月經(jīng)病總論-課件

月經(jīng)病民勤縣人民醫(yī)院趙伯元月經(jīng)病民勤縣人民醫(yī)院1（一）月經(jīng)病的概念

凡月經(jīng)的周期、經(jīng)期、經(jīng)量、經(jīng)色和經(jīng)質(zhì)發(fā)生異常，以及伴隨月經(jīng)周期或于經(jīng)斷前后出現(xiàn)明顯不適癥狀的疾病，稱為“月經(jīng)病”。

THESOUTHERNMEDICALUNIVERSITY是婦科臨床的多發(fā)?。ㄒ唬┰陆?jīng)病的概念凡月經(jīng)的周期、經(jīng)期、經(jīng)量、THE22428352428353（二）月經(jīng)病的病因寒熱濕邪侵襲內(nèi)傷七情體質(zhì)因素飲食不節(jié)勞倦過(guò)度房勞多產(chǎn)THESOUTHERNMEDICALUNIVERSITY（二）月經(jīng)病的病因寒熱濕邪侵襲THESOUTHERN4（三）月經(jīng)病的病機(jī)臟腑功能失常，氣血不和，沖任二脈損傷及腎氣－天癸－沖任－胞宮生殖軸失調(diào)。THESOUTHERNMEDICALUNIVERSITY（三）月經(jīng)病的病機(jī)臟腑功能失常，氣血不和，THESO5（四）月經(jīng)病的辨證月經(jīng)的期、量、色、質(zhì)的異常及伴隨月經(jīng)周期或經(jīng)斷前后出現(xiàn)的癥狀，舌、脈及全身證候，四診八綱進(jìn)行綜合分析。著重THESOUTHERNMEDICALUNIVERSITY結(jié)合運(yùn)用（四）月經(jīng)病的辨證月經(jīng)的期、量、色、質(zhì)的異61、辨月經(jīng)先期、量多、色淡、質(zhì)稀——?dú)馓摵笃?、量少、色淡、質(zhì)稀——血虛后期、量少、色黯、有塊——血寒先期、量多、色深、質(zhì)稠——血熱先期、量少、色鮮、質(zhì)稠——陰虛先后無(wú)定期、色黯淡、質(zhì)稀——腎虛先后無(wú)定期、量少或多、色紫、有塊——肝郁氣滯量多或少、色黯、有塊——血瘀THESOUTHERNMEDICALUNIVERSITY1、辨月經(jīng)THESOUTHERNMEDIC72、辨局部癥狀腹痛乳脹或痛兩脅作痛THESOUTHERNMEDICALUNIVERSITY2、辨局部癥狀THESOUTHERNMED8（五）鑒別診斷月經(jīng)后期、閉經(jīng)與生理性停經(jīng)相鑒別月經(jīng)過(guò)少與胎漏、激經(jīng)相鑒別經(jīng)期延長(zhǎng)、月經(jīng)過(guò)多、崩漏等與胎、產(chǎn)后病、雜病等引起的下血證相鑒別痛經(jīng)與異位妊娠相鑒別與發(fā)生在月經(jīng)期內(nèi)的內(nèi)外科疾病相鑒別THESOUTHERNMEDICALUNIVERSITY（五）鑒別診斷月經(jīng)后期、閉經(jīng)與生理性停經(jīng)相鑒別THE9（六）月經(jīng)病的治療原則治本以調(diào)經(jīng)治本：消除導(dǎo)致月經(jīng)病的病因病機(jī)調(diào)經(jīng)：通過(guò)治療使月經(jīng)恢復(fù)正常（六）月經(jīng)病的治療原則治本以調(diào)經(jīng)治本：消除導(dǎo)致月經(jīng)病的病因病10THESOUTHERNMEDICALUNIVERSITY1、調(diào)經(jīng)方法補(bǔ)腎——腎主生殖，經(jīng)水出諸腎。填補(bǔ)精血為主，輔以溫陽(yáng)之品。扶脾——脾為后天之本，氣血生化之源。健脾益氣，健脾升陽(yáng)除濕。疏肝——肝主疏泄。疏肝理氣調(diào)經(jīng)。THESOUTHERNMEDICAL11調(diào)理氣血——病在氣者，治氣為主，佐以理血；病在血者，治血為主，佐以理氣。調(diào)理沖任THESOUTHERNMEDICALUNIVERSITY調(diào)理氣血——病在氣者，治氣為主，佐以理血；病在血者，治血為主12THESOUTHERNMEDICALUNIVERSITY“故調(diào)經(jīng)之要，貴在補(bǔ)脾胃以資血之源，養(yǎng)腎氣以安血之室，知斯二者，則盡善矣?！薄鳌埦霸繲HESOUTHERNMEDICAL132、調(diào)經(jīng)注意事項(xiàng)分清經(jīng)病和他病的主次先病他病：當(dāng)先治病先經(jīng)不調(diào)：當(dāng)先調(diào)經(jīng)辨標(biāo)本緩急急則治其標(biāo)，緩則治其本THESOUTHERNMEDICALUNIVERSITY2、調(diào)經(jīng)注意事項(xiàng)THESOUTHERNME143、治療月經(jīng)病要順應(yīng)和掌握的規(guī)律（1）經(jīng)前經(jīng)后用藥有別（2）順應(yīng)不同年齡階段論治的規(guī)律青春期重腎生育期重肝絕經(jīng)期重脾（3）掌握虛實(shí)補(bǔ)瀉規(guī)律虛證：補(bǔ)腎扶脾養(yǎng)血實(shí)證：疏肝理氣活血

THESOUTHERNMEDICALUNIVERSITY3、治療月經(jīng)病要順應(yīng)和掌握的規(guī)律THESOUTHER15小結(jié)1.掌握月經(jīng)病的概念、病因病機(jī)、診斷、辨證及治療原則；2.掌握常見(jiàn)月經(jīng)病的概念和辨證論治。THESOUTHERNMEDICALUNIVERSITY小結(jié)1.掌握月經(jīng)病的概念、病因病機(jī)、診斷、辨證及治療原則；16

月經(jīng)來(lái)潮…………調(diào)血活血排卵溫補(bǔ)腎陽(yáng)補(bǔ)腎健脾疏肝理氣調(diào)養(yǎng)氣血經(jīng)前、經(jīng)后、經(jīng)時(shí)、平時(shí)月經(jīng)來(lái)潮…………調(diào)血活血排卵溫補(bǔ)腎陽(yáng)補(bǔ)腎健脾疏肝理氣調(diào)養(yǎng)氣17月經(jīng)病民勤縣人民醫(yī)院趙伯元月經(jīng)病民勤縣人民醫(yī)院18（一）月經(jīng)病的概念

凡月經(jīng)的周期、經(jīng)期、經(jīng)量、經(jīng)色和經(jīng)質(zhì)發(fā)生異常，以及伴隨月經(jīng)周期或于經(jīng)斷前后出現(xiàn)明顯不適癥狀的疾病，稱為“月經(jīng)病”。

THESOUTHERNMEDICALUNIVERSITY是婦科臨床的多發(fā)?。ㄒ唬┰陆?jīng)病的概念凡月經(jīng)的周期、經(jīng)期、經(jīng)量、THE1924283524283520（二）月經(jīng)病的病因寒熱濕邪侵襲內(nèi)傷七情體質(zhì)因素飲食不節(jié)勞倦過(guò)度房勞多產(chǎn)THESOUTHERNMEDICALUNIVERSITY（二）月經(jīng)病的病因寒熱濕邪侵襲THESOUTHERN21（三）月經(jīng)病的病機(jī)臟腑功能失常，氣血不和，沖任二脈損傷及腎氣－天癸－沖任－胞宮生殖軸失調(diào)。THESOUTHERNMEDICALUNIVERSITY（三）月經(jīng)病的病機(jī)臟腑功能失常，氣血不和，THESO22（四）月經(jīng)病的辨證月經(jīng)的期、量、色、質(zhì)的異常及伴隨月經(jīng)周期或經(jīng)斷前后出現(xiàn)的癥狀，舌、脈及全身證候，四診八綱進(jìn)行綜合分析。著重THESOUTHERNMEDICALUNIVERSITY結(jié)合運(yùn)用（四）月經(jīng)病的辨證月經(jīng)的期、量、色、質(zhì)的異231、辨月經(jīng)先期、量多、色淡、質(zhì)稀——?dú)馓摵笃凇⒘可?、色淡、質(zhì)稀——血虛后期、量少、色黯、有塊——血寒先期、量多、色深、質(zhì)稠——血熱先期、量少、色鮮、質(zhì)稠——陰虛先后無(wú)定期、色黯淡、質(zhì)稀——腎虛先后無(wú)定期、量少或多、色紫、有塊——肝郁氣滯量多或少、色黯、有塊——血瘀THESOUTHERNMEDICALUNIVERSITY1、辨月經(jīng)THESOUTHERNMEDIC242、辨局部癥狀腹痛乳脹或痛兩脅作痛THESOUTHERNMEDICALUNIVERSITY2、辨局部癥狀THESOUTHERNMED25（五）鑒別診斷月經(jīng)后期、閉經(jīng)與生理性停經(jīng)相鑒別月經(jīng)過(guò)少與胎漏、激經(jīng)相鑒別經(jīng)期延長(zhǎng)、月經(jīng)過(guò)多、崩漏等與胎、產(chǎn)后病、雜病等引起的下血證相鑒別痛經(jīng)與異位妊娠相鑒別與發(fā)生在月經(jīng)期內(nèi)的內(nèi)外科疾病相鑒別THESOUTHERNMEDICALUNIVERSITY（五）鑒別診斷月經(jīng)后期、閉經(jīng)與生理性停經(jīng)相鑒別THE26（六）月經(jīng)病的治療原則治本以調(diào)經(jīng)治本：消除導(dǎo)致月經(jīng)病的病因病機(jī)調(diào)經(jīng)：通過(guò)治療使月經(jīng)恢復(fù)正常（六）月經(jīng)病的治療原則治本以調(diào)經(jīng)治本：消除導(dǎo)致月經(jīng)病的病因病27THESOUTHERNMEDICALUNIVERSITY1、調(diào)經(jīng)方法補(bǔ)腎——腎主生殖，經(jīng)水出諸腎。填補(bǔ)精血為主，輔以溫陽(yáng)之品。扶脾——脾為后天之本，氣血生化之源。健脾益氣，健脾升陽(yáng)除濕。疏肝——肝主疏泄。疏肝理氣調(diào)經(jīng)。THESOUTHERNMEDICAL28調(diào)理氣血——病在氣者，治氣為主，佐以理血；病在血者，治血為主，佐以理氣。調(diào)理沖任THESOUTHERNMEDICALUNIVERSITY調(diào)理氣血——病在氣者，治氣為主，佐以理血；病在血者，治血為主29THESOUTHERNMEDICALUNIVERSITY“故調(diào)經(jīng)之要，貴在補(bǔ)脾胃以資血之源，養(yǎng)腎氣以安血之室，知斯二者，則盡善矣。”——明·張景岳THESOUTHERNMEDICAL302、調(diào)經(jīng)注意事項(xiàng)分清經(jīng)病和他病的主次先病他病：當(dāng)先治病先經(jīng)不調(diào)：當(dāng)先調(diào)經(jīng)辨標(biāo)本緩急急則治其標(biāo)，緩則治其本THESOUTHERNMEDICALUNIVERSITY2、調(diào)經(jīng)注意事項(xiàng)THESOUTHERNME313、治療月經(jīng)病要順應(yīng)和掌握的規(guī)律（1）經(jīng)前經(jīng)后用藥有別（2）順應(yīng)不同年齡階段論治的規(guī)律青春期重腎生育期重肝絕經(jīng)期重脾（3）掌握虛實(shí)補(bǔ)瀉規(guī)律虛證：補(bǔ)腎扶脾養(yǎng)血實(shí)證：疏肝理氣活血

THESOUTHERNMEDICALUNIVERSITY3、治療月經(jīng)病要順應(yīng)和掌握的規(guī)律