导师梁学林教授从瘀论治慢性盆腔炎的经验总结
摘要
慢性盆腔炎是妇科常见病之一,多为急性盆腔炎未能彻底治愈,或患者体质较差,病情迁延所致,但也可无急性炎症病史。临床以病程长、反复发作、久治不愈为主要特点。其临床表现主要为下腹痛、腰痛、月经不调、白带量多及不孕等。一般全身症状多不明显,有时可有低热,易感疲乏。多由下生殖道感染、宫腔内手术操作后感染、性卫生不良、邻近器官炎症的直接蔓延等引起。其证属祖国医学“妇人腹痛”、“癥瘕”、“带下病”、“痛经”等病证范畴,多因经期产后或术后正气虚弱,湿热邪毒等趁虚而入,凝滞气血,致气滞血瘀。导师梁学林教授经过多年的临床观察和研究,认为本病病久耗气,气虚不足以推血,血必有瘀,即本病的主要病机为“血瘀”,擅长从瘀论治慢性盆腔炎,治疗上以活血化瘀为主,辅以清热、利湿、理气、补虚、温经等方法。方选晚清名医王清任《医林改错》的“少腹逐瘀汤”随证加减化裁,在临床上取得显著疗效。本人师从学习期间对从瘀论治慢性盆腔炎稍有体会,对此做出总结。
The chronic pelvic inflammation is one of the more common gynecologic acute pelvic inflammation, for not thoroughly treatment, or the patient's constitution is poorer, illness caused by delay, but also no history of acute inflammation. To delay of, repeated attacks, cured as its main characteristic. The clinical expression basically the following abdominal and lumbago, menstruation, leucorrhea capacity is much, infertility primarily. Systemic symptom not more apparent, can sometimes have low thermal, at-risk fatigue. By next genital infection, more uterine cavity operation after operating infection, sexual hygiene, adjacent organs inflammation caused directly spread. While the country medicine thinks its card belong to "woman abdominal pain," "remove lump" and "carry disease", "dysmenorrhea, many categories such as" because menstruation postpartum or postoperative upright weak, dampness of the evil rickshaw enter, heat and blood stasis, the qi. Teacher LiangXueLin professor after years of clinical observation and study the main pathogenesis, think this disease, blood stasis "for" from stasis treatment at the chronic pelvic inflammation, treatment with promoting blood circulation to remove blood stasis primarily, complementary with heat, deficiency, suits, filling method such as by the temperature. Party WangQingRen the late qing dynasty famous doctors selected subjects" "medical Lin lower abdomen, and blood stasis soup" chase with card based on clinical symptoms of add and subtract in clinic made cutting, remarkable curative effect. I studied during study on treatment qi stagnancy and blood stasis syndrome the chronic pelvic inflammation, which make a slight experience summary.
The chronic pelvic inflammation is one of the more common gynecologic acute pelvic inflammation, for not thoroughly treatment, or the patient's constitution is poorer, illness caused by delay, but also no history of acute inflammation. To delay of, repeated attacks, cured as its main characteristic. The clinical expression basically the following abdominal and lumbago, menstruation, leucorrhea capacity is much, infertility primarily. Systemic symptom not more apparent, can sometimes have low thermal, at-risk fatigue. By next genital infection, more uterine cavity operation after operating infection, sexual hygiene, adjacent organs inflammation caused directly spread. While the country medicine thinks its card belong to "woman abdominal pain," "remove lump" and "carry disease", "dysmenorrhea, many categories such as" because menstruation postpartum or postoperative upright weak, dampness of the evil rickshaw enter, heat and blood stasis, the qi. Teacher LiangXueLin professor after years of clinical observation and study the main pathogenesis, think this disease, blood stasis "for" from stasis treatment at the chronic pelvic inflammation, treatment with promoting blood circulation to remove blood stasis primarily, complementary with heat, deficiency, suits, filling method such as by the temperature. Party WangQingRen the late qing dynasty famous doctors selected subjects" "medical Lin lower abdomen, and blood stasis soup" chase with card based on clinical symptoms of add and subtract in clinic made cutting, remarkable curative effect. I studied during study on treatment qi stagnancy and blood stasis syndrome the chronic pelvic inflammation, which make a slight experience summary.
引文
[1]丰有吉,沈铿.妇产科学[M].人民卫生出版社.第二版2006：275-277.
[2]罗颂平,邓高丕等.中西医妇产科治疗学[M].人民军医出版社.第一版2008：170.
[3]司徒仪.中西医结合妇产科学[M].北京科学出版社.第一版2003：233.
[4]余和平,曹万群等.He-Ne激光等物理疗法综合治疗慢性盆腔炎[J].激光杂志.2007,28(4)：89-90.
[5]塔娜,潘慧敏.体外高频热疗治疗慢性盆腔炎临床观察[J].包头医学院学报.2007,23(5)：511-512.
[6]王民.中药离子导入治疗慢性盆腔炎临床体会[J].中医中药.2009,16(18)：72-72.
[7]WalkerCK, W iesenfeldHC. Antibiotic therapy for acute pelvicinflammatory disease:the 2006 Centers forDisease Control andPrevention sexually transmitted diseases treat—ment guidelines[J]. Clin InfectDis,2007,44 (Suppl3):111—122.
[8]狄文,吴霞.美国疾病及预防控制中心2006版盆腔炎性疾病诊治指南解读[J].中国实用妇科与产科杂志.2008,24(4)：421-423.
[9]罗春莉.克林美联合甲硝唑腹腔灌注与静脉给药治疗慢性盆腔炎疗效比较[J].现代医药卫生.2007, (23)：532.
[10]付廷敏,李忠敏.氧氟沙星联合替硝唑腹腔灌注治疗慢性盆腔炎35例[J].现代中西医结合杂志.2009,18(1)：76.
[11]金秀楠.盆腔插管灌注治疗慢性盆腔炎102例[J].现代中西医结合杂志.2008,17(10)：1471.
[12]张金环,张玉英,孙兴梅.甲硝唑、庆大霉素等直肠灌注治疗慢性盆腔炎40例疗效观察[J].中国伤残医学.2006.14(2)：45.
[13]徐秀梅,许玉兰,林丽霞等.宫腔注药治疗慢性盆腔炎[J].中国实用乡村医生杂志.2006,13(3)：32-33.
[14]陈家琼.阴道侧穹隆注射治疗慢性盆腔炎86例临床观察[J].广西医学.2008,30(8)：1239.
[15]张玉珍.新编中医妇产科学[M].北京人民军医出版社.2001：380-381.
[16]肖承惊.中医妇科临床研究[M].人民卫生出版社.第一版2009：154.
[17]吴克明,张庆文.中西医临床妇产科学[M].北京：中国医药科技以出版社.2001：207.
[18]辛茜庭.从瘀论治慢性盆腔炎[J].中日友好医院学报.2005,19(1)：54-55.
[19]孟静寿.辨证治疗慢性盆腔炎106例[J].辽宁中医杂志.2005,30(3)：207
[20]尤庆华.浅谈从瘀论治慢性盆腔炎[J].陕西中医.2007,28(3)：360.
[21]齐津丽.辨证治疗慢性盆腔炎80例[J].吉林中医药.2005,25(2)：21.
[22]钟晓玲,王霞灵,曹大农等.温阳化瘀法治疗慢性盆腔炎临床研究[J].新中 医.2009,14(7)：52.
[23]钱菁.夏桂成教授辨治盆腔炎的经验与特色[J].南京中医药大学学报.2005,210)：182.
[24]凌爱,于杰.中药保留灌肠治疗慢性盆腔炎的规范化研究[J].中华中医药学刊.2007,25(8)：1631-1633.
[25]廖佐琴,邓辉.棱莪败酱汤保留灌肠治疗慢性盆腔炎临床研究[J].实用中西医结合临床.2004,4(5)：4.
[26]郑纯,徐洁.藤药外敷治疗盆腔炎226例临床观察[J].湖南中医杂志.2001,17(4) ：24
[27]曲如玫,范杰先外用活血化瘀法治疗慢性盆腔炎临床观察[J].实用医技杂志.2005.12(12)：3703.
[28]谢玉华.针灸治疗慢性盆腔炎疗效观察[J].中医临床研究.2010,2(1)：27-28.
[29]于东歌,罗伟.穴位注射配合TDP治疗慢性盆腔炎40例1临床观察[J].上海针灸杂志.2005,24(11)：19-20.
[30]苏佩清,周晓宏,曹丽君.六神栓治疗慢性盆腔炎118例[J].四川中医.2002,20(12)：45—-46.
[31]壬爱华,王莉.清热活血汤为主治疗慢性盆腔炎58例[J].山东中医药杂志.2004,23(1)：34
[32]康文娟,靳庆丰.综合疗法治疗慢性盆腔炎67例疗效观察[J].云南中医中药杂志.2008,29(7)：22.
[33]国家中医药管理局.中药新药临床研究指导原则[M].北京中国医药科技出版社.2002.85-89.
[1]丰有吉、沈铿.妇产科学[M].人民卫生出版社.第二版2006：275.
[2]尤昭玲.中西医结合妇产科学.中国中医药出版社出版.第1版2006：419.
[3]北京中医医院.刘奉五妇科经验[M].人民卫生出版社.第一版2006：253.
[4]吴大真、刘学春等.现代名中医妇科绝技[M].科学技术文献出版社.第一版2004：114.
[5]司徒仪,杨家林.妇科专病中医临床诊治.人民卫生出版社.第二版2005：274.
[6]尹香花,匡继林,刘文娥.尤昭玲教授巧用药对治疗慢性盆腔炎经验拾萃[J].中医药学刊.2005,23(9)：1572-1573.
[7]王福关,王粉安.坤复康胶囊对子宫微循环影响的实验研究[J].西北药学杂志.2007,22(2)
[8]王玲娟,徐惠军.刘岩慢性盆腔炎愈后康复治疗与甲襞微循环相关性的探讨[J].长春中医学院学报,2001,17(2)
[2]罗颂平,邓高丕等.中西医妇产科治疗学[M].人民军医出版社.第一版2008：170.
[3]司徒仪.中西医结合妇产科学[M].北京科学出版社.第一版2003：233.
[4]余和平,曹万群等.He-Ne激光等物理疗法综合治疗慢性盆腔炎[J].激光杂志.2007,28(4)：89-90.
[5]塔娜,潘慧敏.体外高频热疗治疗慢性盆腔炎临床观察[J].包头医学院学报.2007,23(5)：511-512.
[6]王民.中药离子导入治疗慢性盆腔炎临床体会[J].中医中药.2009,16(18)：72-72.
[7]WalkerCK, W iesenfeldHC. Antibiotic therapy for acute pelvicinflammatory disease:the 2006 Centers forDisease Control andPrevention sexually transmitted diseases treat—ment guidelines[J]. Clin InfectDis,2007,44 (Suppl3):111—122.
[8]狄文,吴霞.美国疾病及预防控制中心2006版盆腔炎性疾病诊治指南解读[J].中国实用妇科与产科杂志.2008,24(4)：421-423.
[9]罗春莉.克林美联合甲硝唑腹腔灌注与静脉给药治疗慢性盆腔炎疗效比较[J].现代医药卫生.2007, (23)：532.
[10]付廷敏,李忠敏.氧氟沙星联合替硝唑腹腔灌注治疗慢性盆腔炎35例[J].现代中西医结合杂志.2009,18(1)：76.
[11]金秀楠.盆腔插管灌注治疗慢性盆腔炎102例[J].现代中西医结合杂志.2008,17(10)：1471.
[12]张金环,张玉英,孙兴梅.甲硝唑、庆大霉素等直肠灌注治疗慢性盆腔炎40例疗效观察[J].中国伤残医学.2006.14(2)：45.
[13]徐秀梅,许玉兰,林丽霞等.宫腔注药治疗慢性盆腔炎[J].中国实用乡村医生杂志.2006,13(3)：32-33.
[14]陈家琼.阴道侧穹隆注射治疗慢性盆腔炎86例临床观察[J].广西医学.2008,30(8)：1239.
[15]张玉珍.新编中医妇产科学[M].北京人民军医出版社.2001：380-381.
[16]肖承惊.中医妇科临床研究[M].人民卫生出版社.第一版2009：154.
[17]吴克明,张庆文.中西医临床妇产科学[M].北京：中国医药科技以出版社.2001：207.
[18]辛茜庭.从瘀论治慢性盆腔炎[J].中日友好医院学报.2005,19(1)：54-55.
[19]孟静寿.辨证治疗慢性盆腔炎106例[J].辽宁中医杂志.2005,30(3)：207
[20]尤庆华.浅谈从瘀论治慢性盆腔炎[J].陕西中医.2007,28(3)：360.
[21]齐津丽.辨证治疗慢性盆腔炎80例[J].吉林中医药.2005,25(2)：21.
[22]钟晓玲,王霞灵,曹大农等.温阳化瘀法治疗慢性盆腔炎临床研究[J].新中 医.2009,14(7)：52.
[23]钱菁.夏桂成教授辨治盆腔炎的经验与特色[J].南京中医药大学学报.2005,210)：182.
[24]凌爱,于杰.中药保留灌肠治疗慢性盆腔炎的规范化研究[J].中华中医药学刊.2007,25(8)：1631-1633.
[25]廖佐琴,邓辉.棱莪败酱汤保留灌肠治疗慢性盆腔炎临床研究[J].实用中西医结合临床.2004,4(5)：4.
[26]郑纯,徐洁.藤药外敷治疗盆腔炎226例临床观察[J].湖南中医杂志.2001,17(4) ：24
[27]曲如玫,范杰先外用活血化瘀法治疗慢性盆腔炎临床观察[J].实用医技杂志.2005.12(12)：3703.
[28]谢玉华.针灸治疗慢性盆腔炎疗效观察[J].中医临床研究.2010,2(1)：27-28.
[29]于东歌,罗伟.穴位注射配合TDP治疗慢性盆腔炎40例1临床观察[J].上海针灸杂志.2005,24(11)：19-20.
[30]苏佩清,周晓宏,曹丽君.六神栓治疗慢性盆腔炎118例[J].四川中医.2002,20(12)：45—-46.
[31]壬爱华,王莉.清热活血汤为主治疗慢性盆腔炎58例[J].山东中医药杂志.2004,23(1)：34
[32]康文娟,靳庆丰.综合疗法治疗慢性盆腔炎67例疗效观察[J].云南中医中药杂志.2008,29(7)：22.
[33]国家中医药管理局.中药新药临床研究指导原则[M].北京中国医药科技出版社.2002.85-89.
[1]丰有吉、沈铿.妇产科学[M].人民卫生出版社.第二版2006：275.
[2]尤昭玲.中西医结合妇产科学.中国中医药出版社出版.第1版2006：419.
[3]北京中医医院.刘奉五妇科经验[M].人民卫生出版社.第一版2006：253.
[4]吴大真、刘学春等.现代名中医妇科绝技[M].科学技术文献出版社.第一版2004：114.
[5]司徒仪,杨家林.妇科专病中医临床诊治.人民卫生出版社.第二版2005：274.
[6]尹香花,匡继林,刘文娥.尤昭玲教授巧用药对治疗慢性盆腔炎经验拾萃[J].中医药学刊.2005,23(9)：1572-1573.
[7]王福关,王粉安.坤复康胶囊对子宫微循环影响的实验研究[J].西北药学杂志.2007,22(2)
[8]王玲娟,徐惠军.刘岩慢性盆腔炎愈后康复治疗与甲襞微循环相关性的探讨[J].长春中医学院学报,2001,17(2)