乳核散结片治疗肝郁气滞型经前期综合征的临床观察
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摘要
目的
经前期综合征(premenstrual syndrome，PMS)是指妇女反复在黄体期周期性出现躯体、精神以及行为方面的改变，严重者影响生活质量，月经来潮后，症状自然消失。发生率为30％～40％，严重者占5％～10％。值得强调的是只有对日常生活和工作有明显影响的才称为PMS。中医古籍中无此病名，有关论述散见于“经行诸证”中。现代中医妇科学将其归属于“月经前后诸证”范畴，根据不同症状，可见“经行眩晕”、“经行头痛”、“经行泄泻”、“经行吐衄”、“经行乳房胀痛”等。目前，PMS的病因和发病机制尚不明确，且临床表现多样化，严重性不一。中西医治疗此病表现出不同的优势。西药对缓解症状明显，但抗焦虑剂、利尿剂、性激素等均有一定副作用，长期服用患者顺从性差。而中医对巩固远期疗效，防止复发大有优势，但其疗程较长，且均为一病一治，所以，如何在缩短疗程，获取远期疗效的同时，提高中医治疗效果，是中医药治疗PMS的主要发展方向。因此，导师丁玎主任医师根据丰富的临床经验，并结合现代中药药理研究，拟定“乳核散结片”，用于经前期综合征的治疗研究。
对象和方法
本研究的对象为60例临床诊断为经前期综合征(肝郁气滞证)的患者。按病人就诊顺序，将病人随机分为治疗组(乳核散结片)30例，平均年龄33.57岁；对照组(逍遥丸)30例，平均年龄34.41岁；以随机的方式进行给药。治疗组：乳核散结片，药物组成：柴胡、郁金、当归、海藻、昆布、漏芦、山慈姑、黄芪、淫羊藿、鹿衔草等，口服，一次4片，一日3次；对照组：逍遥丸，药物组成：柴胡、当归、白芍、茯苓、白术(炒)、甘草(蜜制)等，口服，一次9克，一日2次。两组都是于经前14天开始服药，服至月经来潮即停止，3个月经周期为一疗程，连续治疗3个疗程，观察疗效，统计结果。
结果
治疗组痊愈12例(40.00％)，显效9例(30.00％)，有效6例(20.00％)，无效3例(10.00％)，总有效率90.00％；对照组痊愈3例(10.00％)，显效10例(33.33％)，有效9例(30.00％)，无效8例(26.67％)，总有效率66.67％；经统计学分析，两组总疗效有显著性差异(P＜0.05)。就其单项临床症状缓解方面，治疗组均优于对照组，且差异有显著性或极显著性(P＜0.05或P＜0.01)。
结论
乳核散结片，方用柴胡、郁金，疏肝理气、解郁化滞、活血止痛；当归，补血、活血、调经、止痛；在疏肝理气、活血止痛的基础上，配以漏芦、山慈姑，清热解毒、消痈散结、通经下乳；海藻、昆布，消痰软坚；黄芪，补气升阳；以及淫羊藿、鹿衔草，温肾壮阳。全方合用补气而不滞，益血不留瘀，共奏疏肝解郁、软坚散结、理气活血、调和冲任之功效。现代药理研究也表明，以上药物主要通过调节机体免疫力，保护肝脏功能，保持血流通畅，从而起到改善症状的作用。
本研究中，乳核散结片与经典方逍遥丸在疗效上与治疗前相比均有显著差异；本方主要针对经前期综合征肝郁气滞证，拟定疏肝理气活血之治法，在改善患者临床症状方面有显著性差异。
Objective
PMS is refer to the women repeatedly to appear the body , the spiritual as well as the behavior aspect change in the luteal phase periodicity, the serious influence quality of life, after the menstruation incoming tide, the symptom naturally vanishes. Its formation rate for 30 %～40 %, seriousoccupies for 5 %～10 % . Its worth emphasizing is only then has the obvious influence to the daily life and the work only then to be called PMS. In the Chinese medicine ancient book does not have this sickness name, the related elaboration sees here and there in the "jing xing zhu zheng" . Modern Chinese medicine gynecology department study its ownership around "menstruation various cards" category, according to the different symptom, obviously "jing xing xuan yun", "jing xing tou tong", "jing xing xie xie ", "jing xing tu niu ", "jing xing ru fang zhang tong " and so on. At present, the PMS cause of disease and the pathogens is not still clear about, also clinical manifestation diversification, gravity not one. The doctor practice Chinese and western medicine treats this sickness to display the different superiority. The western medicine to alleviates the symptom to be obvious , but the anti-anxious medicinal preparation, the diuretic the sex hormone and so on have the certain side effect, the patient long-term use can not endure. But the Chinese medicine to the consolidated forward curative effect, prevented the recrudescence has the superiority greatly, but its treatment course is long, as soon as also for gets sick governs. Therefore, how in the reduction treatment course, gain forward curative effect at the same time, enhances the Chinese medicine treatment result, is the Chinese medicine treats PMS the main development direction. Therefore, Teacher , physician-in-charge Ding-ding, acts according to the rich clinical experience ,and unifies the union modern Chinese native medicine pharmacology research , drew up the lumps in the breast to relieve congestion the piece, uses in treatment research which the premenstrual synthes is drafted.
Object and method
This research object is 60 examples clinical diagnoses for passes through the earlier period synthesis drafts PMS(liver qi invasion).rhese women receive medical examination the order according to the patient, divide into the patient the treatment group (the lumps in the breast to relieve congestion the piece) 30 examples, the average age is 33.57 years old; The comparison group (free pill) 30 examples, the average age is 34.41 years old; I carrie on by the stochastic Dan Mang way for the medicine. THe treatment group: the lumps in the breast relieve congestion piece, medicine composition are chai hu ,yu jin , dang gui, hai zao, kun bu, lou lu, shan ci gu, huang qi, yin yang huo, lu xian cao, and so on. The comparison group is free pill,medicine composition are chai hu, dang gui, baishao, fuling, bai zhu, gan cao, and so on. Two groups both are start to take medicine, namely stops the clothing to the menstruation incoming tide, three menstrual cycles are a treatment course, continuously treat three treatment courses, the observation curative effect, the statistical result.
Finally
The treatment group recover from illness 12 examples (40.00%), shows results 9 examples (30.00%), effective 6 examples (20.00%), invalid 3 examples (10.00%), totaleffectiveness is 90.00% ; The comparison group recover from illness 3 examples (10. 00%), shows results 10 examples (33.33 %), effective 9 examples (30. 00%), invalid 8 examples (26.67%), total effectiveness is 66.67%; After statistics analysis, two groups of total curative effects has significance difference (P<0. 05). On its single item clinical symptom alleviation aspect, the treatment group surpasses the comparison group (P < 0. 05 or P < 0. 01).
Conclution
The lumps in the breast to relieve congestion the piece, the side with the chai hu, yu jin, the sparse liver regulates the flow of vital energy, Xie Yuhua stagnates, invigorates the blood to stop pain; The Chinese angelica, the blood circulation pain-relieving;Regulats the flow of vital energy in the foundation in the sparseliver which, invigorates the blood to stop pain, matches by lou lu ,shan ci gu , alleviates fever the disintoxicating, disappears yong relieves congestion, passes after xia ru ; The hai zao and kun bu disappear the phlegm softly to be firm; Huang qi makes up the air to be positive; As well as yin yang huo, Lu Xiancao, the warmkidney fortifies yang. The modern pharmacology also indicated that, the above medicine mainly through the adjustment organism immunity, protects the liver function, thus plays the improvement symptom role.
In this research, the lumps in the breast relieve congestion the piece to compare with the classical side ramble pill in the curative effect with the treatmentbefore has the remarkable difference; We mainly aim at the premenstrual phase synthesis to draft the liver strongly fragrant stagnation of flow of vital energy card, draws up regulates the flow of vital energy blood circulation removing extravasted blood to govern the law, is improving the patient clinical symptom aspect to have the significance difference.
经前期综合征(premenstrual syndrome，PMS)是指妇女反复在黄体期周期性出现躯体、精神以及行为方面的改变，严重者影响生活质量，月经来潮后，症状自然消失。发生率为30％～40％，严重者占5％～10％。值得强调的是只有对日常生活和工作有明显影响的才称为PMS。中医古籍中无此病名，有关论述散见于“经行诸证”中。现代中医妇科学将其归属于“月经前后诸证”范畴，根据不同症状，可见“经行眩晕”、“经行头痛”、“经行泄泻”、“经行吐衄”、“经行乳房胀痛”等。目前，PMS的病因和发病机制尚不明确，且临床表现多样化，严重性不一。中西医治疗此病表现出不同的优势。西药对缓解症状明显，但抗焦虑剂、利尿剂、性激素等均有一定副作用，长期服用患者顺从性差。而中医对巩固远期疗效，防止复发大有优势，但其疗程较长，且均为一病一治，所以，如何在缩短疗程，获取远期疗效的同时，提高中医治疗效果，是中医药治疗PMS的主要发展方向。因此，导师丁玎主任医师根据丰富的临床经验，并结合现代中药药理研究，拟定“乳核散结片”，用于经前期综合征的治疗研究。
对象和方法
本研究的对象为60例临床诊断为经前期综合征(肝郁气滞证)的患者。按病人就诊顺序，将病人随机分为治疗组(乳核散结片)30例，平均年龄33.57岁；对照组(逍遥丸)30例，平均年龄34.41岁；以随机的方式进行给药。治疗组：乳核散结片，药物组成：柴胡、郁金、当归、海藻、昆布、漏芦、山慈姑、黄芪、淫羊藿、鹿衔草等，口服，一次4片，一日3次；对照组：逍遥丸，药物组成：柴胡、当归、白芍、茯苓、白术(炒)、甘草(蜜制)等，口服，一次9克，一日2次。两组都是于经前14天开始服药，服至月经来潮即停止，3个月经周期为一疗程，连续治疗3个疗程，观察疗效，统计结果。
结果
治疗组痊愈12例(40.00％)，显效9例(30.00％)，有效6例(20.00％)，无效3例(10.00％)，总有效率90.00％；对照组痊愈3例(10.00％)，显效10例(33.33％)，有效9例(30.00％)，无效8例(26.67％)，总有效率66.67％；经统计学分析，两组总疗效有显著性差异(P＜0.05)。就其单项临床症状缓解方面，治疗组均优于对照组，且差异有显著性或极显著性(P＜0.05或P＜0.01)。
结论
乳核散结片，方用柴胡、郁金，疏肝理气、解郁化滞、活血止痛；当归，补血、活血、调经、止痛；在疏肝理气、活血止痛的基础上，配以漏芦、山慈姑，清热解毒、消痈散结、通经下乳；海藻、昆布，消痰软坚；黄芪，补气升阳；以及淫羊藿、鹿衔草，温肾壮阳。全方合用补气而不滞，益血不留瘀，共奏疏肝解郁、软坚散结、理气活血、调和冲任之功效。现代药理研究也表明，以上药物主要通过调节机体免疫力，保护肝脏功能，保持血流通畅，从而起到改善症状的作用。
本研究中，乳核散结片与经典方逍遥丸在疗效上与治疗前相比均有显著差异；本方主要针对经前期综合征肝郁气滞证，拟定疏肝理气活血之治法，在改善患者临床症状方面有显著性差异。
Objective
PMS is refer to the women repeatedly to appear the body , the spiritual as well as the behavior aspect change in the luteal phase periodicity, the serious influence quality of life, after the menstruation incoming tide, the symptom naturally vanishes. Its formation rate for 30 %～40 %, seriousoccupies for 5 %～10 % . Its worth emphasizing is only then has the obvious influence to the daily life and the work only then to be called PMS. In the Chinese medicine ancient book does not have this sickness name, the related elaboration sees here and there in the "jing xing zhu zheng" . Modern Chinese medicine gynecology department study its ownership around "menstruation various cards" category, according to the different symptom, obviously "jing xing xuan yun", "jing xing tou tong", "jing xing xie xie ", "jing xing tu niu ", "jing xing ru fang zhang tong " and so on. At present, the PMS cause of disease and the pathogens is not still clear about, also clinical manifestation diversification, gravity not one. The doctor practice Chinese and western medicine treats this sickness to display the different superiority. The western medicine to alleviates the symptom to be obvious , but the anti-anxious medicinal preparation, the diuretic the sex hormone and so on have the certain side effect, the patient long-term use can not endure. But the Chinese medicine to the consolidated forward curative effect, prevented the recrudescence has the superiority greatly, but its treatment course is long, as soon as also for gets sick governs. Therefore, how in the reduction treatment course, gain forward curative effect at the same time, enhances the Chinese medicine treatment result, is the Chinese medicine treats PMS the main development direction. Therefore, Teacher , physician-in-charge Ding-ding, acts according to the rich clinical experience ,and unifies the union modern Chinese native medicine pharmacology research , drew up the lumps in the breast to relieve congestion the piece, uses in treatment research which the premenstrual synthes is drafted.
Object and method
This research object is 60 examples clinical diagnoses for passes through the earlier period synthesis drafts PMS(liver qi invasion).rhese women receive medical examination the order according to the patient, divide into the patient the treatment group (the lumps in the breast to relieve congestion the piece) 30 examples, the average age is 33.57 years old; The comparison group (free pill) 30 examples, the average age is 34.41 years old; I carrie on by the stochastic Dan Mang way for the medicine. THe treatment group: the lumps in the breast relieve congestion piece, medicine composition are chai hu ,yu jin , dang gui, hai zao, kun bu, lou lu, shan ci gu, huang qi, yin yang huo, lu xian cao, and so on. The comparison group is free pill,medicine composition are chai hu, dang gui, baishao, fuling, bai zhu, gan cao, and so on. Two groups both are start to take medicine, namely stops the clothing to the menstruation incoming tide, three menstrual cycles are a treatment course, continuously treat three treatment courses, the observation curative effect, the statistical result.
Finally
The treatment group recover from illness 12 examples (40.00%), shows results 9 examples (30.00%), effective 6 examples (20.00%), invalid 3 examples (10.00%), totaleffectiveness is 90.00% ; The comparison group recover from illness 3 examples (10. 00%), shows results 10 examples (33.33 %), effective 9 examples (30. 00%), invalid 8 examples (26.67%), total effectiveness is 66.67%; After statistics analysis, two groups of total curative effects has significance difference (P<0. 05). On its single item clinical symptom alleviation aspect, the treatment group surpasses the comparison group (P < 0. 05 or P < 0. 01).
Conclution
The lumps in the breast to relieve congestion the piece, the side with the chai hu, yu jin, the sparse liver regulates the flow of vital energy, Xie Yuhua stagnates, invigorates the blood to stop pain; The Chinese angelica, the blood circulation pain-relieving;Regulats the flow of vital energy in the foundation in the sparseliver which, invigorates the blood to stop pain, matches by lou lu ,shan ci gu , alleviates fever the disintoxicating, disappears yong relieves congestion, passes after xia ru ; The hai zao and kun bu disappear the phlegm softly to be firm; Huang qi makes up the air to be positive; As well as yin yang huo, Lu Xiancao, the warmkidney fortifies yang. The modern pharmacology also indicated that, the above medicine mainly through the adjustment organism immunity, protects the liver function, thus plays the improvement symptom role.
In this research, the lumps in the breast relieve congestion the piece to compare with the classical side ramble pill in the curative effect with the treatmentbefore has the remarkable difference; We mainly aim at the premenstrual phase synthesis to draft the liver strongly fragrant stagnation of flow of vital energy card, draws up regulates the flow of vital energy blood circulation removing extravasted blood to govern the law, is improving the patient clinical symptom aspect to have the significance difference.
引文
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[1] 乔明琦，张珍玉等．经前期综合征征候分布规律的流行病学调查研究[J]．中国中医基础医学杂志，1997，3(3)：31～34．
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[13] 刘红星，程勇鹏，丁树栋．舒肝宁神汤治疗经前期紧张综合征68例．中国民间疗法，2002，10(8)：36～37．
[14] 乔明琦，张惠云，姜坤等．经前平颗粒多中心，随机双盲模拟对照治疗经前期综合征肝气逆证403例．中国新药杂志，2002，11(5)：389～392．
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[17] 黄巧红．经前平颗粒治疗经前期紧张综合征82例临床观察．江苏临床医学杂志，2002，6(4)：358．
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[20] 王君，尹红梅．经前康治疗经前期紧张综合征120例[J]．山东中医杂志，2004，23(9)：524～525．
[21] 绍明英，郭亚丽．中西医结合治疗经前期综合征98例．四川中医，2005，23(12)：71～72．
[22] 寇绍杰，王文治．中西医结合治疗经前期综合征52例．实用中医内科学杂志，2001，15(4)：36．
[23] 程泾．中医周期疗法治疗经前期紧张征102例．辽宁中医杂志，1982，6(26)．
[24] 乐杰主编．妇产科学(第6片反)[M]．北京：人民卫生出版社，2004．348～349．
[25] Elechman EA, Clay CJ, kipke MD, etal. The premenstrual experience. IN: Blechman EA. Handbook of behavioral medicine for women. New York: Pergamon press, 1988, 80.
[26] Slade P. Psychological therapy for premenstrual emption symptoms. Behav Psychother, 1989, 17: 135.
[27] 袁浩龙，周蓓蓓，尹小红等．经前期综合征妇女的应付方式研究[J]．中国神经精神疾病杂志，1997，23(2)：97～98．
[28] 张德利，岳文浩，宋希俊等．经前期综合征的心理症状研究[J]．泰山医学院学报，2000，21(2)：115～116．
[29] 张德利，刘志超，梁玉涛等．467名女学生个性心理特征与经前期综合征调查[J]．1999，20(4)：321～323．
[30] 赵更力，王临虹，梁川琰．育龄妇女经前期综合征的发生情况及影响因素[J]．中华妇产科杂志，1998，33(4)：222～224．
[31] Brzezinski A.D-fenfluramine suppresses the increased calorie and carbohydrate intake and improves the mood and women with premenstrual depression. Obstet Gynecol, 1990, 76: 296.
[32] Rapkin AJ. The role of serotonin in premenstrual syndrome. Clin Obstet Gynecol, 1992, 36: 629.
[33] Gonda X, Bagdy G. Neurochemical background of the premenstrual syndrome: the role of the serotonerg system. Neuropsychopharacol Hung. 2004 Oct; 6(3): 153～162.
[34] 严庆惠．经前期综合征[J]．国外医学-内科学分册，1999，26(12)：543．
[35] Damberg M, Westberg L, Berggard C, etal. Investigation of transcription factor AP-2 beta genotype in women with premenstrual dysphoric disorder. Neurosci Lett 2005 MAR 22; 377(1): 49～52.
[36] 李燕琴译．经前期综合征的治疗．国外医学-妇幼保健分册，2000，11(2)：70～75．
[37] 张玉勤译．经前期综合征的病理生理研究．国外医学情报，1998，19(6)：37．
[38] 杨秀清等．消各通治疗乳腺增生及经前期综合征．天津药学，2000，12(2)：47．
[39] 李恒芬等．罗拉治疗妇女经前期综合征初步研究．中国心理卫生杂志，1999，13(2)：117～118．