兰亭集序赏析Clinical Journal of Chine Medicine 2020 V ol.(12) No.15 -108- 中西医学·外妇骨伤•妇产
从经水出诸肾论治亚临床甲状腺功能减退引起的月经过少Treatment of hypomenorrhea caud by subclinical hypothyroidism from Menstruation comes from kidney
赵秀萍朱秀娟
语重心什么成语（北京中医药大学第三附属医院，北京，102209）
中图分类号：R271.111文献标识码：A文章编号：1674-7860（2020）15-0108-证型：DGBI
我的红颜知己
【摘要】月经过少属于一种常见的妇科月经失调症状，临床上常见的病因包括内分泌激素紊乱、宫腔操作术后内膜损伤、先天子宫发育畸形等。近年来临床研究发现，亚临床甲状腺功能减退（Subclinical Hypothyroidism，SCH）可引起女性内分泌功能紊乱出现月经量少、周期异常、不良妊娠结局甚至不孕症等情况。对于有临床症状及有生育要求的女性，临床上多给予左甲状腺素钠片口服治疗，可迅速降低促甲状腺激素（Thyroid-Stimulating Hormone，TSH）水平，但停药后易复发，治疗时间较长，且对月经量及其他临床症状改善的效果不佳。中医理论认为肾藏精，主生殖，为女性月经来潮及种子的物质基础。《傅青主女科》中指出“经水出诸肾”为临床治疗月经过少奠定了理论基础。现代中医理论将亚临床甲减病因归为脾肾阳虚，甚至各脏腑功能衰退。本文作者基于“经水出诸肾”理论，拟用温肾活血汤治疗亚临床甲减引起月经过少患者，临床上取得了较好的临床疗效。春节作文开头
言为心声
张慧颖【关键词】经水出诸肾；亚临床甲状腺功能减退；月经过少
【Abstract】Hypomenorrhea is a common gynecological menstrual symptoms. The common clinical caus include endocrine hormone disorder, endometrial injury after uterine cavity operation, congenital uterine malformation and so on. In recent years, clinical studies have found that subclinical hypothyroidism (SCH) can cau endocrine dysfunction in women, such as less menstruation, abnormal cycle, adver pregnancy outcomes and even infertility. For women with clinical symptoms and fertility requirements, oral administration of levothyroxine sodium tablets can rapidly reduce the level of thyroid stimulating hormone (TSH), but it is easy to relap after withdrawal, and the treatment time is longer, and the effect of improving menstrual volume and other clinical symptoms is not good. The theory of traditional Chine medicine holds that kidney concentrates esnce and mainly reproduces, which is the material basis of female menstruation and eds. In the ancient book Fu Qingzhu Nvke (傅青主女科), it was pointed out that "Menstruation comes from kidney" laid a theoretical foundation for the clinical treatment of menorrhea. Modern Chine medicine theory attributes the cau of subclinical hypothyroidism to deficiency of spleen and kidney yang, and even the decline of the functions of various organs. Bad on the theory of "Menstruation comes from kidney", the author intends to u Wenshen Huoxue Decoction (温肾活血
汤) to treat patients with hypomenorrhea caud by subclinical hypothyroidism, and has achieved good clinical efficacy.
【Keywords】Menstruation comes from kidney; Subclinical hypothyroidism; Hypomenorrhea
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doi:10.3969/j.issn.1674-7860.2020.15.045
prrsv
月经过少属于一种常见的妇科月经失调症状，一般指月经周期基本正常，经量明显减少或点滴即净，或经期不足2天，经量少于正常，连续出现2个月经周期以上者[1]。更多的则表现为较以前月经量明显减少[2]。近年来研究发现，亚临床甲状腺功能减退（简称亚临床甲减）可引起月经量减少、周期异常、不良妊娠结局甚至造成不孕等情况[3]。临床上常以左甲状腺素钠片作为替代治疗药物，可很好地并迅速地降低促甲状腺激素（Thyroid-Stimulating Hormone，TSH）水平，但对月经量及其他临床症状改善的效果不佳，且长期口服可引起肝损害、胃肠道反应等不良反应[4]，而中药治疗该类疾病可有效改善患者的月经量、临床症状，且可减少长期口服西药的不良反应，尤其受益于计划妊娠的妇女。本文基于傅青主经典理论“经水出诸肾”论治亚临床甲减引起的月经过少，且有扎实的理论基础。1中医理论渊源
1.1何为“经水出诸肾”
“经水”一词最早见于《素问•离合真邪论》“天有宿度，地有经水，人有经脉。天地温和，则经水安静；天寒地冻，则经水凝泣；天暑地热，则经水沸溢，卒风暴起，则经水波涌而陇起”。此处的“经水”原指河流，比喻人体一身之经脉。而在妇科理论中“经水”为月经的别称，是指有规律的，周期性的子宫出血，月月如期，经常不变，也称为“月水”“月事”。“夫经水出诸肾”是《傅青主女科》中提出的经典理论，文中亦提出了“夫经本于肾，而其流五脏六腑之血皆归之，故经来而诸经之血尽来附益，以经水行而门启不遑迅阖，诸经之血乘其隙而皆出也，但血既出矣，则成不足。”“经水早断，似乎肾水衰竭”等[5]经典理论，并制订了两地汤、定经汤等经典方剂，一直沿用至今。充分体现了傅氏在治疗月经病过程中对肾的重视。中医理论认为肾藏精，精能生
