中医膏方治疗月经失调的临床组方用药分析

目的 探讨中医膏方治疗月经失调的临床组方用药规律.方法 回顾性分析月经失调服用膏方治疗患者122例.收集患者病史、膏方所用中药,按照月经先期、月经后期、月经过多、月经过少进行分组,对患者病性分布、膏方常用药物及其归经分布、功效分类进行统计分析.结果 122例患者中,月经先期30例,月经后期32例,月经过多28例,月经过少32例.按阳偏衰、阴偏衰病性进行统计,2种经期失调患者病性差异有统计学意义(P<0.05),其中月经先期阴偏衰占比高于阳偏衰,月经后期阳偏衰占比高于阴偏衰,差异有统计学意义(P<0.05).122张膏方中频率>50%的高频药物23味,归肾经、脾经占比高于肝经,差异有统计学意义(P<0.05).其中月经先期、月经过少膏方常用药物肾经占比高于脾经,月经后期、月经过多膏方常用药物脾经占比高于肾经,差异有统计学意义(P<0.05).按药物功效统计,2种经期失调膏方常用药物补阴与补阳分布差异有统计学意义(P<0.05),其中月经先期补阴药占比高于补阳药,月经后期补阳药占比高于补阴药,差异有统计学意义(P<0.05);4种月经失调膏方理气药、活血药占比差异无统计学意义(P>0.05).Apriori分析显示,常用药对有补阴类女贞子-墨旱莲&熟地黄、阿胶-龟甲胶&熟地黄,补阳类当归-鹿角胶&杜仲、当归-黄芪&枸杞子,也有行气和血类如当归-川芎&白芍.结论 治疗月经失调膏方应以补肾、脾为主,加适量肝经药物为辅,药物选用要兼顾阴阳平衡,适量加用行气和血药物.不同类型月经失调补肾与补脾、补阴与补阳的药物占比要因证配比.

Objective To explore the clinical prescription rule of traditional Chinese medicine ointment in the treatment of recurrence of menstrual disorders.Methods A retrospective analysis was performed on 122 patients with recurrent menstrual disorders.According to the disease,they were divided into the early menstruation group,the late menstruation group,the menorrhagia group,and the hypomenorrhea group.122 patients with recurrent menstrual disorders were divided into early menstruation,late menstruation,excessive menstruation and less menstruation according to the disease types.The distribution of patients'disease nature,commonly used drugs of ointment,meridian tropism and efficacy classification were analyzed.Results Among 122 patients,there were 30 cases of early menstruation,32 cases of late menstruation,28 cases of excessive menstruation and 32 cases of hypomenorrhea.According to the statistics of yang-biased decline and yin-biased decline,there was a statistically significant difference in the nature of the disease between the two menstrual disorders(P<0.05).The proportion of yin-biased decline in early menstruation was significantly higher than that of yang-biased decline.The proportion of yang-biased decline in late menstruation was significantly higher than that of yin-biased decline,and the difference was statistically significant(P<0.05).There were 23 kinds of high-frequency medicines with frequency over 50%in 122 ointments.The medicines in kidney meridian and spleen meridian were higher than those in liver meridian,with statistical significance(P<0.05).The proportion of kidney meridian commonly used in early menstruation and hypomenorrhea was higher than that of spleen meridian.The proportion of spleen meridian commonly used in late menstruation and menorrhagia was higher than that of kidney meridian,with statistical significance(P<0.05).According to the statistics of drug efficacy,there was a statistically significant difference in the distribution of yin-tonifying and yang-tonifying drugs commonly used in the two menstrual disorders(P<0.05).The proportion of yin-tonifying drugs in the early menstrual period was significantly higher than that of yang-tonifying drugs,and the proportion of yang-tonifying drugs in the late menstrual period was significantly higher than that of yin-tonifying drugs,the difference was statistically significant(P<0.05).There was no significant difference in the proportion of regulating qi medicine and activating blood medicine in 4 kinds of menstrual disorders ointment(P>0.05).Association rule analysis showed that the commonly used drug pairs were yin-tonifying Ligustri Lucidi Fructus-Eclipta prostrata&Rehmanniae Radix Praeparata,donkey-hide gelatin&Tortoise-shell glue&Rehmanniae Radix Praeparata,yang-tonifying Angelicae Sinensis Radix-Cervi Cornu Gum&Eucommia Ulmoides Oliver,Angelicae Sinensis Radix-Astragali Radix&Lyci Fructus,and qi-promoting and blood-activating drugs such as Angelicae Sinensis Radix-Chuanxiong Rhizoma&Paeoniae Radix Alba.Conclusion The treatment of recurrent menstrual disorders cream should be based on regulating kidney,spleen,plus an appropriate amount ofliver drugs.The drug selection should take into account the balance of yin and yang,with an appropriate amount ofqi and blood drugs.The proportion of drugs for tonifying kidney and spleen,yin and yang in different types of menstrual disorders should be matched according to syndrome.