台湾地区妇女绝经综合征的中医症候研究
摘要
目的：
探讨绝经综合征的主要症状、中医证候及发病的影响因素,以便采取相应的预防措施。
方法：
研究对象为自然绝经的妇女。病例来源：依据课题研究目的,本研究采用临床流行病学横断面调查的方法,收集从2011年1月至2011年11月,在台湾吴国贤中医诊所及相关医院和门诊的就诊时确诊为绝经综合征的自然绝经妇女的相关资料。调查对象为500例,年龄范围在35-55岁之间,有分娩史的妇女作为调查对象。采用听写测验询问记录法,询问表系用作者自制的简略更年期症状发生情况,分娩时的情况,分娩后来潮的时间,中医证候等。
绝经综合征的西医诊断标准参照1997年卫生部颁发的《中药新药临床研究指导原则》中女性绝经综合征的西医诊断标准制定：年龄在35-55岁的女性或人工绝经者；烘热汗出的典型症状,可伴有烦躁易怒、心悸失眠,胸闷头痛.情志异常、记忆力减退、腰腿酸软等。内分泌测定：血清雌二醇降低,促卵泡激素、促黄体生成激素上升。
绝经综合征的严重程度按Kupperman评分法来测评。以改良的Kupperman症状评分总积分≥6分绝经综合征诊断确立。积分≤15分为轻度；积分16-30分为中度；积分≥31分为重度。绝经综合征的严重程度,按Kupperman评分法来测评,共有12项,具体包括潮热出汗、感觉异常、失眠、忧郁、眩晕、乏力等,每项症状都有基本分和分为四级的程度分(0、1、2、3)。评分方法是用基本分乘以程度评分,如某项症状的基本分为4分,程度分为2分,那么该项症状得分为8分。各项症状评分相加之和为总分。医生常常根据总分判断绝经综合征的严重程度并以此选择药物和治疗方法。具体见附表Kupperman评分标准。
中医辨证标准参照《中华人民共和国中医药行业标准》和《中药新药临床研究指导原则》、张玉珍主编的《中医妇科学》制订如下证候辨证标准：
肾阴虚：绝经前后,月经紊乱,月经提前量少或量多,或崩或漏,经色鲜红,头目晕眩,耳鸣,头部面颊阵发性烘热,汗出,五心烦热,腰膝酸疼,足跟疼痛,口干便结,或皮肤干燥、疹痒,尿少色黄,舌红少苔,脉细数。
肾阳虚：绝经前后,经行量多,经色淡黯,或崩中漏下,精神萎靡,面色晦暗,腰背冷痛,小便清长,夜尿频数,或面浮肢肿,舌淡,或胖嫩边有齿印,苔薄白,脉沉细弱。
肾阴阳俱虚：绝经前后,月经紊乱,量少或多,乍寒乍热,烘热汗出,头晕耳鸣,健忘,腰背冷痛,舌淡,苔薄,脉沉弱。
肝肾阴虚：绝经前后,月经紊乱,量多色红或淋漓不绝,头晕目眩,视物模糊,烘热汗出,五心烦热,腰膝酸软,失眠多梦,舌红少苔,脉细数。
肾虚肝郁：绝经前后,月经紊乱,量多色红,头晕目眩,胸胁、乳房胀痛,烘热汗出,烦躁易怒,或抑郁善太息,多疑多虑,口苦口干,纳差,舌红苔薄,脉弦或细数。
心肾不交：绝经前后,月经紊乱,腰膝酸软,头晕耳鸣,烘热汗出,心悸怔忡,心烦不宁,失眠多梦,舌尖红苔薄,脉细数。
脾肾阳虚：绝经前后,月经衍后或闭而不行,行则量多,色淡质稀,精神萎靡,(?)寒肢冷,腰膝下腹冷痛,久泻久痢,或下利清谷,小便清长,面浮肢肿,带下清稀,舌淡苔薄白,脉沉细无力。
纳入病例标准：(1)年龄35～55周岁。(2)符合上述绝经综合征诊断标准。(3)改良Kupperman评分总分>10分。(4)近3月未经过雌、孕激素替代治疗。
排除标准：不符合中医辨证及西医诊断标准。①原发性高血压、原发性低血压及慢性贫血患者；②双侧卵巢切除、卵巢肿瘤及卵巢功能早衰患者;③年龄小于35岁或大于55岁者；④甲亢、结核、及合并心血管、肺、肝、肾等严重原发性疾病、精神病患者。
研究设计：本研究采用临床流行病学调查问卷进行横断面调查。收集从确诊为绝经综合征的自然绝经妇女的相关资料；采用听写测验询问记录法,填写《女性更年期健康调查表》(调查表为作者自制,内容包括更年期症状发生情况,分娩时的情况,分娩后来潮的时间),辩证分型,确定中医证候。
严格执行所设计的临床流行病学调查问卷,减少选择性偏倚和测量性偏倚。具体而言：调查人员相对固定,指定专人负责调查问卷填写,调查人员为中医妇科医师。统一诊断标准、纳入标准和排除标准：严格执行统一的临床诊断和辨证标准,制定研究人员手册,记录采用的诊断标准、纳入标准和排除标准。统一调查表格：各调查点一律采用本项目的《调查问卷》,统一调查时间：2011年1月至2011年11月。对调查人员进行集中培训,包括《调查表》填写要求、有关中医名词术语及其他需定义的名词统一解释等。
调查内容包括患者一般情况(如性别、年龄、月经史、孕产史、既往史等),一般症状(包括潮热、精神、睡眠、饮食、二便、局部症状、全身症状、面色、形体、舌脉等),中西医病名诊断和中医证型诊断,及绝经综合征主要症状,详见附录——《女性更年期健康调查表》。
现场调查：采用临床流行病学横断面调查方法,入院后或首次门诊确诊为月经不调的患者即进行证候问卷调查。调查人员根据调查表内容详细询问受试者,当同一患者病情有变化或症状有变化,伴或不伴辨证分型改变时,可以重复纳入。两位以上中医师同时辨证诊断,将数据及时、完整、正确、清晰地载人入调查表,以尽可能减少辨证诊断的偏倚。调查表填写正确完整后,如修改需保持原有记录清晰可见,改正处需经研究者签名并注明日期。
统计学处理与资料总结：将全部数据录入EpiData3.01软件,建立本项目相关数据库。据各症状项目的有无,分别赋值0、1,逐一整理输入相应的数值,并进行数据库与调查表的逐一校对,确保提取和录入过程中无遗漏和错误。应用SPSS17.0统计软件进行频数、相关性等统计分析。统计图形采用Graphd Prism4.03绘制。
结果：
本研究共收集到合格病例报告表500份,均为门诊病人。本次调查的500名自然绝经妇女中,有400人在绝经前后出现了更年期症状,发生率在80.0%,绝经平均年龄为50.0岁。一般资料的具体情况详见以下各表。年龄分布在(35-55)岁之间,平均年龄(50.0±4.7)岁。45-49岁组居多,占41.8%,其次分别为40-44岁组与50-55岁组；40岁以下,占9.5%。
职业分布百分构成比序列如下：买卖工作人员、服务工作人员、农、林、渔、牧工作人员、专门性、技术性及有关人员、生产及有关工人、运输设备操作工、行政及主管人员、家务、监督及佐理人员。
职业构成方面比较：买卖工作人员(29.8%)、服务工作人员(24.4%)、农、林、渔、牧工作人员(12.4%)居多。
文化程度构成方面：女性文化程度本科以上的约占43.70%,素质较高。
婚姻构成状况：有配偶占总人数92.2%,无配偶31人,占总人数7.8%。有配偶者居多。
月经初潮年龄以14-17岁居多,约占61.4%；小于13岁93人,约占23.3%；大于18岁61人,约占15.3%。
绝经综合征病情程度构成情况：轻度症状的有125人,约占31.3%；中度症状的有199人,约占49.7%；重度症状的有76人,约占19.0%。中度症状居多。
中医证候问卷调查情况：妇女到一定年龄,卵巢功能逐渐减退,这一阶段称更年期,这期间出现的症状和体征称更年期综合期。绝经综合征的症状很多,大体可分为心血管系统症状,精神神经系统症状及新陈代谢性障碍等3类。症状的程度,持续时间长短、症状的多少,与卵巢功能减退的快慢以及体质、绝经年龄、神经类型等因素有关。本次调查的500名绝经妇女中,有400人在绝经前后出现了绝经综合征症状。各种症状的发生情况具体见以下各表所示。
(一)心血管系统症状表现
心血管系统症状表现有潮热、心悸、头晕、高血压等,而潮热也是更年期的典型症状。潮热发生率为71.7%,心悸为44.9%,高血压为16.8%,头晕者占70.3%。
(二)精神神经系统症状
精神神经系统症状更年期精神神经系统症状的出现,是由于雌激素的减少,而引起一系列物质代谢的改变而产生。结果显示,情绪不稳的占55.4%,失眠者占42.4%。
(三)新陈代谢性障碍
新陈代谢性障碍更年期女妇女是由于骨质疏松发生关节痛,本次调查有25.2%。肥胖是体内脂肪、水和盐代谢失常而致,占16.8%。由于更年期肥胖者血脂增加,动脉粥样硬化,而易患高血压、冠心病及其他疾病。生殖道萎缩,常表现是阴道炎,排尿不畅及感染,子宫和阴道脱垂、大小便失禁等。本次阴道炎的发生率为24.3%。
绝经综合征主要症状体征分布情况：通过对400例纳入对象的症状和体征出现频率的调查分析,结果发现绝经综合征患者临床症状出现百分比由高到低,分别是烦躁易怒(78.7%)、骨关节痛(76.6%)、疲倦乏力(74.5%)、失眠(73.1%)、潮热出汗(71.7%)、头晕(70.3%)、头痛(68.2%)、抑郁(67.5%)、心悸(64.0%)、皮肤瘙痒(63.6%)、感觉异常(61.2%)、泌尿道症状(59.4%)、性欲下降(57.1%)。主要症状出现最多的十个症状分别为烦躁易怒、骨关节痛、疲倦乏力、失眠、潮热出汗、头晕、头痛、抑郁、心悸、皮肤瘙痒。
在绝经综合征患者诸多表现症状中,精神神经系统中的烦躁易怒最为常见,有近4/5的患者有易激动、焦虑、抑郁等心理状态的变化。究其原因,笔者认为一方面与被调查对象由于对绝经综合征的不甚了解,增加了对本病的过分担忧,沉重的心理负担进一步影响绝经综合征症状的加重,导致患者多表现为烦躁易怒等；另一方面结合被调查对象的学历、职业等,不难发现角色转变、以及妇女与社会适应的矛盾抵触性,也是更年期妇女病发绝经综合征至关重要的因素。中医学认为,肝主疏泄,调畅情志,情志失调致肝失疏泄,气机郁滞,日久郁而化火,扰及心神,故在临床上多见烦躁易怒等情志失常症状。骨关节痛症状出现的百分比为76.6%仅次于烦躁易怒的78.7%。骨关节痛的出现与更年期妇女卵巢功能降低、雌激素分泌较少,进而引起骨丢失、骨质疏松,出现骨关节痛症状。中医学认为,肾藏元阴元阳,肾主藏精、主骨生髓。人至中年以后,肾气渐衰,藏精主骨生髓功能也随之减弱,而致骨失精髓之养,不荣则痛,故多呈现骨关节痛之症。疲倦乏力出现的百分率为74.5%,名列第三。疲倦乏力多见于气虚,由于脏腑虚损无气以生、重病久病损耗元气所致。脾主运化,主四肢肌肉；胃为水谷之海,六腑之大源。脾胃为后天之本,气血生化之源。就绝经综合征而言,笔者认为疲倦乏力多因患者脾胃虚弱,气血生化不足所致。综上所述,单从绝经综合征临床中最为常见的三症状(烦躁易怒、骨关节痛、疲倦乏力)发生的病机来看,体现了绝经综合征病变的在脏为“肾”、“肝”、“脾”。
在对400例绝经综合征患者的调查研究中,发现就辨证分型而言,肾虚肝郁居多,占29.9%,其次为肾阴虚型占20.2%,肝肾阴虚型占17.3%,心肾不交型占12.3%,肾阳虚型占10.5%,肾阴阳两虚型占6.2%,脾肾阳虚占3.6%。
在绝经综合征的7种分型中,以肾虚肝郁(占29.9%)为最多、肾阴虚(占20.2%)次之、肝肾阴虚型(17.3%)为第三,合占67.4%,较为全面的体现了“肾虚为本、肝郁(虚)为标”的特性。肾阳虚、肾阴阳两虚和脾肾阳虚三种证型之和约占总数的20.3%,究其原因,笔者认为这与调查研究的对象的年龄段选取不无关系。一般情况下,年龄35-55周岁之间的患者,虽然会出现诸如“肾气不足,天癸将竭,阴精不足,月经来潮乏源或闭绝”等趋势,但就个体而言,因现阶段人体体质较以前较强,尚不至于频现肾阳虚、肾阴阳两虚和脾肾阳虚等证型。
结论：
1.绝经综合征各种症状的发生受多种因素的影响。精神因素对于绝经综合征的发生具有较大的影响。此外,亦与不同职业、学历层次、分娩时异常现象、分娩后
月经复潮时间等因素有关。提示在绝经综合征的防治方面应减少精神因素的影响,保持心胸开朗,情绪愉快,这是顺利度过更年期的根本保证。
2.烦躁易怒、骨关节痛、疲倦乏力是绝经综合征临床中最为常见的三个症状,应为主症,从发生的病机来看,体现了绝经综合征病变的在脏为“肾”、为“肝”、为“脾”。
3.在对400例绝经综合征患者辨证分型的研究中发现：肾虚肝郁居多,占29.9%,其次为肾阴虚型占20.2%,肝肾阴虚型占17.3%,心肾不交型占12.3%,肾阳虚型占10.5%,肾阴阳两虚型占6.2%,脾肾阳虚占3.6%。其中以肾虚肝郁、肾阴虚和肝肾阴虚型三者合占67.4%,较为全面的体现了“肾虚为本、肝郁(虚)为标”的特性。肾阳虚、肾阴阳两虚和脾肾阳虚三种证型合占总数的20.3%。笔者认为这与调查研究的对象的年龄段选取可能存在一定关系,亦是今后研究的重点领域。
Objective
To discuss the symptoms of Menopause Syndrome and influence factors of the disease, in order to take corresponding prevention measures.
Methods
The research objects are natural postmenopausal women. Cases source:on the basis of the research objective, in the study, the clinical epidemiology cross-sectional survey method is adopted. Cases are collected from January2011to November2011in Taiwan Wu Guoxian's TCM clinic and related hospital and clinics who are natural post-menopausal women diagnosed as Menopause Syndrome. Survey the500women with an age range of35-55years and a history of childbirth as research objects. Use dictation and consultation questionnaire. The questionnaire is designed by the author, covering menopausal symptoms, delivery, and menstruation onset time after the birth, TCM syndromes, etc.
The Western Medicine diagnosis standard of Menopause Syndrome refers to the Chinese Herbal Medicine New Drug Clinical Research Guiding Principles issued by the Ministry of Health in1997:women at the age of35to55years old or artificial postmenopausal women; sweating due to heat, associated with irritability, heart palpitations, insomnia, chest distress and headache, sentimental disorders, memory loss, waist sour and ache, etc. Endocrine determination:reduced serum estradiol, rise of follicle-stimulating hormone, and luteum hormone.
The severity of the Menopause Syndrome is.evaluated by Kupperman evaluation method. With improved Kupperman symptom scores, six points or above indicates the Menopause Syndrome diagnosis is established. Equal to or less than15points indicates mild degree;16-30:medium; Equal to or above31:severe.
The severity of the Menopause Syndrome, according to Kupperman evaluation meti(?) to evaluate, there were12, concrete including hot flashes sweating, feeling is unusual, insomnia, depression, dizziness, lack of power, and so on, each symptoms are basic points and divided into four level of degree points (0,1,2,3). Rating method is to use the basic cent times degree score, such as a symptom of the basic divided into4points, the measures are two points, so the symptoms score for eight points. The symptom scores for the sum total score. The doctor often total Menopause Syndrome according to judge the severity of this choice and drugs and treatment method. Specific see form Kupperman rating criteria.
(?)M syndrome differentiation standard according to the traditional Chinese medicine industry standard of the People's Republic of China "and" the Chinese herbal medicine new medicine clinical research guiding principle", ZhangYuZhen editor of "Chinese woman science" make the following syndrome differentiation standard:
Kidney Yin deficiency:before and after menopause, menstrual disorders, menstrual DiQianLiang less or capacity is much, or collapse or leak, the bright red color, leader dizzy, tinnitus, head of paroxysmal face hot flashes, sweat out, five upset hot, waist knees acid aches, sufficient with pain, or dry skin rash, itching, dry mouth and they, less urine color yellow, red tongue less moss, pulse count.
Kidney Yang:before and after menopause, the line capacity is much, the dark lubricious weak, or collapse under the leak, sluggishness, complexion is dull, low back pain cold, urinate qing long, a night of urinary frequency number, or floating face limb is swollen, tongue weak, or fat tender side have teeth marks, moss thin white, pulse heavy thin.
Kidney Yin and Yang all virtual:before and after menopause, menstrual disorders, quantity is little or much, at first glance at cold heat, baking hot sweat out, dizziness tinnitus, forgetfulness, low back pain cold, tongue light, moss thin, weak pulse sink.
Kidney Yin deficiency:before and after menopause, menstrual disorders, multiple color red or dripping wet is not unique, dizzy, inspect content fuzzy, baking hot sweat out, five upset hot, lumbar debility, insomnia, red tongue less moss, pulse count.
Kidney empty stomach:before and after menopause, menstrual disorders, capacity is much color red, dizzy, breast, breast pain threat, baking hot sweat out, be agitated irritability, depression or good TaiXi, seem suspicious, dry mouth tastes bitter, NaCha, red tongue moss thin, pulse string or count.
Heart renal don't pay:before and after menopause, menstrual disorders, lumbar debility, dizziness tinnitus, baking hot sweat out, palpitation, upset the restless, insomnia, the tip of the tongue red moss thin, pulse count.
Spleen and kidney Yang:before and after menopause, menstruation yan or closed after and do not, do the capacity is much, color light qualitative thin, sluggishness, fear of the cold, cold extremities, waist knees abdomen cold pain, long xie long dysentery, or the valley of the qing dynasty, the qing long urine, floating face is swollen limbs, taken down to the rare, tongue light moss thin white, pulse heavy thin and weak.
In case the standard:(1) the age40to60one full year of life.(2) with the above Menopause Syndrome diagnostic criteria.(3) improved Kupperman score10points total score>.(4) nearly3months pregnant female, without the hormone therapy.
Exclusion criteria do not conform to the diagnosis of traditional Chinese medicine and western medicine diagnosis standard.(1) primary hypertension, primary low blood pressure and chronic anemia patients;(2) the two side spayed, ovarian tumor and ovarian function premature aging patients;(3) less than45years old age or greater than55years old;(4) the hyperthyroidism, n/med tuberculosis, and combined cardiovascular, lung, liver, kidney and other serious primary disease, mental patients.
Study design:the clinical epidemiology investigation questionnaire were cross-sectional survey. Using dictations asked several record methods, ask the table with the author of the homemade brief menopausal symptoms occur, delivery, and after the birth of the time head, syndromes, etc.
Strictly carry out the design of clinical epidemiology investigation questionnaire, reduce selective bias and measuring sexual bias. Fixed investigators:investigation unit designate special persons to take charge of investigation, investigators for Chinese medicine gynecologists. Unified examination standard:strictly carry out the clinical diagnosis of unity and its standards, clinical symptoms standards. Set the personnel manual, are recorded by diagnostic criteria, into the standard and exclusion standard, the traditional Chinese medicine and other terms of the definition of the term unity to explain; Survey to participate in before investigators undertake unity training. Unified survey form:the deals in the project shall be by the questionnaire ", the formal investigation before the small scope project feasibility the investigation.(4) unified survey of time.
Investigation contents including patients generally (such as gender, date of birth, menstrual history, history, etc in pregnancy), menstrual history, history, various kinds of Chinese medical symptoms down (including spirit, sleep, diet, ErBian, local symptoms, systemic symptom, etc), tongue pulse and traditional Chinese and western medicine diagnosis, named TCM syndrome type diagnosis, etc.
Scene investigation:the clinical epidemiology cross-sectional survey methods, for the first time after admission or outpatient diagnosis of menstruation to be not moved patients the syndrome questionnaire survey, the investigators according to the questionnaire content ask for details of the subjects, when the same symptoms in patients have change or symptoms have change, with and without type change with syndrome differentiation points, can repeat into. More than two doctors and dialectical diagnosis, data timely, complete and correct, and clearly manned into the questionnaires, in order to reduce the dialectical diagnosis bias. Fill in the questionnaire is correct and complete, modify the need to maintain the original record clearly visible and correct place must be approved by the researchers sign and date indicated.
Statistics processing and data conclusion:will all data entry EpiData3.01software, establish the relevant project database. According to the symptoms of the project have, value0,1respectively, finishing each input corresponding numerical and database and questionnaires one by one to check, make sure the extraction and the entry process without omissions and errors. Application SPSS17.0statistical software for frequency, and statistical correlation analysis. Statistical graphics Graphd Prism4.03by drawing.
Results
This research altogether collected to report cases of500qualified, all for the clinic patients. The survey of500natural post-menopausal women, there are400people in there before and after menopause symptoms of menopause, incidence in80.0%, menopause at an average age of50.0years. The general information of the specific conditions of the see the following each table. Age distribution in (35-55) between age, with an average age of50.0+/-4.7years old.45to49years old group is in the majority,41.8%, second respectively for40～44years old group and50to55years old group;40years old the following, accounted for9.5%.
Vocational distribution percentage than a sequence as follows:business staff, service personnel, agriculture, forestry, fishery, animal husbandry staff, professional or technical and relevant personnel and production and related workers, transportation equipment operators, administrative and directors, housework, supervision and ZuoLi personnel.
Professional composition of comparison:business personnel (29.8%), service personnel (24.4%), agriculture, forestry, fishery, animal husbandry staff (12.4%) are in the majority.
The composition of cultural degree:women cultural degree bachelor of about43.7%, quality is higher.
Marriage composing in:married the total92.2%, no spouse31, accounting for7.8%of the total number. In the majority of a spouse.
Age at menarche17years old to14-the majority, about61.4%; Less than1393people, about23.3%; More than61people in18years old, about15.3%.
Menopause Syndrome illness degree constitution:the mild symptoms of125people, about31.3%; Moderate symptoms of199people, about49.7%; Severe symptoms of76people, about19.0%. Moderate symptoms are in the majority.
Syndromes questionnaire investigation:women to a certain age, ovarian function gradually decreases, this stage says menopause, it appears during the signs and symptoms of menopause comprehensive said. The symptoms of Menopause Syndrome many, can be classified as the cardiovascular system symptoms, spirit nervous system symptoms and metabolism and barriers of3kinds. The extent of the symptoms, duration of symptoms length, how much, and ovarian function to drop the speed of the constitution, and menopause, neural type age related to such factors. The survey of500natural post-menopausal women, there are400people in the before and after menopause symptoms of Menopause Syndrome appear. All symptoms of specific conditions in the following each table shows.
(1) the cardiovascular system symptoms
The cardiovascular system symptoms have hot flashes, heart palpitations, dizziness, high blood pressure, etc., and also is the typical symptom menopausal hot flashes. Hot flashes a rate of71.7%, palpitations is44.9%, and16.8%for high blood pressure, dizziness70.3%.
(2) spirit nervous system symptoms
Spirit nervous system symptoms of menopause spirit nervous system symptoms appear, is because the estrogen loss, and cause a series of material from the chabge of metabolism. The results show, moody's55.4%,42.4%of the insomnia.
(3) metabolism disorders
The metabolism of female menopause is because women obstacles osteoporosis happen joint pain, this investigation has25.2%. Obesity is body fat, water and salt and the functional disorder, accounting for16.8%. Due to increased blood lipid menopause are obese, atherosclerosis, and is likely to develop (?)h blood pressure, coronary heart disease and other ailments. The genital tract atrophy, and often present is vaginitis, micturition impeded and infection, uterine and vaginal prolapse, incontinence, etc. This vaginitis of incidence of24.3%.
Menopause Syndrome, the clinical symptoms and signs the main distribution
Menopause Syndrome main symptoms and signs distribution and the percentage constitute sequence arrangement as follows:be agitated irritable, joint pain, fatigue, insomnia, tired damp sweating, dizziness, headache, depression, heart palpitations, itchy skin, feeling is unusual, urinary tract symptoms, sexual desire decline. The main symptoms appear most ten symptoms were fidgety irritable, joint pain, fatigue, insomnia, tired damp sweating, dizziness, headache, depression, heart palpitations, itchy skin.
Among the symptoms of Menopause Syndrome patients, irritability is the most frequently occurred psychiatric and nerve disorder. About4/5of the patients have such psychological changes like irritability, anxiety and depression, etc. The author thinks on one hand it's because the objects'little knowledge about Menopause Syndrome brings about too much worry about this disease and heavy psychological burden will further worsen the disease which may cause patients to become agitated and irritable. On the other hand, considering the education and occupation of the objects, the author thinks the changes of roles and the conflicts between women and the society are very critical elements for the occurrence of Menopause Syndrome. Liver is in control of dispersion and adjusting sentiment. The disharmony of sentiment may lead to the disfunciton of dispersion of the liver and the stagnation of qi. The stagnation may develop into fire and disturb heart-spirit and that's why many sentimental disorders like fidgety and irritability are observed clinically. The percentage of the occurrence of arthralgia is76.6%, which is just next to fidgety and irritability (78.7%). Its occurrence is due to the decrease of menopause women's ovary function and less ESG secretion which cause the bone loss and bone rarefaction and finally arthralgia. TCM theories believe that kidney stores the renal yin and renal yang as well as essence. It affects the production of marrow in bone. After reaching middle age, people's kidney qi gradually declines and its function of storing essence and producing marrow also wanes. As bone loses the nutrition of marrow and essence, many symptoms of arthralgia occur. The percentage of the occurrence of fatigue is74.5%, ranking the third which is caused many by the deficiency of qi. That's because zang and fu organs (entrails) are too weak to produce qi and serious and long-time diseases also damage pneuma. Spleen is in charge of digestion and muscles of limbs. Stomach is regarded as the water and cereal sea and the essential origin of6fu organs. Spleen and stomach are the acquired foundation and the origin of qi and blood. Considering Menopause Syndrome, the author thinks fatigue is caused by the weak spleen and stomach and in sufficiency of generating and transforming of qi and blood. To summarize the most frequently met three clinical symptoms (fidgety and irritability, arthralgia, fatigue), their pathogenesis exists in liver, spleen and kidney in terms of zang organs.
In the investigation of400Menopause Syndrome patients, it is observed that in terms of differentiation types, kidney-deficiency and liver-stagnation ranks29.9%and what follows are kidney yin deficiency (20.2%), liver and kidney yin deficiency (17.3%), failure of heart and kidney integration (12.3%), kidney yang deficiency (10.5%), kidney yin and yang deficiency (6.2%) and spleen and kidney yang deficiency (3.6%). Among the7types of Menopause Syndrome, the first three are kidney-deficiency and liver-stagnation ranks (29.9%), kidney yin deficiency (20.2%), liver and kidney yin deficiency (17.3%), totally67.4%. This explains fully that kidney deficiency is the root and liver stagnation (deficiency) is the sign. Kidney yang deficiency, kidney yin and yang deficiency and spleen and kidney yang deficiency account for20.3%of the total. The author believes this is related to the age period of objects. Generally, patients aged between35to55years old will not have such syndrome types like kidney yang deficiency, kidney yin and yang deficiency and spleen and kidney yang deficiency, though there's the tendency of kidney qi deficiency, exhaustion of menstruation, deficiency of yin fluid, insufficiency or failure of menstruation onset, etc.
Conclusion:
1. The occurrence of Menopause Syndrome is affected by many factors. Mental factors have huge impact on it. Other factors are different occupations, education levels, abnormal phenomenon at childbirth, the time of menstruation onset after birth, etc. These indicate that in the prevention and treatment of Menopause Syndrome, we should reduce the impact of mental factors. Being broad-minded and happy in spirit is the foundation for smoothly passing the climacterium.
2. Fidgety and irritability, arthralgia and fatigue are the three most frequently occurred symptoms in clinic whose pathogenesis exists in liver, spleen and kidney in terms of zang organs.
3. In the investigation of the syndrome differentiation types of400Menopause Syndrome patients, kidney-deficiency and liver-stagnation ranks first (29.9%) and what follows are kidney yin deficiency (20.2%), liver and kidney yin deficiency (17.3%), failure of heart and kidney integration (12.3%), kidney yang deficiency (10.5%), kidney yin and yang deficiency (6.2%) and spleen and kidney yang deficiency (3.6%). Three types of kidney-deficiency and liver-stagnation ranks, kidney yin deficiency and liver and kidney yin deficiency account for67.4%in total. This explains fully that kidney deficiency is the root and liver stagnation (deficiency) is the sign. Kidney yang deficiency, kidney yin and yang deficiency and spleen and kidney yang deficiency account for20.3%of the total. The author believes this is related to the age period of objects. And this is the focus of future research.
探讨绝经综合征的主要症状、中医证候及发病的影响因素,以便采取相应的预防措施。
方法：
研究对象为自然绝经的妇女。病例来源：依据课题研究目的,本研究采用临床流行病学横断面调查的方法,收集从2011年1月至2011年11月,在台湾吴国贤中医诊所及相关医院和门诊的就诊时确诊为绝经综合征的自然绝经妇女的相关资料。调查对象为500例,年龄范围在35-55岁之间,有分娩史的妇女作为调查对象。采用听写测验询问记录法,询问表系用作者自制的简略更年期症状发生情况,分娩时的情况,分娩后来潮的时间,中医证候等。
绝经综合征的西医诊断标准参照1997年卫生部颁发的《中药新药临床研究指导原则》中女性绝经综合征的西医诊断标准制定：年龄在35-55岁的女性或人工绝经者；烘热汗出的典型症状,可伴有烦躁易怒、心悸失眠,胸闷头痛.情志异常、记忆力减退、腰腿酸软等。内分泌测定：血清雌二醇降低,促卵泡激素、促黄体生成激素上升。
绝经综合征的严重程度按Kupperman评分法来测评。以改良的Kupperman症状评分总积分≥6分绝经综合征诊断确立。积分≤15分为轻度；积分16-30分为中度；积分≥31分为重度。绝经综合征的严重程度,按Kupperman评分法来测评,共有12项,具体包括潮热出汗、感觉异常、失眠、忧郁、眩晕、乏力等,每项症状都有基本分和分为四级的程度分(0、1、2、3)。评分方法是用基本分乘以程度评分,如某项症状的基本分为4分,程度分为2分,那么该项症状得分为8分。各项症状评分相加之和为总分。医生常常根据总分判断绝经综合征的严重程度并以此选择药物和治疗方法。具体见附表Kupperman评分标准。
中医辨证标准参照《中华人民共和国中医药行业标准》和《中药新药临床研究指导原则》、张玉珍主编的《中医妇科学》制订如下证候辨证标准：
肾阴虚：绝经前后,月经紊乱,月经提前量少或量多,或崩或漏,经色鲜红,头目晕眩,耳鸣,头部面颊阵发性烘热,汗出,五心烦热,腰膝酸疼,足跟疼痛,口干便结,或皮肤干燥、疹痒,尿少色黄,舌红少苔,脉细数。
肾阳虚：绝经前后,经行量多,经色淡黯,或崩中漏下,精神萎靡,面色晦暗,腰背冷痛,小便清长,夜尿频数,或面浮肢肿,舌淡,或胖嫩边有齿印,苔薄白,脉沉细弱。
肾阴阳俱虚：绝经前后,月经紊乱,量少或多,乍寒乍热,烘热汗出,头晕耳鸣,健忘,腰背冷痛,舌淡,苔薄,脉沉弱。
肝肾阴虚：绝经前后,月经紊乱,量多色红或淋漓不绝,头晕目眩,视物模糊,烘热汗出,五心烦热,腰膝酸软,失眠多梦,舌红少苔,脉细数。
肾虚肝郁：绝经前后,月经紊乱,量多色红,头晕目眩,胸胁、乳房胀痛,烘热汗出,烦躁易怒,或抑郁善太息,多疑多虑,口苦口干,纳差,舌红苔薄,脉弦或细数。
心肾不交：绝经前后,月经紊乱,腰膝酸软,头晕耳鸣,烘热汗出,心悸怔忡,心烦不宁,失眠多梦,舌尖红苔薄,脉细数。
脾肾阳虚：绝经前后,月经衍后或闭而不行,行则量多,色淡质稀,精神萎靡,(?)寒肢冷,腰膝下腹冷痛,久泻久痢,或下利清谷,小便清长,面浮肢肿,带下清稀,舌淡苔薄白,脉沉细无力。
纳入病例标准：(1)年龄35～55周岁。(2)符合上述绝经综合征诊断标准。(3)改良Kupperman评分总分>10分。(4)近3月未经过雌、孕激素替代治疗。
排除标准：不符合中医辨证及西医诊断标准。①原发性高血压、原发性低血压及慢性贫血患者；②双侧卵巢切除、卵巢肿瘤及卵巢功能早衰患者;③年龄小于35岁或大于55岁者；④甲亢、结核、及合并心血管、肺、肝、肾等严重原发性疾病、精神病患者。
研究设计：本研究采用临床流行病学调查问卷进行横断面调查。收集从确诊为绝经综合征的自然绝经妇女的相关资料；采用听写测验询问记录法,填写《女性更年期健康调查表》(调查表为作者自制,内容包括更年期症状发生情况,分娩时的情况,分娩后来潮的时间),辩证分型,确定中医证候。
严格执行所设计的临床流行病学调查问卷,减少选择性偏倚和测量性偏倚。具体而言：调查人员相对固定,指定专人负责调查问卷填写,调查人员为中医妇科医师。统一诊断标准、纳入标准和排除标准：严格执行统一的临床诊断和辨证标准,制定研究人员手册,记录采用的诊断标准、纳入标准和排除标准。统一调查表格：各调查点一律采用本项目的《调查问卷》,统一调查时间：2011年1月至2011年11月。对调查人员进行集中培训,包括《调查表》填写要求、有关中医名词术语及其他需定义的名词统一解释等。
调查内容包括患者一般情况(如性别、年龄、月经史、孕产史、既往史等),一般症状(包括潮热、精神、睡眠、饮食、二便、局部症状、全身症状、面色、形体、舌脉等),中西医病名诊断和中医证型诊断,及绝经综合征主要症状,详见附录——《女性更年期健康调查表》。
现场调查：采用临床流行病学横断面调查方法,入院后或首次门诊确诊为月经不调的患者即进行证候问卷调查。调查人员根据调查表内容详细询问受试者,当同一患者病情有变化或症状有变化,伴或不伴辨证分型改变时,可以重复纳入。两位以上中医师同时辨证诊断,将数据及时、完整、正确、清晰地载人入调查表,以尽可能减少辨证诊断的偏倚。调查表填写正确完整后,如修改需保持原有记录清晰可见,改正处需经研究者签名并注明日期。
统计学处理与资料总结：将全部数据录入EpiData3.01软件,建立本项目相关数据库。据各症状项目的有无,分别赋值0、1,逐一整理输入相应的数值,并进行数据库与调查表的逐一校对,确保提取和录入过程中无遗漏和错误。应用SPSS17.0统计软件进行频数、相关性等统计分析。统计图形采用Graphd Prism4.03绘制。
结果：
本研究共收集到合格病例报告表500份,均为门诊病人。本次调查的500名自然绝经妇女中,有400人在绝经前后出现了更年期症状,发生率在80.0%,绝经平均年龄为50.0岁。一般资料的具体情况详见以下各表。年龄分布在(35-55)岁之间,平均年龄(50.0±4.7)岁。45-49岁组居多,占41.8%,其次分别为40-44岁组与50-55岁组；40岁以下,占9.5%。
职业分布百分构成比序列如下：买卖工作人员、服务工作人员、农、林、渔、牧工作人员、专门性、技术性及有关人员、生产及有关工人、运输设备操作工、行政及主管人员、家务、监督及佐理人员。
职业构成方面比较：买卖工作人员(29.8%)、服务工作人员(24.4%)、农、林、渔、牧工作人员(12.4%)居多。
文化程度构成方面：女性文化程度本科以上的约占43.70%,素质较高。
婚姻构成状况：有配偶占总人数92.2%,无配偶31人,占总人数7.8%。有配偶者居多。
月经初潮年龄以14-17岁居多,约占61.4%；小于13岁93人,约占23.3%；大于18岁61人,约占15.3%。
绝经综合征病情程度构成情况：轻度症状的有125人,约占31.3%；中度症状的有199人,约占49.7%；重度症状的有76人,约占19.0%。中度症状居多。
中医证候问卷调查情况：妇女到一定年龄,卵巢功能逐渐减退,这一阶段称更年期,这期间出现的症状和体征称更年期综合期。绝经综合征的症状很多,大体可分为心血管系统症状,精神神经系统症状及新陈代谢性障碍等3类。症状的程度,持续时间长短、症状的多少,与卵巢功能减退的快慢以及体质、绝经年龄、神经类型等因素有关。本次调查的500名绝经妇女中,有400人在绝经前后出现了绝经综合征症状。各种症状的发生情况具体见以下各表所示。
(一)心血管系统症状表现
心血管系统症状表现有潮热、心悸、头晕、高血压等,而潮热也是更年期的典型症状。潮热发生率为71.7%,心悸为44.9%,高血压为16.8%,头晕者占70.3%。
(二)精神神经系统症状
精神神经系统症状更年期精神神经系统症状的出现,是由于雌激素的减少,而引起一系列物质代谢的改变而产生。结果显示,情绪不稳的占55.4%,失眠者占42.4%。
(三)新陈代谢性障碍
新陈代谢性障碍更年期女妇女是由于骨质疏松发生关节痛,本次调查有25.2%。肥胖是体内脂肪、水和盐代谢失常而致,占16.8%。由于更年期肥胖者血脂增加,动脉粥样硬化,而易患高血压、冠心病及其他疾病。生殖道萎缩,常表现是阴道炎,排尿不畅及感染,子宫和阴道脱垂、大小便失禁等。本次阴道炎的发生率为24.3%。
绝经综合征主要症状体征分布情况：通过对400例纳入对象的症状和体征出现频率的调查分析,结果发现绝经综合征患者临床症状出现百分比由高到低,分别是烦躁易怒(78.7%)、骨关节痛(76.6%)、疲倦乏力(74.5%)、失眠(73.1%)、潮热出汗(71.7%)、头晕(70.3%)、头痛(68.2%)、抑郁(67.5%)、心悸(64.0%)、皮肤瘙痒(63.6%)、感觉异常(61.2%)、泌尿道症状(59.4%)、性欲下降(57.1%)。主要症状出现最多的十个症状分别为烦躁易怒、骨关节痛、疲倦乏力、失眠、潮热出汗、头晕、头痛、抑郁、心悸、皮肤瘙痒。
在绝经综合征患者诸多表现症状中,精神神经系统中的烦躁易怒最为常见,有近4/5的患者有易激动、焦虑、抑郁等心理状态的变化。究其原因,笔者认为一方面与被调查对象由于对绝经综合征的不甚了解,增加了对本病的过分担忧,沉重的心理负担进一步影响绝经综合征症状的加重,导致患者多表现为烦躁易怒等；另一方面结合被调查对象的学历、职业等,不难发现角色转变、以及妇女与社会适应的矛盾抵触性,也是更年期妇女病发绝经综合征至关重要的因素。中医学认为,肝主疏泄,调畅情志,情志失调致肝失疏泄,气机郁滞,日久郁而化火,扰及心神,故在临床上多见烦躁易怒等情志失常症状。骨关节痛症状出现的百分比为76.6%仅次于烦躁易怒的78.7%。骨关节痛的出现与更年期妇女卵巢功能降低、雌激素分泌较少,进而引起骨丢失、骨质疏松,出现骨关节痛症状。中医学认为,肾藏元阴元阳,肾主藏精、主骨生髓。人至中年以后,肾气渐衰,藏精主骨生髓功能也随之减弱,而致骨失精髓之养,不荣则痛,故多呈现骨关节痛之症。疲倦乏力出现的百分率为74.5%,名列第三。疲倦乏力多见于气虚,由于脏腑虚损无气以生、重病久病损耗元气所致。脾主运化,主四肢肌肉；胃为水谷之海,六腑之大源。脾胃为后天之本,气血生化之源。就绝经综合征而言,笔者认为疲倦乏力多因患者脾胃虚弱,气血生化不足所致。综上所述,单从绝经综合征临床中最为常见的三症状(烦躁易怒、骨关节痛、疲倦乏力)发生的病机来看,体现了绝经综合征病变的在脏为“肾”、“肝”、“脾”。
在对400例绝经综合征患者的调查研究中,发现就辨证分型而言,肾虚肝郁居多,占29.9%,其次为肾阴虚型占20.2%,肝肾阴虚型占17.3%,心肾不交型占12.3%,肾阳虚型占10.5%,肾阴阳两虚型占6.2%,脾肾阳虚占3.6%。
在绝经综合征的7种分型中,以肾虚肝郁(占29.9%)为最多、肾阴虚(占20.2%)次之、肝肾阴虚型(17.3%)为第三,合占67.4%,较为全面的体现了“肾虚为本、肝郁(虚)为标”的特性。肾阳虚、肾阴阳两虚和脾肾阳虚三种证型之和约占总数的20.3%,究其原因,笔者认为这与调查研究的对象的年龄段选取不无关系。一般情况下,年龄35-55周岁之间的患者,虽然会出现诸如“肾气不足,天癸将竭,阴精不足,月经来潮乏源或闭绝”等趋势,但就个体而言,因现阶段人体体质较以前较强,尚不至于频现肾阳虚、肾阴阳两虚和脾肾阳虚等证型。
结论：
1.绝经综合征各种症状的发生受多种因素的影响。精神因素对于绝经综合征的发生具有较大的影响。此外,亦与不同职业、学历层次、分娩时异常现象、分娩后
月经复潮时间等因素有关。提示在绝经综合征的防治方面应减少精神因素的影响,保持心胸开朗,情绪愉快,这是顺利度过更年期的根本保证。
2.烦躁易怒、骨关节痛、疲倦乏力是绝经综合征临床中最为常见的三个症状,应为主症,从发生的病机来看,体现了绝经综合征病变的在脏为“肾”、为“肝”、为“脾”。
3.在对400例绝经综合征患者辨证分型的研究中发现：肾虚肝郁居多,占29.9%,其次为肾阴虚型占20.2%,肝肾阴虚型占17.3%,心肾不交型占12.3%,肾阳虚型占10.5%,肾阴阳两虚型占6.2%,脾肾阳虚占3.6%。其中以肾虚肝郁、肾阴虚和肝肾阴虚型三者合占67.4%,较为全面的体现了“肾虚为本、肝郁(虚)为标”的特性。肾阳虚、肾阴阳两虚和脾肾阳虚三种证型合占总数的20.3%。笔者认为这与调查研究的对象的年龄段选取可能存在一定关系,亦是今后研究的重点领域。
Objective
To discuss the symptoms of Menopause Syndrome and influence factors of the disease, in order to take corresponding prevention measures.
Methods
The research objects are natural postmenopausal women. Cases source:on the basis of the research objective, in the study, the clinical epidemiology cross-sectional survey method is adopted. Cases are collected from January2011to November2011in Taiwan Wu Guoxian's TCM clinic and related hospital and clinics who are natural post-menopausal women diagnosed as Menopause Syndrome. Survey the500women with an age range of35-55years and a history of childbirth as research objects. Use dictation and consultation questionnaire. The questionnaire is designed by the author, covering menopausal symptoms, delivery, and menstruation onset time after the birth, TCM syndromes, etc.
The Western Medicine diagnosis standard of Menopause Syndrome refers to the Chinese Herbal Medicine New Drug Clinical Research Guiding Principles issued by the Ministry of Health in1997:women at the age of35to55years old or artificial postmenopausal women; sweating due to heat, associated with irritability, heart palpitations, insomnia, chest distress and headache, sentimental disorders, memory loss, waist sour and ache, etc. Endocrine determination:reduced serum estradiol, rise of follicle-stimulating hormone, and luteum hormone.
The severity of the Menopause Syndrome is.evaluated by Kupperman evaluation method. With improved Kupperman symptom scores, six points or above indicates the Menopause Syndrome diagnosis is established. Equal to or less than15points indicates mild degree;16-30:medium; Equal to or above31:severe.
The severity of the Menopause Syndrome, according to Kupperman evaluation meti(?) to evaluate, there were12, concrete including hot flashes sweating, feeling is unusual, insomnia, depression, dizziness, lack of power, and so on, each symptoms are basic points and divided into four level of degree points (0,1,2,3). Rating method is to use the basic cent times degree score, such as a symptom of the basic divided into4points, the measures are two points, so the symptoms score for eight points. The symptom scores for the sum total score. The doctor often total Menopause Syndrome according to judge the severity of this choice and drugs and treatment method. Specific see form Kupperman rating criteria.
(?)M syndrome differentiation standard according to the traditional Chinese medicine industry standard of the People's Republic of China "and" the Chinese herbal medicine new medicine clinical research guiding principle", ZhangYuZhen editor of "Chinese woman science" make the following syndrome differentiation standard:
Kidney Yin deficiency:before and after menopause, menstrual disorders, menstrual DiQianLiang less or capacity is much, or collapse or leak, the bright red color, leader dizzy, tinnitus, head of paroxysmal face hot flashes, sweat out, five upset hot, waist knees acid aches, sufficient with pain, or dry skin rash, itching, dry mouth and they, less urine color yellow, red tongue less moss, pulse count.
Kidney Yang:before and after menopause, the line capacity is much, the dark lubricious weak, or collapse under the leak, sluggishness, complexion is dull, low back pain cold, urinate qing long, a night of urinary frequency number, or floating face limb is swollen, tongue weak, or fat tender side have teeth marks, moss thin white, pulse heavy thin.
Kidney Yin and Yang all virtual:before and after menopause, menstrual disorders, quantity is little or much, at first glance at cold heat, baking hot sweat out, dizziness tinnitus, forgetfulness, low back pain cold, tongue light, moss thin, weak pulse sink.
Kidney Yin deficiency:before and after menopause, menstrual disorders, multiple color red or dripping wet is not unique, dizzy, inspect content fuzzy, baking hot sweat out, five upset hot, lumbar debility, insomnia, red tongue less moss, pulse count.
Kidney empty stomach:before and after menopause, menstrual disorders, capacity is much color red, dizzy, breast, breast pain threat, baking hot sweat out, be agitated irritability, depression or good TaiXi, seem suspicious, dry mouth tastes bitter, NaCha, red tongue moss thin, pulse string or count.
Heart renal don't pay:before and after menopause, menstrual disorders, lumbar debility, dizziness tinnitus, baking hot sweat out, palpitation, upset the restless, insomnia, the tip of the tongue red moss thin, pulse count.
Spleen and kidney Yang:before and after menopause, menstruation yan or closed after and do not, do the capacity is much, color light qualitative thin, sluggishness, fear of the cold, cold extremities, waist knees abdomen cold pain, long xie long dysentery, or the valley of the qing dynasty, the qing long urine, floating face is swollen limbs, taken down to the rare, tongue light moss thin white, pulse heavy thin and weak.
In case the standard:(1) the age40to60one full year of life.(2) with the above Menopause Syndrome diagnostic criteria.(3) improved Kupperman score10points total score>.(4) nearly3months pregnant female, without the hormone therapy.
Exclusion criteria do not conform to the diagnosis of traditional Chinese medicine and western medicine diagnosis standard.(1) primary hypertension, primary low blood pressure and chronic anemia patients;(2) the two side spayed, ovarian tumor and ovarian function premature aging patients;(3) less than45years old age or greater than55years old;(4) the hyperthyroidism, n/med tuberculosis, and combined cardiovascular, lung, liver, kidney and other serious primary disease, mental patients.
Study design:the clinical epidemiology investigation questionnaire were cross-sectional survey. Using dictations asked several record methods, ask the table with the author of the homemade brief menopausal symptoms occur, delivery, and after the birth of the time head, syndromes, etc.
Strictly carry out the design of clinical epidemiology investigation questionnaire, reduce selective bias and measuring sexual bias. Fixed investigators:investigation unit designate special persons to take charge of investigation, investigators for Chinese medicine gynecologists. Unified examination standard:strictly carry out the clinical diagnosis of unity and its standards, clinical symptoms standards. Set the personnel manual, are recorded by diagnostic criteria, into the standard and exclusion standard, the traditional Chinese medicine and other terms of the definition of the term unity to explain; Survey to participate in before investigators undertake unity training. Unified survey form:the deals in the project shall be by the questionnaire ", the formal investigation before the small scope project feasibility the investigation.(4) unified survey of time.
Investigation contents including patients generally (such as gender, date of birth, menstrual history, history, etc in pregnancy), menstrual history, history, various kinds of Chinese medical symptoms down (including spirit, sleep, diet, ErBian, local symptoms, systemic symptom, etc), tongue pulse and traditional Chinese and western medicine diagnosis, named TCM syndrome type diagnosis, etc.
Scene investigation:the clinical epidemiology cross-sectional survey methods, for the first time after admission or outpatient diagnosis of menstruation to be not moved patients the syndrome questionnaire survey, the investigators according to the questionnaire content ask for details of the subjects, when the same symptoms in patients have change or symptoms have change, with and without type change with syndrome differentiation points, can repeat into. More than two doctors and dialectical diagnosis, data timely, complete and correct, and clearly manned into the questionnaires, in order to reduce the dialectical diagnosis bias. Fill in the questionnaire is correct and complete, modify the need to maintain the original record clearly visible and correct place must be approved by the researchers sign and date indicated.
Statistics processing and data conclusion:will all data entry EpiData3.01software, establish the relevant project database. According to the symptoms of the project have, value0,1respectively, finishing each input corresponding numerical and database and questionnaires one by one to check, make sure the extraction and the entry process without omissions and errors. Application SPSS17.0statistical software for frequency, and statistical correlation analysis. Statistical graphics Graphd Prism4.03by drawing.
Results
This research altogether collected to report cases of500qualified, all for the clinic patients. The survey of500natural post-menopausal women, there are400people in there before and after menopause symptoms of menopause, incidence in80.0%, menopause at an average age of50.0years. The general information of the specific conditions of the see the following each table. Age distribution in (35-55) between age, with an average age of50.0+/-4.7years old.45to49years old group is in the majority,41.8%, second respectively for40～44years old group and50to55years old group;40years old the following, accounted for9.5%.
Vocational distribution percentage than a sequence as follows:business staff, service personnel, agriculture, forestry, fishery, animal husbandry staff, professional or technical and relevant personnel and production and related workers, transportation equipment operators, administrative and directors, housework, supervision and ZuoLi personnel.
Professional composition of comparison:business personnel (29.8%), service personnel (24.4%), agriculture, forestry, fishery, animal husbandry staff (12.4%) are in the majority.
The composition of cultural degree:women cultural degree bachelor of about43.7%, quality is higher.
Marriage composing in:married the total92.2%, no spouse31, accounting for7.8%of the total number. In the majority of a spouse.
Age at menarche17years old to14-the majority, about61.4%; Less than1393people, about23.3%; More than61people in18years old, about15.3%.
Menopause Syndrome illness degree constitution:the mild symptoms of125people, about31.3%; Moderate symptoms of199people, about49.7%; Severe symptoms of76people, about19.0%. Moderate symptoms are in the majority.
Syndromes questionnaire investigation:women to a certain age, ovarian function gradually decreases, this stage says menopause, it appears during the signs and symptoms of menopause comprehensive said. The symptoms of Menopause Syndrome many, can be classified as the cardiovascular system symptoms, spirit nervous system symptoms and metabolism and barriers of3kinds. The extent of the symptoms, duration of symptoms length, how much, and ovarian function to drop the speed of the constitution, and menopause, neural type age related to such factors. The survey of500natural post-menopausal women, there are400people in the before and after menopause symptoms of Menopause Syndrome appear. All symptoms of specific conditions in the following each table shows.
(1) the cardiovascular system symptoms
The cardiovascular system symptoms have hot flashes, heart palpitations, dizziness, high blood pressure, etc., and also is the typical symptom menopausal hot flashes. Hot flashes a rate of71.7%, palpitations is44.9%, and16.8%for high blood pressure, dizziness70.3%.
(2) spirit nervous system symptoms
Spirit nervous system symptoms of menopause spirit nervous system symptoms appear, is because the estrogen loss, and cause a series of material from the chabge of metabolism. The results show, moody's55.4%,42.4%of the insomnia.
(3) metabolism disorders
The metabolism of female menopause is because women obstacles osteoporosis happen joint pain, this investigation has25.2%. Obesity is body fat, water and salt and the functional disorder, accounting for16.8%. Due to increased blood lipid menopause are obese, atherosclerosis, and is likely to develop (?)h blood pressure, coronary heart disease and other ailments. The genital tract atrophy, and often present is vaginitis, micturition impeded and infection, uterine and vaginal prolapse, incontinence, etc. This vaginitis of incidence of24.3%.
Menopause Syndrome, the clinical symptoms and signs the main distribution
Menopause Syndrome main symptoms and signs distribution and the percentage constitute sequence arrangement as follows:be agitated irritable, joint pain, fatigue, insomnia, tired damp sweating, dizziness, headache, depression, heart palpitations, itchy skin, feeling is unusual, urinary tract symptoms, sexual desire decline. The main symptoms appear most ten symptoms were fidgety irritable, joint pain, fatigue, insomnia, tired damp sweating, dizziness, headache, depression, heart palpitations, itchy skin.
Among the symptoms of Menopause Syndrome patients, irritability is the most frequently occurred psychiatric and nerve disorder. About4/5of the patients have such psychological changes like irritability, anxiety and depression, etc. The author thinks on one hand it's because the objects'little knowledge about Menopause Syndrome brings about too much worry about this disease and heavy psychological burden will further worsen the disease which may cause patients to become agitated and irritable. On the other hand, considering the education and occupation of the objects, the author thinks the changes of roles and the conflicts between women and the society are very critical elements for the occurrence of Menopause Syndrome. Liver is in control of dispersion and adjusting sentiment. The disharmony of sentiment may lead to the disfunciton of dispersion of the liver and the stagnation of qi. The stagnation may develop into fire and disturb heart-spirit and that's why many sentimental disorders like fidgety and irritability are observed clinically. The percentage of the occurrence of arthralgia is76.6%, which is just next to fidgety and irritability (78.7%). Its occurrence is due to the decrease of menopause women's ovary function and less ESG secretion which cause the bone loss and bone rarefaction and finally arthralgia. TCM theories believe that kidney stores the renal yin and renal yang as well as essence. It affects the production of marrow in bone. After reaching middle age, people's kidney qi gradually declines and its function of storing essence and producing marrow also wanes. As bone loses the nutrition of marrow and essence, many symptoms of arthralgia occur. The percentage of the occurrence of fatigue is74.5%, ranking the third which is caused many by the deficiency of qi. That's because zang and fu organs (entrails) are too weak to produce qi and serious and long-time diseases also damage pneuma. Spleen is in charge of digestion and muscles of limbs. Stomach is regarded as the water and cereal sea and the essential origin of6fu organs. Spleen and stomach are the acquired foundation and the origin of qi and blood. Considering Menopause Syndrome, the author thinks fatigue is caused by the weak spleen and stomach and in sufficiency of generating and transforming of qi and blood. To summarize the most frequently met three clinical symptoms (fidgety and irritability, arthralgia, fatigue), their pathogenesis exists in liver, spleen and kidney in terms of zang organs.
In the investigation of400Menopause Syndrome patients, it is observed that in terms of differentiation types, kidney-deficiency and liver-stagnation ranks29.9%and what follows are kidney yin deficiency (20.2%), liver and kidney yin deficiency (17.3%), failure of heart and kidney integration (12.3%), kidney yang deficiency (10.5%), kidney yin and yang deficiency (6.2%) and spleen and kidney yang deficiency (3.6%). Among the7types of Menopause Syndrome, the first three are kidney-deficiency and liver-stagnation ranks (29.9%), kidney yin deficiency (20.2%), liver and kidney yin deficiency (17.3%), totally67.4%. This explains fully that kidney deficiency is the root and liver stagnation (deficiency) is the sign. Kidney yang deficiency, kidney yin and yang deficiency and spleen and kidney yang deficiency account for20.3%of the total. The author believes this is related to the age period of objects. Generally, patients aged between35to55years old will not have such syndrome types like kidney yang deficiency, kidney yin and yang deficiency and spleen and kidney yang deficiency, though there's the tendency of kidney qi deficiency, exhaustion of menstruation, deficiency of yin fluid, insufficiency or failure of menstruation onset, etc.
Conclusion:
1. The occurrence of Menopause Syndrome is affected by many factors. Mental factors have huge impact on it. Other factors are different occupations, education levels, abnormal phenomenon at childbirth, the time of menstruation onset after birth, etc. These indicate that in the prevention and treatment of Menopause Syndrome, we should reduce the impact of mental factors. Being broad-minded and happy in spirit is the foundation for smoothly passing the climacterium.
2. Fidgety and irritability, arthralgia and fatigue are the three most frequently occurred symptoms in clinic whose pathogenesis exists in liver, spleen and kidney in terms of zang organs.
3. In the investigation of the syndrome differentiation types of400Menopause Syndrome patients, kidney-deficiency and liver-stagnation ranks first (29.9%) and what follows are kidney yin deficiency (20.2%), liver and kidney yin deficiency (17.3%), failure of heart and kidney integration (12.3%), kidney yang deficiency (10.5%), kidney yin and yang deficiency (6.2%) and spleen and kidney yang deficiency (3.6%). Three types of kidney-deficiency and liver-stagnation ranks, kidney yin deficiency and liver and kidney yin deficiency account for67.4%in total. This explains fully that kidney deficiency is the root and liver stagnation (deficiency) is the sign. Kidney yang deficiency, kidney yin and yang deficiency and spleen and kidney yang deficiency account for20.3%of the total. The author believes this is related to the age period of objects. And this is the focus of future research.
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