| 张科进,叶旭星.张丹山治疗复发性流产经验[J].浙江中医药大学学报,2023,47(2):179-183. |
| 张丹山治疗复发性流产经验 |
| ZHANG Danshan‘s Experience in Treating Recurrent Spontaneous Abortion |
| DOI：10.16466/j.issn1005-5509.2023.02.013 |
| 中文关键词: 复发性流产 滑胎 孕期前后 安胎 食疗 临证经验 张丹山 |
| 英文关键词: recurrent spontaneous abortion habitual abortion before and after pregnancy soothing fetus diet therapy clinical experience ZHANG Danshan |
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| 摘要点击次数: 1707 |
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| 中文摘要: |
| [目的] 总结张丹山主任治疗复发性流产的临床经验，为临床提供有益借鉴。[方法] 通过跟师随诊，搜集名医张丹山主任临床治疗复发性流产的案例并查阅文献，从滑胎治疗的基本总则、孕前孕后治疗特点以及食疗调养三个层面总结介绍张主任治疗复发性流产的临床经验，并举案例一则加以佐证。[结果] 张主任认为，胎儿的孕育需特别重视调养精血之本源，治疗上以“预培其元”为原则，常选用熟地黄、菟丝子、川断、补骨脂、女贞子、覆盆子、龟板等补肾养血以培其元。同时，认为滑胎在孕前多因于肝郁血瘀，孕后多因于冲任不固，由此提出孕前予疏肝解郁、活血祛瘀，同时兼顾月经周期分期论治的治疗方法，行经期治以行气活血、祛瘀调经；经后期治以滋阴养血、补肾健脾，促进卵泡生长发育；经间期治以理气活血通络，促进卵泡排出；经前期治以补肾助阳，促进胚胎着床，以造就孕育环境。孕后予补肾健脾、清热凉血，以固摄冲任，安度滑胎，再结合食疗辅助。所举验案为肾虚肝郁兼血瘀型滑胎患者，治宜补肾疏肝、活血化瘀，予月季饮治疗，同时配合家传“寿胎经验方”随证加减，孕后治以补肾益气、清肝和荣，疗效显著。[结论] 张丹山主任治疗复发性流产以调养元气、益肾填精为基础，抓住孕期的不同特点，孕前重视行气解郁、化瘀生新，以改善孕育环境；孕后侧重补肾健脾、清热凉血、调和冲任，以达安胎之目的，治疗效果明显，其经验值得学习与推广。 |
| 英文摘要: |
| [Objective] To summarize Director ZHANG Danshan‘s clinical experience in the treatment of recurrent spontaneous abortion(RSA) so as to provide useful reference for better clinical treatment. [Methods] Through learning from teacher in outpatient service， this paper collected the cases of Director ZHANG‘s clinical treatment of RSA and consulted the literature， summarized the clinical experience of ZHANG‘s treatment of RSA from three aspects including total treatment principles， character of pre- and post-pregnancy treatment and dietary recuperation， with a medical case as evidence. [Results] Director ZHANG believes that the pregnancy of fetus needs to pay special attention to regulating and nourishing the origin of essence and blood. The principle of treatment is “pre-cultivating vitality”， Rehmanniae Radix Praeparata， Cuscutae Semen， Dipsaci Radix， Psoraleae Fructus， Fructus Ligustri Lucidi， Rubi Fructus and Testudinis Carapacis et Plastri are often used to nourish the kidney and blood to cultivate vitality. At the same time， Director ZHANG considers that the RSA is mostly due to liver depression and blood stasis before pregnancy， and Chong Ren‘s weakness after pregnancy. Therefore， it is concluded that before pregnancy， the treatment should include soothing the liver and removing depression， promoting blood circulation and removing blood stasis， giving consideration to the treatment by stages of menstrual cycle， and promoting Qi and blood circulation， removing blood stasis and regulating menstruation during menstrual period. After menstruation， treatment should include nourishing Yin and blood， tonifying the kidney and spleen， and promoting follicular growth and development. The treatment of menstrual interval is to regulate Qi， activate blood circulation and dredge collaterals， so as to promote the excretion of follicles. During intermenstrual period， it is used to tonify the kidney and Yang， promote embryo implantation， so as to create a breeding environment. After pregnancy， the treatment is to tonify the kidney and spleen， clear away heat and cool blood， so as to stabilize Chong Ren， prevent abortion， and then combine with auxiliary diet therapy. The case mentioned was of kidney deficiency， liver depression and blood stasis type RSA， the treatment was carried out by nourishing the kidney and liver， promoting blood circulation and removing blood stasis， and Yueji Drink was used for treatment， combined with modified Shoutai Jingyan Formula. After pregnancy， treatment of nourishing the kidney and Qi， clearing the liver and harmonizing Ying Qi was recommended and remarkable curative effect was achieved. [Conclusion] Director ZHANG‘s treatment of RSA is based on recuperation of vital energy， tonifying the kidney and filling the essence， seizing the characteristics of different pregnancy stages， paying attention to promoting Qi， relieving depression， removing blood stasis in order to improve the pregnant environment before pregnancy； and focusing on tonifying the kidney and spleen， clearing away heat and cooling blood and harmonizing Chong Ren after pregnancy， so as to achieve the purpose of miscarriage prevention. The treatment effect is obvious and worthy of study and promotion. |
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