从火论治女性高雄激素血症痤疮
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摘要
[目的]从火邪探讨女性高雄激素血症痤疮的中医病机及治疗,为多囊卵巢综合征患者高雄激素血症痤疮的中医辨证治疗提供新的思路,更好地指导临床用药。[方法]结合传统医学理论与现代医学研究成果,从肺经蕴热、肝郁化火、脾胃湿热之实火及肝肾阴虚、心肾不交、上热下寒之虚火两个方面论述女性高雄激素血症痤疮的中医病因病机、临床表现与治法方药,并举一验案佐证。[结果]火邪是致使多囊卵巢综合征患者高雄激素血症痤疮发生的重要致病因素,包括肝脾肺之实火、肾之虚火,可分别治以清泄肺火、泻火解郁、辛开苦降、补肾之阴阳,临床疗效显著。验案中患者为肝肾阴虚型多囊卵巢综合征伴高雄激素血症,面部痤疮明显,选方二至丸和杞菊地黄汤滋补肝肾,疗效较显。[结论]多囊卵巢综合征患者高雄激素血症患病率逐年升高,具有损容性的痤疮也困扰着越来越多的年轻女性,本文从火邪论治该病,有助于形成较为完整的辨证体系,更好地指导临床用药,有一定的临床实用性。
[Objective]To explore the pathological mechanism and treatment of female hyperandrogenism with acne in traditional Chinese from the perspective of fire, to provide new ideas in the dialectical treatment for acne of polycystic ovarian syndrome(PCOS) patients with hyperandrogenism, and to lead to better clinical medication. [Methods]Based on ancient literature and modern clinic investigation, according to theory of exuberant fire, including lung heat congestion,liver depression transforming into fire,damp heat of spleen and stomach and deficient fire of kidney, including liver and kidney Yin deficiency syndrome,heart and kidney disjoint type,upper heat and lower cold syndrome, the pathological mechanism, clinical manifestation and principle of treatment of acne of PCOS patients with hyperandrogenism was discussed. A consilia was reported as proof. [Results]Fire is an important cause of acne in PCOS patients with hyperandrogenism, including the exuberant fires of lung, liver, spleen and stomach, the deficient fire of kidney, which can be treated separately by clearing the fire of lung, dispersing stagnated liver Qi for relieving Qi stagnation method, pungent dispersion bitter purgation method,nourishing the kidney-Yin and warming the kidney-Yang. These may achieve significant clinical efficacy. The typical case is about a patient who was diagnosed as PCOS with hyperandrogenism, and judged as liver and kidney Yin deficiency syndrome. The prescription of Erzhi Pill and Qiju Dihuang Decoction was used to nourish liver and kidney,which achieved significant results. [Conclusion]The prevalence of PCOS with hyperandrogenism has increased year by year, and acne of PCOS patients with hyperandrogenism has also plagued more and more young female. This article discusses the treatment of this disease, contributes to a more complete dialectical system, which may lead to a certain clinical utility.
[Objective]To explore the pathological mechanism and treatment of female hyperandrogenism with acne in traditional Chinese from the perspective of fire, to provide new ideas in the dialectical treatment for acne of polycystic ovarian syndrome(PCOS) patients with hyperandrogenism, and to lead to better clinical medication. [Methods]Based on ancient literature and modern clinic investigation, according to theory of exuberant fire, including lung heat congestion,liver depression transforming into fire,damp heat of spleen and stomach and deficient fire of kidney, including liver and kidney Yin deficiency syndrome,heart and kidney disjoint type,upper heat and lower cold syndrome, the pathological mechanism, clinical manifestation and principle of treatment of acne of PCOS patients with hyperandrogenism was discussed. A consilia was reported as proof. [Results]Fire is an important cause of acne in PCOS patients with hyperandrogenism, including the exuberant fires of lung, liver, spleen and stomach, the deficient fire of kidney, which can be treated separately by clearing the fire of lung, dispersing stagnated liver Qi for relieving Qi stagnation method, pungent dispersion bitter purgation method,nourishing the kidney-Yin and warming the kidney-Yang. These may achieve significant clinical efficacy. The typical case is about a patient who was diagnosed as PCOS with hyperandrogenism, and judged as liver and kidney Yin deficiency syndrome. The prescription of Erzhi Pill and Qiju Dihuang Decoction was used to nourish liver and kidney,which achieved significant results. [Conclusion]The prevalence of PCOS with hyperandrogenism has increased year by year, and acne of PCOS patients with hyperandrogenism has also plagued more and more young female. This article discusses the treatment of this disease, contributes to a more complete dialectical system, which may lead to a certain clinical utility.
引文
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[5]郑冬雪,刘新敏,赵一鸣.半夏泻心汤加减治疗多囊卵巢综合征胰岛素抵抗(脾虚胃热型)的时效关系研究[J].环球中医药,2017,10(2):221-224.
[6]孔庆晅,王媛.从肾论治痤疮小议[J].浙江中医杂志,2014,49(10):770-771.
[7]赵君谊.从肾论治痤疮浅析[J].江苏中医药,2015,47(5):53-54.
[8]周萌,王建辉.滋补肝肾法治疗女性青春期后痤疮及对血清睾酮的影响[J].实用中西医结合临床,2008,8(6):30-31.
[9]李慕白,高敬书,寇丽辉,等.小檗碱对胰岛素抵抗多囊卵巢综合征患者激素水平的调节作用[J].中国妇幼保健,2015,30(11):1718-1720.
[10]张介宾.景岳全书[M].上海:上海科学技术出版社,1959:26.
[11]陈怡君,蔡梅玉.八味肾气丸治疗肾虚型多囊卵巢综合征临床分析[J].中外医疗,2018,37(7):170-172,175.
[2]吴谦.医宗金鉴[M].北京:人民卫生出版社,1956:176.
[3]万全.万氏妇人科[M].武汉:湖北人民出版社,1983:4.
[4]庞颖,王国华,赵秀萍,等.王国华教授治疗多囊卵巢综合征型痤疮经验拾萃[J].中国医药导报,2018,15(6):149-152.
[5]郑冬雪,刘新敏,赵一鸣.半夏泻心汤加减治疗多囊卵巢综合征胰岛素抵抗(脾虚胃热型)的时效关系研究[J].环球中医药,2017,10(2):221-224.
[6]孔庆晅,王媛.从肾论治痤疮小议[J].浙江中医杂志,2014,49(10):770-771.
[7]赵君谊.从肾论治痤疮浅析[J].江苏中医药,2015,47(5):53-54.
[8]周萌,王建辉.滋补肝肾法治疗女性青春期后痤疮及对血清睾酮的影响[J].实用中西医结合临床,2008,8(6):30-31.
[9]李慕白,高敬书,寇丽辉,等.小檗碱对胰岛素抵抗多囊卵巢综合征患者激素水平的调节作用[J].中国妇幼保健,2015,30(11):1718-1720.
[10]张介宾.景岳全书[M].上海:上海科学技术出版社,1959:26.
[11]陈怡君,蔡梅玉.八味肾气丸治疗肾虚型多囊卵巢综合征临床分析[J].中外医疗,2018,37(7):170-172,175.
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