基于“女子以肝为先天”思想论治围绝经期无排卵性异常子宫出血  

Treatment of Perimenopausal Anovulatory Dysfunctional Uterine Bleeding Based on Thought of Liver Being Innate Basis of Women

作　　者：丁宁 姜秀新[2] 徐世杰[1] ING Ning;JIANG Xiu-xin;XU Shi-jie(Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国中医科学院中医基础理论研究所,北京100700 [2]中国中医科学院,北京100700

出　　处：《中国实验方剂学杂志》2021年第13期191-198,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：中国中医科学院中医基础理论研究所基本科研业务费自主选题(YZ-202006)。

摘　　要：围绝经期无排卵性异常子宫出血是妇科的疑、难、重、急症,约占异常子宫出血的70%。由于其出血模式差异较大,治疗颇为棘手。该病主要表现为经期延长、月经淋漓不尽或非经期的阴道大量流血等,属中医"崩漏"范畴。历代医家对该病的研究较为深入,在病因、病机、鉴别、治疗等各方面积累了丰富的经验,形成了比较系统的理论体系。现存文献对其病机的研究多集中在血热、血瘀、脾虚、肾虚四型,对肝的论述较少,而在临床实践中,常见因肝的功能失常而致崩漏者。"女子以肝为先天"理论从女子的特殊生理病理特点出发,强调肝的功能特性、经络循行在该病治疗过程中的重要作用。因肝气、肝血与脾肾二脏、冲任二脉密切相关,故从疏肝气养肝血、肝肾同源、肝脾同调、肝经循行四个方面探讨中医治疗围绝经期无排卵性异常子宫出血,可为临床治疗拓宽思路。围绝经期是女性特有的生理时期,此期多表现为气郁血虚的状态,而肝体阴而用阳,主疏泄气机指导排卵又藏血而调节血量,故从肝论治围绝经期无排卵性异常子宫出血,不仅可以解决因排卵异常而导致的激素水平紊乱,起到止血的作用,又可改善围绝经期症状,打破传统理念,为临床治疗提供新的方向。Perimenopausal anovulatory dysfunctional uterine bleeding(ADUB)is a severe acute disease that is difficult to be dealt with in gynecology,accounting for about 70% of abnormal uterine bleeding. The significant differences in bleeding patterns make it particularly challenging to treat. The main manifestations of perimenopausal ADUB are prolonged menstrual period, inexhaustible menstrual bleeding, or heavy intermenstrual vaginal bleeding,which allow it to be classified into the category of metrorrhagia and metrostaxis in traditional Chinese medicine(TCM). After conducting in-depth research on this disease,physicians of the past dynasties have figured out its etiology and pathogenesis and accumulated rich experience in its differentiation and treatment,thus forming a relatively systematic theoretical system. The existing literature mainly focuses on four types of its pathogenesis,namely blood heat,blood stasis,spleen deficiency,and kidney deficiency,and there are few discussions on liver. However,patients with metrorrhagia and metrostaxis due to liver dysfunction are commonly seen in clinical practice. The theory of liver being innate basis of women explores the special physiological and pathological characteristics of women and emphasizes the important role of liver in the treatment of this disease based on its characteristic functions and meridian circulation. Considering the close relationship of liver Qi and blood with spleen,kidney,and thoroughfare and conception vessels,this paper discussed the TCM treatment of perimenopausal ADUB from the following four aspects:soothing liver Qi and nourishing liver blood,liver and kidney sharing the same source,simultaneous regulation of liver and spleen,and liver meridian circulation,so as to broaden the clinical treatment options. Perimenopause is a unique physiological period when women tend to suffer from Qi stagnation and blood deficiency. Liver,characterized by Yin in property and Yang in function,governs the free flow of Qi,induces ovulation,stores blood,and regulates

关 键 词：围绝经期 异常子宫出血 女子以肝为先天 崩漏 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]