健脾益肾汤治疗男性不育症的临床研究

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英文题名：Jianpiyishen Decoction (Tonify the Spleen and Supplement the Kidney Decoction) Clinical Study in the Treatment of Male Infertility 作者：阮世盛 论文级别：博士 学科专业名称：中医外科学 学位年度：2010 导师：郑泽棠 学科代码：100507 学位授予单位：广州中医药大学 论文提交日期：2010-05-01

摘要

研究目的
     中医药是一个巨大的宝库。近年来,许多学者依据中国的医学理论研究本病,取得了可喜的成绩,治疗上立足于辨证论治,具有疗效肯定、无明显副作用的特点,但如何更好的提高精子的数量和质量,提高治愈率,是我们目前急待解决的问题。
     研究内容
     郑老师根据多年临床经验,反复实践,形成的自己独特的辨证论治体系,认为男性不育症以肾虚为主,与肝、脾等脏有关,兼夹湿热、肝郁、血瘀等,治疗主张健脾益肾为根本大法,补肾又根据阴阳互根理论辩证进行阴中求阳、阳中求阴,自拟健脾益肾汤,取得了良好临床效果,现用随机对照的科研设计方法进一步验证健脾益肾汤的临床疗效。
     研究方法
     以黄精赞育胶囊为对照组,随机对照的科研设计方法验证健脾益肾汤的临床疗效,严格执行随访。
     研究结果
     郑教授认为男性不育症的主要证候是肾脾虚,故治疗以健脾益肾生精,滋阴填精立法,同时应考虑到阴阳互根之理论,滋阴中伍以温阳之物,以达到阴生阳长之功。纵观本方,标本兼顾,阴阳双补,诸药合用,共奏健脾益肾生精益髓之效。取得良好的临床效果。结果显示：健脾益肾汤能提高精子数量、活率及精子活力,改善患者临床症状。根据制定的疗效评定标准评定：对照组41例患者黄精赞育胶囊治疗,治愈19例,占46.3%,有效14例,占34.1%,无效8例,占19.5%,总有效率80.5%；治疗组35例患者健脾益肾汤治疗,治愈14例,占40.0%,有效13例,占37.1%,无效8例,占22.9%,总有效率77.1%：对照组、治疗组治疗后的结果比较,两组间治疗后的结果没有差别(P>0.05)。总之,健脾益肾汤在治疗男性不育症方面疗效确切。
     结语
     男性不育症是一种多系统、复杂的疾病,发病原因有多种,先天因素、房事过度、久病劳倦、饮食不节、毒邪侵袭、外伤等均可导致本病。
     1、健脾益肾汤能有效地提高精子总数量、活动精子总数,精子密度,精子活率和精子活力。
     2、健脾益肾汤可显著改善患者腰酸膝软、阳萎、早泄等临床症状。
     3、健脾益肾汤使用无明显毒副作用。
     4、健脾益肾汤能显著提高男性不育症的治愈率。
Objective
     Chinese medicine is a huge treasure trove. In recent years, many scholars based on Chinese medical theories to study the disease, has made gratifying achievements in treatment based on syndrome differentiation, with positive effects, no significant side effects, focuses on how to better improve sperm quantity and quality, improve cure rate, as the major issues.
     The study
     Professor Zheng Ze Tang many years of clinical experience concluded with the formation of its own unique syndrome differentiation system, in which the principal male infertility-involved viscera are the kidney, liver and, spleen, and heat dampness as the main pathogenic external influences, which leads to liver depression, blood stasis, etc. His treatment method advocates Jianpiyishen Decoction as the five phases law of reinforcing the spleen to strengthen the kidney, supplementing both earlier and later heavens as well as the theory of mutual engenderment of yin and yang all concur to the creation of Jianpiyishen Decoction that proved very effective in numerous isolated case study reports. The current clinical randomized controlled trial is aimed at method further verify and standardize the clinical efficacy Jianpiyishen Decoction.
     Methods
     We chose randomized controlled research method to validate the Jianpiyishen Decoction clinical efficacy. Huangjingzanyu capsule has been adopted as the standard treatment for the reference group, while for the study group the Jianpiyishen Decoction has been administered.
     Results
     Professor Zheng Ze Tang said that the main male infertility pattern is dual deficiency of both kidney and spleen. Therefore, treatment targets strengtherning both spleen and kidney through tonifying essence, nourishing yin replenishing essence, as the general principles while in patients with spleen deficiency in the kidney on the basis of the disease over both poisoning and damp, it should be accompanied by heat clearing, detoxification as well as drying dampness prescription. In accordance with the theory of yin and yang in each, nourishing yin herbs with synergic action in order to warm the yang to stimulate the spermatogenesis and resolve the erectile dysfunction have been added. From this theoretical perspective, yin-yang mutual engenderment theory, heat-clearing, dampness elimination and detoxification, as well as drugs' mutual strengthening effect in combination, all played a role in the great clinical effectiveness Jianpiyishen Decoction. The laboratory results showed that Jianpiyishen Decoction can increase sperm count, sperm motility as well as sperm vitality, beyond the alleviation patient clinical symptoms. Efficacy evaluation was done according to the established standards for evaluation to improve the clinical symptoms. According to evaluation criteria established efficacy assessment: control group,41 patients Huangjingzanyu capsule treatment cured 19 cases, accounting for 46.3%, effective in 14 cases, accounting for 34.1%,8 cases, accounting for 19.5%, with a total effective rate 80.5%; treatment group of 35 patients treated Jianpiyishen Decoction soup, cured 14 cases, accounting for 40.0%, effective in 13 cases, accounting for 37.1%,8 cases, accounting for 22.9%, the total effective rate 77.1%:Comparison of the two groups after treatment, two the results between the two groups after treatment there was no difference (P> 0.05) significantly higher than that. In conclusion, in the treatment of male infertility Jianpiyishen Decoction has a certain curative effect.
     Conclusion
     Male infertility is a multi-system, complex diseases, the incidence of a variety of factors including congenital factors, sexual intemperance, long-standing untreated illnesses, as well as dietary, atmospheric or traumatic factors which alone or in combination may lead to the disease.
     1, Jianpiyishen Decoction can effectively improve the total number of sperm, the total number of motile sperm, sperm density, sperm motility and sperm vitality.
     2, Jianpiyishen Decoction can significantly improve patient lumbago and knees weakness, impotence, premature ejaculation and other clinical symptoms.
     3, The use of Jianpiyishen Decoction hasn't been associated with any distressing side effects.
     4, Jianpiyishen Decoction can significantly increase male infertility the cure rate.

引文

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