥(7%)、止血藥(6%)、解表藥(6%)、利水滲濕藥(6%)、收澀藥(5%)、化痰止咳平喘藥(5%)、安神藥(4%)、消食藥(4%)、祛風(fēng)濕藥(4%)、化濕藥(3%)、溫里藥(3%)、平肝熄風(fēng)藥(2%)、驅(qū)蟲(chóng)藥(1%)、開(kāi)竅藥(1%)。5、所有涉及到的不孕癥中藥累計(jì)使用的頻率,按照中藥類(lèi)別來(lái)統(tǒng)計(jì),可得到如下結(jié)果,補(bǔ)虛藥(38%)、活血化瘀藥(12%)、理氣藥(12%)、清熱藥(9%)、解表藥(5%)、利水滲濕藥(4%)、安神藥(4%)、溫里藥(3%)、化痰止咳平喘藥(3%)、消食藥(3%)、化濕藥(2%)、收澀藥(2%)、止血藥(2%)、祛風(fēng)濕藥(1%)。6、聚類(lèi)分析結(jié)果在距離標(biāo)尺為24的情況下,錄入中藥大體被聚為5類(lèi),具體為:c1(橘核、荔枝核、青皮、小茴香、延胡索、丹參、香附、麥芽、山楂、益母草);c2(牛膝、桃仁、柴胡、枳殼、赤芍、紅花);c3(北沙參、川楝子、當(dāng)歸、麥冬、枸杞子、生地黃、枳實(shí));c4(阿膠、吳茱萸、杜仲、淫羊藿、砂仁、熟地黃、桂枝、牡丹皮、半夏、太子參、陳皮、白術(shù)、甘草、白芍、茯苓、川芎);c5(酸棗仁、遠(yuǎn)志、龍眼肉、木香、茯神、黃芪、黨參、山藥)。7、因子分析結(jié)果(1)肝郁氣滯證,可抽取3個(gè)主成分進(jìn)行分析,分別為:f1:橘核、荔枝核、青皮、小茴香、延胡索、香附f2:香附、麥芽、山楂f3:延胡索、丹參、益母草(2)血瘀氣滯證,可抽取2個(gè)主成分進(jìn)行分析,分別為:f1:牛膝、桃仁、赤芍、紅花f2:柴胡、枳殼(3)肝腎陰虛證,可抽取2個(gè)主成分進(jìn)行分析,分別為:f1:北沙參、當(dāng)歸、麥冬、枸杞子、生地黃f2:川楝子、枳實(shí)(4)沖任虛寒證,可抽取5個(gè)主成分進(jìn)行分析,分別為:f1:砂仁、半夏、太子參、陳皮、白術(shù)、甘草、茯苓f2:阿膠、吳茱萸、桂枝、牡丹皮、半夏、太子參、甘草、白芍、茯苓、川芎f3:桂枝、牡丹皮、白芍、茯苓f4:杜仲、淫羊藿、熟地黃f5:熟地黃、白芍、川芎(5)肝陰不足、心脾兩虛證,可抽取5個(gè)主成分進(jìn)行分析,分別為:f1:酸棗仁、山藥f2:酸棗仁、遠(yuǎn)志、龍眼肉、茯神f3:木香、黃芪、黨參、山藥。研究結(jié)論1、虛乃不孕之本,瘀乃不孕之標(biāo)。不孕癥病機(jī)主要還是“虛”、“瘀”。2、在臨床診治不孕癥時(shí),大體將其分為五個(gè)證型從沖任與肝脾腎的調(diào)理方面著手,五證型分別為:肝郁氣滯證、血瘀氣滯證、肝腎陰虛證、沖任虛寒證、肝陰不足心脾兩虛證。3、在臨床診療過(guò)程中,要多注重藥物的合理搭配,注意藥對(duì)的搭配使用,要做到舊藥搭配出新用。
[Abstract]:The purpose of this study is to study the main symptoms, syndrome types and prescriptions in the medical case, and to carry out the standardized treatment according to the requirements, and carry out frequency analysis, cluster analysis and factor analysis. In order to see the whole thought and law of the treatment of infertility by Professor Tian Yumei, it can provide some reference and reference for later generations to better inherit the academic thought of Professor Tian. The frequency and frequency of the tongue, vein, meridian, Chinese traditional Chinese medicine four-gas, five-flavor, the return and the syndrome type were calculated by using the excel form, and the statistical analysis was carried out by using the SPSS21.0 statistical software to carry out cluster analysis, factor analysis and other descriptive statistics on the entered Chinese medicine. According to the study result 1,9 kinds of Chinese medicinal properties related to the infertility are described, and according to the size of the frequency of occurrence, the medicinal properties of the traditional Chinese medicine are as follows: the temperature (50), the flat (37), the cold (32), the micro-cold (26), the micro-temperature (12), the cooling (7), the heat (4), the large heat (2) and the large-cold (1). 7 kinds of Chinese medicinal materials for treating the infertility, according to the size of the frequency of occurrence, are bitter (90), sweet (82), symplectic (68), acid (15), astringent (11), salt (10) and light (9) in turn, according to the frequency of occurrence, the liver (94), the spleen (65), the kidney (58), the lung (58) and the heart (50) are arranged in turn from big to small, The invention has the advantages of promoting blood circulation to remove blood stasis (12%), regulating the flow of qi (7%), the hemostatic (6%), the solution (6%), the diuresis and the dampness (6%), the astringent (5%), the phlegm and the cough and the asthma (5%), the tranquillizing agent (4%), the digestion promoting agent (4%), the wind-dispelling and dampness-removing medicine (4%), The frequency of the cumulative use of the traditional Chinese medicine for infertility, which is related to the total use of the traditional Chinese medicine for infertility, can be obtained according to the traditional Chinese medicine category, and the following results can be obtained (38%), Has the effects of promoting blood circulation, removing blood stasis (12%), regulating qi-flowing (12%), clearing away heat, clearing away heat (9%), relieving exterior syndrome (5%), eliminating dampness (4%), tranquilizing, (4%), warming and (3%), resolving phlegm, relieving cough and asthma (3%), promoting digestion (3%), and removing dampness (2%). In the case of 24 cases of distance scale, the results of cluster analysis are as follows: c1 (orange, lychee, green, small, fragrant, corydalis, red-rooted, cyperus, malt, and mountain). (Herba Leonuri); c2 (Achyranthis Radix, Semen Persicae, Bupleuri Radix, Fructus Aurantii, Radix Paeoniae Rubra, and Carthami Flos); c3 (Radix Glehniae, Radix Dipsaci, Radix Angelicae Sinensis, Radix Ophiopogonis, Fructus Lycii, Radix Rehmanniae, and Fructus Aurantii); c4 (Colla Corii Asini, Radix Rehmanniae, Ramulus Cinnamomi, Cortex Moutan, and Rhizoma Pinelliae, Radix Pseudostellariae, Pericarpium Citri Tangerinae, Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae, Radix Paeoniae Alba, Poria, and Radix Dipsaci, and c5 (Semen Ziziphi Spinosae, Radix Polygalae, Arillus Longan, Radix Aucklandiae, Poria, Radix Polygalae, Radix Codonopsis, and Rhizoma Dioscoreae). Semen Litchi, Pericarpium Citri Reticulatae, Fructus Hordei Germinatus, Rhizoma Corydalis, Rhizoma Cyperi, Fructus Hordei Germinatus, and Fructus Hordei Germinatus f3: Rhizoma Corydalis, Saviae Miltiorrhizae Radix, and Herba Leonuri (2) for blood stasis and qi stagnation, and extracting two main components for analysis, respectively: f1: Achyranthis Radix, Semen Persicae, Radix Paeoniae Rubra, and Carthami Flos, and Radix Bupleuri. The liver and kidney yin deficiency syndrome of the bitter orange shell (3) can be analyzed by extracting two main components, namely: f1: radix glehniae, angelica, dwarf lilyturf root, wolfberry fruit, radix rehmanniae f2, and immature bitter orange (4), and 5 main components can be extracted for analysis, respectively: f1: fructus amomi and pinellia ternata, Radix Pseudostellariae, Pericarpium Citri Tangerinae, Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae, Poria, Colla Corii Asini, Radix Pseudostellariae, Ramulus Cinnamomi, Cortex Moutan, Rhizoma Pinelliae, Radix Pseudostellariae, Radix Glycyrrhizae, Radix Paeoniae Alba, Poria, and Bulbus Fritillariae Cirrhosae f3: Ramulus Cinnamomi, Cortex Moutan, Radix Paeoniae Alba, Poria, and Radix Paeoniae Alba, and Radix Rehmanniae Preparata, Radix Rehmanniae Preparata, and Radix Paeoniae Alba, (5) Deficiency of liver yin and deficiency of heart and spleen, and analysis of 5 main components, respectively: f1: Semen Ziziphi Spinosae, Rhizoma Dioscoreae, Semen Ziziphi Spinosae, Radix Polygalae, Arillus Longan, and Poria f3: Radix Aucklandiae, Radix Polygalae, Radix Codonopsis, and Rhizoma Dioscoreae. The conclusion is that the deficiency is the root of the infertility, and the blood stasis is the standard of the infertility. The pathogenesis of the infertility is mainly the "virtual" and the "blood stasis". In the clinical diagnosis and treatment of the infertility, it is divided into five types, namely, the liver-qi stagnation syndrome, the blood stasis and qi stagnation syndrome, the liver and kidney yin deficiency syndrome, and the deficiency cold syndrome. In the course of clinical diagnosis and treatment, we should pay more attention to the rational collocation of the drugs and the combination of the drugs, so that the old medicine should be matched with the new ones.
【學(xué)位授予單位】：湖北中醫(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;R271.14

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