CN105999116A - 一种治疗慢性盆腔痛的中药灌肠方剂 - Google Patents

一种治疗慢性盆腔痛的中药灌肠方剂 Download PDF

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CN105999116A
CN105999116A CN201610588533.5A CN201610588533A CN105999116A CN 105999116 A CN105999116 A CN 105999116A CN 201610588533 A CN201610588533 A CN 201610588533A CN 105999116 A CN105999116 A CN 105999116A
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周庆燕
蒋永红
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Abstract

本发明涉及一种治疗慢性盆腔痛的中药灌肠方剂，由以下中药配制而成：鸡血藤30g、淫羊藿30g、石苇15g、牡丹皮10g、肉桂10g、赤芍10g、丹参15g、益母草30g、甘草15g、蒲公英15g、川牛膝10g、茯苓10g、桃仁10g、五灵脂（炒）10g、郁金10g、细辛10g、当归15g、三棱（炒）10g。配制方法：将上述药物倒入器皿中，加温水500ml浸润一刻钟，慢慢熬制，待药液剩余约200ml，过滤药液，待药温38‑40℃使用，每天100ml（一副药物用2天）。本发明药源丰富、价格便宜、直达根源，无毒副作用，是保守治疗慢性盆腔痛的良药。

Description

一种治疗慢性盆腔痛的中药灌肠方剂
技术领域
本发明涉及中药技术领域，具体是一种治疗慢性盆腔痛的中药灌肠方剂。
背景技术
慢性盆腔痛是指有各种功能性和（或）器质性原因引起的，以骨盆及周围组织疼为主要表现的非周期性疼痛，持续达6个月以上，并引起功能障碍或日常生活活动受限需要药物或手术治疗的一组综合征。慢性盆腔痛的发病率占2-20%，占妇科门诊患者的10-30%，由于其病因复杂，需要依靠病史、体格检查及彩超甚至磁共振等辅助手段，即使这样，大部分的慢性盆腔痛仍等不到明确诊断，给治疗带来许多困难，所以他的治疗愈来愈受医学界的重视。慢性盆腔痛的治疗主要包括西医治疗，西医治疗包括：①药物治疗，如镇痛药物及激素类药物，②物理治疗比如高强度超声波治疗，效果也不理想，③腹腔镜治疗，为治疗和诊断的金标准，使60%的患者症状得以改善，但是疗效不尽人意，达不了患者的需求并且有创伤。所以中医治疗越来越受人们重视。由于直肠位于盆腔之中，中药灌肠可以使直达病所，达到治疗慢性盆腔痛的目的，所以本文研制一种安全有效的中药灌肠方剂用于临床，对于缓解慢性盆腔痛具有非常重要的意义。
发明内容
本发明克服现有治疗技术的不足，提供了一种中药灌肠方剂治疗慢性盆腔痛的方法，此方剂治疗效果明显，弥补了内服药对胃肠道的刺激，生物利用度低、局部药物浓度不足的缺陷，无毒副作用。
本发明的技术方案是：一种治疗慢性盆腔痛的中药灌肠方剂，由以下中药配制而成：鸡血藤30g、淫羊藿30g、石苇15g、牡丹皮10g、肉桂10g、赤芍10g、丹参15g、益母草30g、甘草15g、蒲公英15g、川牛膝10g、茯苓10g、桃仁10g、五灵脂（炒）10g、郁金10g、细辛10g、当归15g、三棱（炒）10g。配制方法：将上述药物倒入器皿中，加温水500ml浸润一刻钟，慢慢熬制，待药液剩余约200ml，过滤药液，待药温38-40℃使用，每天100ml（一副药物用2天）。使用方法：每晚临睡前，排空大小便后，患者取左侧卧位，用灌肠器经肛门插入14-18cm，缓缓注入，保留。
本发明中各种成药的药效及药理：中医痛症范围，其经脉以通为要，如血液不能在脉管内流畅运行，则会出现经脉淤阻的病理变化，从而引起疼痛，即不通则痛是本病的基本病机。从慢性盆腔痛的病邪来源和致病特点的角度去考虑，古代医家共分为血瘀、湿热、寒湿、气滞及气虚五个方面，依据患者的临床表现主要分为气滞血瘀、湿热淤阻、寒湿淤阻及气虚血瘀四个证型。但无论哪一个证型，均是不通则痛引起的，本方主要对气滞血瘀型效果最好，以活血化瘀、止痛、理气为原则。中药灌肠法可以将药液布达全身，利用肺朝百脉的生理功能，就可以通过经脉汇聚全身，女性生殖道和肠道之间间隔较近，而肠道粘膜有半透膜渗透性的特点，从而使药液和肠壁充分接触，直接进入盆腔，因而大大提高了药物局部的生物利用度，加大了盆腔血液中的药物浓度，因而软化、松解症结。本方中的鸡血藤具有活血、通络功效，淫羊藿具有祛风除湿之功效，牡丹皮，肉桂、丹参散寒止痛，活血化瘀之功效，石苇具有利水通淋功效，赤芍、川牛膝、桃仁有活血祛瘀功效，蒲公英具有清热解毒，消肿散结功效，茯苓有除湿、解毒功效，五灵脂有疏通血脉，散瘀止痛功效，郁金具有活血止疼，行气解郁功效，当归具有调经止痛功效，三棱（炒）具有破血行气，消积止痛功效。
本发明药源丰富、价格便宜、直达根源，无毒副作用，是保守治疗慢性盆腔痛的良药。
具体实施方式
下面结合实施例对本发明作进一步说明。
实施例：一种治疗慢性盆腔痛的中药灌肠方剂：由以下中药组成：鸡血藤30g、淫羊藿30g、石苇15g、牡丹皮10g、肉桂10g、赤芍10g、丹参15g、益母草30g、甘草15g、蒲公英15g、川牛膝10g、茯苓10g、桃仁10g、五灵脂（炒）10g、郁金10g、细辛10g、当归15g、三棱（炒）10g。配制方法：将上述药物倒入器皿中，加温水500ml浸润一刻钟，慢慢熬制，待药液剩余约200ml，过滤药液，待药温38-40℃使用，每天100ml（一副药物用2天）。每晚临睡前，排空大小便后，患者取左侧卧位，用灌肠器经肛门插入14-18cm，缓缓注入，保留。月经三天后可用药，7天为一疗程。3个疗程症状可痊愈。
临床资料
取我院2014年11月~2015年11月期间慢性盆腔痛保守治疗病人152例，病程大于6个月，其他治疗效果不佳，其中76例采用妇科千金片联合中药灌肠方剂为治疗组，另外76例选用妇科千金片+敏感抗生素静脉输液2周为对照组。结果：对照组治愈率为72.4%,盆腔积液消失率为65.8%，治疗组治愈率为93.4%，盆腔积液消失率为90.8%，治疗组的疗效明显优于对照组（P<0.01）对于慢性盆腔痛患者，单纯应用敏感抗生素和妇科千金片，存在一定的局限性。联合中药灌肠治疗，可以起到互补作用。妇科千金片具有清热除湿、益气化瘀，主要用于湿热淤阻引起的小腹疼痛，腰骶酸痛，但是口服药物局部吸收效果欠佳，同时应用中药灌肠方剂，可经过直肠直达病灶，丹参、桃仁、赤芍活血化瘀，蒲公英具有清热解毒，消肿散结功效，茯苓有除湿、解毒功效，五灵脂有疏通血脉，散瘀止痛功效，郁金具有活血止疼，行气解郁功效，当归具有调经止痛功效，从而达到止痛，促进盆腔积液吸收作用。结论:本发明的中药成本低廉，安全可靠，且无毒副作用，是保守治疗慢性盆腔痛的良药方剂。
1资料与方法
1.1病例选择：取我院2014年11月~2015年11月期间慢性盆腔痛保守治疗的病人152例，年龄23-39岁，均为有性生活史的女性。分为对照组和治疗组，均符合以下了解且自愿接受药物保守治疗的患者:(1).既往盆腔炎性疾病病史，慢性盆腔疼痛持续6个月以上；（2）符合西医的慢性盆腔炎性疾病诊断标准。（3）符合中医气滞血瘀型诊断标准（4）月经周期规律者（周期25-35天）（5）肝肾功能正常，凝血功能正常，血白细胞＞4*109/L，血小板>100*1012/L。（6）知情同意签署者.
1.2治疗方法：对照组 敏感抗生素头孢曲松钠2g 静滴 bid，连续2周，并口服妇科千金片6片，一天三次，用药后两周复查彩超及行妇科检查。治疗组 使用口服妇科千金片的同时行中药灌肠方剂：鸡血藤30g、淫羊藿30g、石苇15g、牡丹皮10g、肉桂10g、赤芍10g、丹参15g、益母草30g、甘草15g、蒲公英15g、川牛膝10g、茯苓10g、桃仁10g、五灵脂（炒）10g、郁金10g、细辛10g、当归15g、三棱（炒）10g。每天一副，睡前灌肠，保留，7天为一疗程，连用三个疗程。
1.3 观察指标 ：主要监测患者的临床症状、体征改善情况以及患者的疼痛评分
1.3.1 一般状况
1.3.2患者疼痛症状的表现
1.3.3 彩超监测每周1次，动态观察子宫直肠陷凹积液的变化。
1.4 疗效标准：①临床症状的变化：治疗前后及治疗结束后1月进行临床症状观察，内容包括疼痛的部位、性质。程度，与月经的关系、疼痛的特点，对患者生活质量的影响。②体征的变化：治疗前后及治疗结束后1个月进行腹部体检及妇科检查③中医的症候标准：小腹胀痛，乳房胀痛，食欲欠佳，烦躁易怒，舌苔白等
1.4.1治愈：治疗后腹痛及其他症状、体征消失，疼痛评分为0分，妇科检查正常，彩超提示盆腔积液消失。
1.4.2无效：治疗后腹痛症状无减轻或有加重，妇科检查较治疗前无改善或者加重，彩超提示盆腔积液无变化
1.5随访：全部研究对象临床症状消失，并每次月经干净后复查彩超，观察盆腔积液情况，并记录。
2结果
2.1 临床疗效 治疗组:71例治愈，5例无效。治疗后腹痛消失的时间为7-21天，平均15天，妇科检查正常的时间为11-20天，平均16天，彩超提示盆腔积液消失的时间14-21天，平均18天。对照组中，55例治愈，21例无效，其中10例因不孕改成手术治疗，治疗后腹痛消失的时间为13-21天，平均17天，妇科检查正常的时间14-21天，平均18天，盆腔积液消失时间为14--21天，平均18天，两组疗效比较，有显著差异，P<0.01，表示治疗组疗效优于对照组，治愈时间短于对照组。
2.2疗程及毒副作用 对照组中，40例用药两个疗程，36例用药三个疗程，治疗过程中出现胃肠道反应5例，皮疹2例，治疗组中，3例用药1个疗程，50例用药2个疗程，23例用药3个疗程，在治疗过程中1例出现胃肠道反应。
2.3安全性：治疗组患者在用药前后监测肝肾功能、血常规以及心电图均无异常。

Claims (1)

1.一种治疗慢性盆腔痛的中药灌肠方剂，其特征在于，由以下中药组成：鸡血藤30g、淫羊藿30g、石苇15g、牡丹皮10g、肉桂10g、赤芍10g、丹参15g、益母草30g、甘草15g、蒲公英15g、川牛膝10g、茯苓10g、桃仁10g、炒五灵脂10g、郁金10g、细辛10g、当归15g、炒三棱10g；配制方法：将上述药物倒入器皿中，加温水500ml浸润一刻钟，慢慢熬制，待药液剩余约200ml，过滤药液，待药温38-40℃使用，每天100ml; 使用方法：每晚临睡前，排空大小便后，患者取左侧卧位，用灌肠器经肛门插入14-18cm，缓缓注入，保留。
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