藏医妇科病之“隆擦”的诊疗研究
摘要
“隆擦”病是藏医40种妇科病之一,也是藏医妇科学的重要研治对象。藏医妇科学是以藏医理论为指导,在认识和研究妇女生殖器官的解剖、生理、病理、诊治规律和预防妇科疾病的过程中,逐步形成的理论体系。早在公元6-7世纪左右,藏医典籍已有对本病诊疗的相关文献记载。“隆擦”病根据不同的发病部位(头、骨骼、心、肾、胃、小肠)分为六种。根据“隆擦”病的诱因、发病机理及临床症状与现代医学“更年期综合征”非常相似,在临床中有不少医生已把“隆擦”与女性更年期综合征画上了等号。
“更年期综合征”是困扰女性和家庭的重要顽症,是现代医学亟待攻克的世界性难题之一。目前,对此顽症大多采用激素替代疗法(HRT),但激素替代疗法却引起更年期综合征患者多种不良反应。因此寻找疗效更好、毒副作用更小的治疗方法已成为医药界的研究热点。本文理论与实践相结合,根据“以理论引导实践,以实践验证理论”的科学原则,依据藏医药典籍对“隆擦”病的理论阐述和临床诊疗案例,在剖析和考证藏医对“隆擦”病的认识和界定的基础上,从定义、病因、发病机理、症状分类、治疗原则、具体用药以及康复理疗等方面对藏医“隆擦”病的诊疗作了深入研究和系统总结。现就本课题具体研究目的、研究方法、研究内容及主要结论简要总结如下：
[研究目的]：1、本研究在藏医相关“隆擦”病的文献记载和已有临床实践的基础上,进一步论证“更年期综合征”可归纳为藏医“隆擦”病范畴的基本原理；2、初步建立一套对“隆擦”病治疗有效的,包括诊疗标准、用药步骤等环节在内的诊疗质量保证体系,并探讨藏药对此病的疗效与作用机制,寻找更好的治疗方案与特效药物。
[研究方法及内容]：1、理论研究方面：本研究在查阅大量藏医古籍文献及相关学术科研文献资料的基础上,系统地分析和整理女性的生理及与本病相关病因,特别是对藏医《四部医典》中关于“隆擦”病的诊疗措施做了全面的分析和整理。进而从“隆擦”病的病因、发病机理、临床症状、分类、诊疗措施等五个方面对比研究了藏医各个医学流派对本病独特的临床诊疗。2、临床研究方面：(1)从不同理论与临床诊疗角度对“隆擦”病与“更年期综合征”的病因、病机、诊断标准与临床治疗的关系进行了细致的分析；(2)运用发病调查方法：从2012年即选取100例“隆擦”病患者(其中47例来自拉萨市门诊,53例来自拉萨市各县及社区),采用对患者自己或医生逐个询问、填表的方式,从年龄、职业、生理、心理、社会等多方面因素进行调查分析；(3)根据西藏各地区各级医院对“隆擦”病的临床诊疗条件及基础,将研究对象确定为西藏自治区藏医院妇产科和拉萨骨科专病医院两个部门100例“隆擦”(其中西医诊断为更年期综合征占总人数的70%)病人的诊疗过程,收集整理相关资料,分析考核藏医对“隆擦”病的临床诊断标准、治疗措施、临床疗效；(4)、收集名老藏医对“隆擦”病的诊疗经验并进行分析归纳。
[研究结果]：1、通过对藏医“隆擦”病与西医“更年期综合征”的比对研究,可以将“更年期综合征”归纳为藏医“隆擦”病的范畴；2、藏医妇科病之“隆擦”病是源于精血失调,基于内循环紊乱所造成的病变精血与隆侵蚀身体各个脏腑、器官、各类组织而造成的陈旧性病变；3、本病大部分患者出现眩晕、耳鸣、骨痛、月经不调、易激动、失眠、多疑、抑郁、甚至喜怒无常等症状,给女性身心健康带来严重的影响；4、在本病的治疗上,应奉行女性以血为基本,处处顾护精血的理论宗旨；5、近年来该病的发病率逐年升高,严重影响了妇女的生活质量；6、在观察和随访两家医院的100例“隆擦”病人中得知藏医在诊断此病过程中以脉诊与尿诊为基础,主症为诊断依据,主要采用饮食起居疗法、药物疗法、精神治疗、涂抹、药浴等治疗措施。总有效率为90%,治愈率为50%。
[结论]：本研究则表明：臧医妇科病之“隆擦”病的诊疗对“更年期综合征”的诊治具有良好疗效,而藏药来源广泛、价格低廉、具有适宜长期服用及预防性应用的优点,对“更年期综合征”的治疗具有更为广阔的良好前景,因此在吸收现代医学研治成果的基础上,进一步完善、充实藏医治疗“隆擦”病方面所具备的独特方法和措施,挖掘和整理藏医治疗“隆擦”病的秘方药物并将通过临床科研等研究途径予以推广,对发挥藏医药在专科专病方面的优势,改善妇女健康水平有重要的价值和意义。
Long Tsap is one of forty female diseases in Tibetan medicine. It is also an important study subject in female diseases. Under Tibetan medical theory guidance, the doctrine of female diseases has gradually been developed through studying anatomy and biology of female, as well as pathology, diagnosis, treatment of female diseases. About6th-7th centurv. Tibetan medical texts recorded brief descriptions regarding to diagnosis and treatment of female diseases. According to locations, Long Tsap can be divided into six subdivisions: namely, head, bone, heart, kidney, stomach and small intestine disease. According to the cause, condition and symptoms, it seems to me that Long Tsap is very similar to climacteric syndrome. In clinical practice, many physicians believe that Long Tsap is climacteric syndrome.
Climacteric syndrome is one of diseases that cause a great suffering to women and their families. It is one of the diseases which still need to be overcomed by modern medicine globally. In most cases, the disease is treated by Hormone Therapy. Unfortunately, HRT cause many side effects to the patients of climacteric syndrome. Thus, as medical researchers, it is important to find a more effective and safer therapy to treat the disease. In this thesis, by combining theory with practice,'theory guides practice, and practice proves theory'as scientific principle, having based on the theory of Long Tsap in Tibetan medical texts and cases in clinical practice, I analyzed and interpreted how Tibetan medicine diagnose and examine the disease. In addition, I did profound and systematic research on the definition, causes, condition, classification, methods of treatment, therapies, and recovery of Long Tsap. The following is my research aim, methods, results and conclusions:
Research Aim:1. Having based on the theory of Long Tsap in Tibetan medical texts and clinical practice, I try to prove that climacteric syndrome can be included into the category of Long Tsap in Tibetan medicine.2.1try to establish an effective quality control system for diagnosis and treatment, including diagnostic criteria and treatment, procedure of using medicine. I also try to figure out the effect and mechanisms of the function in order to find better treatment and effective drug for the disease.
Research Method and Content:1. Studying on Theory:through reading various Tibetan medical texts and searching modern academic literature, I analyzed biology, causes of the disease, especially the diagnosis and treatment methods of Long Tsap in the Four Treatises. I did comprehensive study on causes, condition, classification, symptom, and methods of treatment in different Tibetan medical texts.2. Clinical Study:(1) from different theories and clinical practice aspects, I compare the cause, condition, diagnosis and treatment of Long Tsap in Tibetan medical with climacteric syndrome in western medicine. (2) Investigation on Cases:I investigated100patients (including47patients from Lhasa People's Hospital and53patients from counties'hospital and communities'clinics from Lhasa City.) Through interviewing physicians and patients, and filling forms, I investigated that how age, occupation, biology, psychology, social factor influence the diseases.(3) Considering the treatment condition in the hospitals in Tibet, I chose100patients with Long Tsap in the department of gynecology in Tibetan Medical Hospital of TAR and Tibet Hospital of Orthopedics (According to examination,70%patients have climacteric syndrome). I examined treatment process, collected relevant data. At the same time, I also analyzed clinical diagnostic criteria, method of treatment, and effect to the patients.(4). I collected and analyzed the experience of treating climacteric syndrome from famous senior Tibetan physicians.
Results:1. Comparison between Long Tsap in Tibetan medical texts and climacteric syndrome in Western medicine, I try to prove that climacteric syndrome can be included into the category of Long Tsap in Tibetan medicine.2. Long Tsap in Tibetan medicine is a disorder of blood and essence of body. The disorder causes chronic diseases to the inner organs, sense organs, and tissues in the body.3. The symptoms of disease include dizziness, buzzing in the ear, pain of bone, menstrual disorders, irritability, insomnia, anxiety, depression, mood changes. It brings a great risk to female health.4. For the treatment to the disease, the blood is a key to the woman. It is important to protect blood and essence of body.5. Recently, incidence of the disease has increased rapidly, it greatly impacts female quality life.6. After interviewed100patients in the two hospitals (70%patients are examined as climacteric syndrome), Tibetan physician uses pulse reading, urine analysis, and questioning to diagnose the disease. The disease is treated with diet, medicine, spiritual therapy, medicinal bath therapy, and massage therapy. The effective rate is90%and recovery rate is50%.
Conclusions:Through this research, we make the following conclusions:the treatment of Long Tsap in Tibetan gynecology is effective to climacteric syndrome in Western medicine. There are rich resources of herbs in Tibet. Tibetan herbal productions are cheap and they can prevent diseases. They also can be used for long term. Thus, we can see that treatment of climacteric syndrome has bright future. Because of this reason, having borrowed knowledge of modern medicine and improved special approaches and methods of Tibetan medicine, by investigating formula of treatment of the disease and doing clinical research on this disease, by utilizing advanced Tibetan medical treatment to the special disease, we can improve female health. There are great values and significances to the female health.
“更年期综合征”是困扰女性和家庭的重要顽症,是现代医学亟待攻克的世界性难题之一。目前,对此顽症大多采用激素替代疗法(HRT),但激素替代疗法却引起更年期综合征患者多种不良反应。因此寻找疗效更好、毒副作用更小的治疗方法已成为医药界的研究热点。本文理论与实践相结合,根据“以理论引导实践,以实践验证理论”的科学原则,依据藏医药典籍对“隆擦”病的理论阐述和临床诊疗案例,在剖析和考证藏医对“隆擦”病的认识和界定的基础上,从定义、病因、发病机理、症状分类、治疗原则、具体用药以及康复理疗等方面对藏医“隆擦”病的诊疗作了深入研究和系统总结。现就本课题具体研究目的、研究方法、研究内容及主要结论简要总结如下：
[研究目的]：1、本研究在藏医相关“隆擦”病的文献记载和已有临床实践的基础上,进一步论证“更年期综合征”可归纳为藏医“隆擦”病范畴的基本原理；2、初步建立一套对“隆擦”病治疗有效的,包括诊疗标准、用药步骤等环节在内的诊疗质量保证体系,并探讨藏药对此病的疗效与作用机制,寻找更好的治疗方案与特效药物。
[研究方法及内容]：1、理论研究方面：本研究在查阅大量藏医古籍文献及相关学术科研文献资料的基础上,系统地分析和整理女性的生理及与本病相关病因,特别是对藏医《四部医典》中关于“隆擦”病的诊疗措施做了全面的分析和整理。进而从“隆擦”病的病因、发病机理、临床症状、分类、诊疗措施等五个方面对比研究了藏医各个医学流派对本病独特的临床诊疗。2、临床研究方面：(1)从不同理论与临床诊疗角度对“隆擦”病与“更年期综合征”的病因、病机、诊断标准与临床治疗的关系进行了细致的分析；(2)运用发病调查方法：从2012年即选取100例“隆擦”病患者(其中47例来自拉萨市门诊,53例来自拉萨市各县及社区),采用对患者自己或医生逐个询问、填表的方式,从年龄、职业、生理、心理、社会等多方面因素进行调查分析；(3)根据西藏各地区各级医院对“隆擦”病的临床诊疗条件及基础,将研究对象确定为西藏自治区藏医院妇产科和拉萨骨科专病医院两个部门100例“隆擦”(其中西医诊断为更年期综合征占总人数的70%)病人的诊疗过程,收集整理相关资料,分析考核藏医对“隆擦”病的临床诊断标准、治疗措施、临床疗效；(4)、收集名老藏医对“隆擦”病的诊疗经验并进行分析归纳。
[研究结果]：1、通过对藏医“隆擦”病与西医“更年期综合征”的比对研究,可以将“更年期综合征”归纳为藏医“隆擦”病的范畴；2、藏医妇科病之“隆擦”病是源于精血失调,基于内循环紊乱所造成的病变精血与隆侵蚀身体各个脏腑、器官、各类组织而造成的陈旧性病变；3、本病大部分患者出现眩晕、耳鸣、骨痛、月经不调、易激动、失眠、多疑、抑郁、甚至喜怒无常等症状,给女性身心健康带来严重的影响；4、在本病的治疗上,应奉行女性以血为基本,处处顾护精血的理论宗旨；5、近年来该病的发病率逐年升高,严重影响了妇女的生活质量；6、在观察和随访两家医院的100例“隆擦”病人中得知藏医在诊断此病过程中以脉诊与尿诊为基础,主症为诊断依据,主要采用饮食起居疗法、药物疗法、精神治疗、涂抹、药浴等治疗措施。总有效率为90%,治愈率为50%。
[结论]：本研究则表明：臧医妇科病之“隆擦”病的诊疗对“更年期综合征”的诊治具有良好疗效,而藏药来源广泛、价格低廉、具有适宜长期服用及预防性应用的优点,对“更年期综合征”的治疗具有更为广阔的良好前景,因此在吸收现代医学研治成果的基础上,进一步完善、充实藏医治疗“隆擦”病方面所具备的独特方法和措施,挖掘和整理藏医治疗“隆擦”病的秘方药物并将通过临床科研等研究途径予以推广,对发挥藏医药在专科专病方面的优势,改善妇女健康水平有重要的价值和意义。
Long Tsap is one of forty female diseases in Tibetan medicine. It is also an important study subject in female diseases. Under Tibetan medical theory guidance, the doctrine of female diseases has gradually been developed through studying anatomy and biology of female, as well as pathology, diagnosis, treatment of female diseases. About6th-7th centurv. Tibetan medical texts recorded brief descriptions regarding to diagnosis and treatment of female diseases. According to locations, Long Tsap can be divided into six subdivisions: namely, head, bone, heart, kidney, stomach and small intestine disease. According to the cause, condition and symptoms, it seems to me that Long Tsap is very similar to climacteric syndrome. In clinical practice, many physicians believe that Long Tsap is climacteric syndrome.
Climacteric syndrome is one of diseases that cause a great suffering to women and their families. It is one of the diseases which still need to be overcomed by modern medicine globally. In most cases, the disease is treated by Hormone Therapy. Unfortunately, HRT cause many side effects to the patients of climacteric syndrome. Thus, as medical researchers, it is important to find a more effective and safer therapy to treat the disease. In this thesis, by combining theory with practice,'theory guides practice, and practice proves theory'as scientific principle, having based on the theory of Long Tsap in Tibetan medical texts and cases in clinical practice, I analyzed and interpreted how Tibetan medicine diagnose and examine the disease. In addition, I did profound and systematic research on the definition, causes, condition, classification, methods of treatment, therapies, and recovery of Long Tsap. The following is my research aim, methods, results and conclusions:
Research Aim:1. Having based on the theory of Long Tsap in Tibetan medical texts and clinical practice, I try to prove that climacteric syndrome can be included into the category of Long Tsap in Tibetan medicine.2.1try to establish an effective quality control system for diagnosis and treatment, including diagnostic criteria and treatment, procedure of using medicine. I also try to figure out the effect and mechanisms of the function in order to find better treatment and effective drug for the disease.
Research Method and Content:1. Studying on Theory:through reading various Tibetan medical texts and searching modern academic literature, I analyzed biology, causes of the disease, especially the diagnosis and treatment methods of Long Tsap in the Four Treatises. I did comprehensive study on causes, condition, classification, symptom, and methods of treatment in different Tibetan medical texts.2. Clinical Study:(1) from different theories and clinical practice aspects, I compare the cause, condition, diagnosis and treatment of Long Tsap in Tibetan medical with climacteric syndrome in western medicine. (2) Investigation on Cases:I investigated100patients (including47patients from Lhasa People's Hospital and53patients from counties'hospital and communities'clinics from Lhasa City.) Through interviewing physicians and patients, and filling forms, I investigated that how age, occupation, biology, psychology, social factor influence the diseases.(3) Considering the treatment condition in the hospitals in Tibet, I chose100patients with Long Tsap in the department of gynecology in Tibetan Medical Hospital of TAR and Tibet Hospital of Orthopedics (According to examination,70%patients have climacteric syndrome). I examined treatment process, collected relevant data. At the same time, I also analyzed clinical diagnostic criteria, method of treatment, and effect to the patients.(4). I collected and analyzed the experience of treating climacteric syndrome from famous senior Tibetan physicians.
Results:1. Comparison between Long Tsap in Tibetan medical texts and climacteric syndrome in Western medicine, I try to prove that climacteric syndrome can be included into the category of Long Tsap in Tibetan medicine.2. Long Tsap in Tibetan medicine is a disorder of blood and essence of body. The disorder causes chronic diseases to the inner organs, sense organs, and tissues in the body.3. The symptoms of disease include dizziness, buzzing in the ear, pain of bone, menstrual disorders, irritability, insomnia, anxiety, depression, mood changes. It brings a great risk to female health.4. For the treatment to the disease, the blood is a key to the woman. It is important to protect blood and essence of body.5. Recently, incidence of the disease has increased rapidly, it greatly impacts female quality life.6. After interviewed100patients in the two hospitals (70%patients are examined as climacteric syndrome), Tibetan physician uses pulse reading, urine analysis, and questioning to diagnose the disease. The disease is treated with diet, medicine, spiritual therapy, medicinal bath therapy, and massage therapy. The effective rate is90%and recovery rate is50%.
Conclusions:Through this research, we make the following conclusions:the treatment of Long Tsap in Tibetan gynecology is effective to climacteric syndrome in Western medicine. There are rich resources of herbs in Tibet. Tibetan herbal productions are cheap and they can prevent diseases. They also can be used for long term. Thus, we can see that treatment of climacteric syndrome has bright future. Because of this reason, having borrowed knowledge of modern medicine and improved special approaches and methods of Tibetan medicine, by investigating formula of treatment of the disease and doing clinical research on this disease, by utilizing advanced Tibetan medical treatment to the special disease, we can improve female health. There are great values and significances to the female health.
引文
94张玉珍 中医妇科学[M]中国中医药出版社2011.8
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97王华 建立更年期妇女中医情志量表的初步研究 [D] 广州中医药大学20050401
98郭桂月 中医药治疗更年期综合征文献系统评价 [D] 广州中医药大学20050418
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95张亚敏 柴胡桂枝干姜汤加减治疗“更年心”的临床研究[D] 黑龙江中医药大学20070501
96姚凤更年新方治疗阴虚火旺型更年期综合征的临床研究 [D] 南京中医药大学20090501
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