调肝益肾法在治疗妇科病中的运用

在妇科病的治疗中，以调肝益肾之法多获良效，例举月经失调、绝经期综合征及带下病验案三则以佐证。     

Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women

Among women in South Asia, the complaint of vaginal discharge (often called leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of vaginal discharge. An anthropological perspective on the cultural meanings of leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. Many South Asian women who complain of vaginal discharge also report a variety of somatic symptoms such as dizziness, backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia. Leukorrhea may represent a culturally shaped "bodily idiom of distress", in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of sexually transmitted infections (STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of infection. A recent evaluation of this approach demonstrates that many women who complain of vaginal discharge do not have RTI, and are inappropriately treated with antibiotics. It seems likely that women are over-reporting vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework.     

论中医学生殖轴对带下生理病理诸环节的调控作用

目的：探讨中医学＂肾-天癸-冲任-胞宫＂生殖轴对带下产生、调节、治疗等方面的调控作用。方法：从中医基础理论出发,借鉴先贤的理论成果,分析带下产生、调节及治疗等环节与中医生殖轴的关系。结果：带下的生成及量、色、质的变化均受＂肾-天癸-冲任-胞宫＂生殖轴的调节,这一生殖轴理论对带下病的治疗具有重要的指导意义。结论：中医生殖轴理论丰富了中医对女性生殖生理的认识,为妇科相关疾病的诊治提供了一种新的思路。     

寿胎丸加减治冲任不固诸症

主要介绍陈雨苍教授对张锡纯寿胎丸加减应用和治疗妇人因肝脾肾功能失调,引起冲任不固的月经先期、经量过多、崩漏、带下、胎动不安、胎漏、滑胎诸症临床经验。     

Streptococcus agalactiae vaginitis: nonhemolytic variant on the Liofilchem? Chromatic StreptoB

Streptococcus agalactiae (group B Streptococcus, GBS) vaginal pathogenicity is not uniformly acknowledged throughout the literature; accordingly, in women, genital itching and burning, along with leukorrhea are commonly and almost exclusively referred to bacterial vaginosis, candidiasis and trichomoniasis. Conversely, GBS virulence for vagina was recognized in the past, as the organism has been observed to potentially cause local inflammation and discharge, as well as lactobacilli rarefaction. We depict here a case where a nonhemolytic (γ-hemolytic) GBS strain was found to be the etiologic agent of vaginal infection. Such uncommon S. agalactiae phenotypes are hard to be recognized and may be therefore responsible for misdiagnosing and underestimation of GBS vaginitis prevalence; here, we had the support of the Liofilchem^® Chromatic StreptoB medium, that successfully detected such an atypical variant.     

Real-world effectiveness and tolerability of Zelesse cream® for treating vulvovaginitis in adult women: an observational,prospective study

ObjectiveTo assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse cream®), either as monotherapy (non-infectious VV) or adjuvant to antimicrobial therapy (infectious VV).MethodsThis prospective, observational, multicenter study included women who attended outpatient offices for VV. The severity of signs (vaginal discharge, erythema, and edema) and symptoms (pruritus, burning, and dysuria) was assessed before and after 15±5 days of daily treatment with Zelesse cream on a 4-point scale (18-point global score).ResultsThe study included 58 women aged 43.0±13.2 years, including 42 who were treated with Zelesse cream only and 16 who used Zelesse cream as adjuvant to antimicrobial therapy. All participants showed significantly reduced scores and absolute prevalence of individual signs and symptoms in both groups. Similarly, the median signs/symptoms decreased by 4.0 and 8.0 points in women using Zelesse only and those using Zelesse plus antimicrobial therapy, respectively. This product was well tolerated and had high acceptability.ConclusionsZelesse cream relieves signs and symptoms of VV, either as monotherapy in non-infectious VV or as adjuvant to antimicrobial therapy in infectious VV. Future randomized, placebo-controlled trials with larger sample sizes are warranted.     

妇科白带涂片快速多项检查的临床应用

目的 :探讨用妇科白带涂片快速多项检查液 (简称 CTB) ,进行妇科白带涂片染色 ,检查滴虫、淋菌、念珠菌等十个以上的项目。方法 :取宫颈刮片用 CTB染色液进行检查 ,并与盐水法、巴氏法、瑞士法及 PCR法进行对比。结果 :2 0 0 82例妇科白带涂片中 ,CTB法线索细胞检出率为 39.0 % ,慢性炎症为 2 7.5 % ,念珠菌为 18.4 %、滴虫为 15 .0 % ,淋菌为 3.6 % ,核异质细胞为 1.8% ,纤毛菌为 1.0 % ,癌细胞为 0 .4 %。混合感染占 2 3.3%。 CTB法检出率均高于盐水法、巴氏法及瑞士法 ,与 PCR技术对照 ,两者无明显差异。结论 :CTB法是目前妇科白带涂片检查的一种最实用的方法 ,操作简便 ,染色过程短 ,结果准确、快速 ,且较经济。     

细菌性阴道病临床特征及相关危险因素分析

目的 探讨细菌性阴道病(BV)的临床特征及相关危险因素,为BV的预防及临床诊治提供帮助.方法 采用前瞻性研究方法,对2008年3～7月天津医科大学总医院妇科收治的150例BV患者及同期100例健康查体妇女进行病例对照研究,记录被研究人群临床资料.结果 BV患者年龄平均(31.92±9.15)岁.白带增多或有异味100例(66.7%),无明显阴道炎症状26例(17.3%).BV阴道pH值>4.5者133例(88.7%).BV阴道清洁度Ⅰ～Ⅱ度136例(90.7%);Ⅲ～Ⅳ度14例(9.3%),其中合并外阴阴道假丝酵母茵性阴道病(VVC)4例,滴虫3例.单因素分析显示,文化程度、非月经期使用护垫、阴道冲洗、阴道炎病史、放置宫内节育器、使用避孕套及口炙与BV有相关性;多因素分析显示非月经期使用护垫(P=0.016)、阴道炎病史(P=0.001)、口交(P=0.003)可增加BV的发生危险;采用避孕套可降低BV的发生危险(P=0.000).结论 BV主要发生于性活跃期育龄妇女.白带增多、有异味是其主要症状,部分患者无明显症状.BV阴道清洁度一般为Ⅰ～Ⅱ度,若为Ⅲ度或Ⅳ度,提示有混合感染的可能.非月经期使用护垫、口交、既往有阴道炎病史是BV发生的高危因素.而避孕套是其保护性因素.     

薏苡附子败酱散治疗妇科疾病验案3则

薏苡附子败酱散出自《金匮要略》,原方由薏苡仁（十分）、附子（二分）、败酱草（五分）组成,杵为末,水煎服。本方具有利湿排脓、破血消肿之功效,主治“腹皮急,按之濡……腹内有痈脓”。本方药用薏苡仁甘寒利湿,败酱草苦寒解毒排脓,更用小剂量辛热之附子“破积聚,血瘕寒湿”,《神农本草经》,以其辛热助阳行血,破散瘕瘕而内消肠痈。笔者师其方义,适当加重附子用量,加强温阳补肾之作用,用于治疗妇科疾病属寒湿内积者,疗效颇佳,现举验案3则如下。     

《傅青主女科》带下篇治疗特色浅析

傅山将带下病分为白带下、青带下、黄带下、黑带下、赤带下,认为带脉损伤,脾气之虚、肝气之郁、湿气之侵是基本病机,故在治疗上注重健脾祛湿、疏肝补肝并提出"治带宜重肾火".其治不拘于古,治病求本,用药精良,随证多变,终使湿有出路,邪得分消,带下症自除.