王国华教授治疗非肥胖型多囊卵巢综合征不孕症的经验
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摘要
肾精是卵子发育成熟的物质基础,肝主疏泄的功能正常是卵子顺利排出的重要条件,肝郁肾虚为非肥胖型多囊卵巢综合征不孕症病之本,肾精亏虚尤其肾阴亏虚乃是发病之基础,精血不足,肝气郁结是其发病的病机关键。治疗上以滋肾、疏肝为大法,以滋水清肝饮加减治疗本病,临床收效颇佳。
Kidney essence is the material basis for follicle maturity. Normal function of liver controlling conveyance and dispersion is an important condition for ovulation. Stagnation of liver qi and kidney deficiency is the basis of non-obese polycystic ovary syndrome infertility disease, deficiency of kidney essence is especially the basis of the disease and deficiency of essence and blood and stagnation of liver qi is the key to pathogenesis. Nourishing the kidney and soothing the liver is the treatment principle. Nourishing the water and clearing the liver is the commonly used prescription, and the clinical effect is quite good.
Kidney essence is the material basis for follicle maturity. Normal function of liver controlling conveyance and dispersion is an important condition for ovulation. Stagnation of liver qi and kidney deficiency is the basis of non-obese polycystic ovary syndrome infertility disease, deficiency of kidney essence is especially the basis of the disease and deficiency of essence and blood and stagnation of liver qi is the key to pathogenesis. Nourishing the kidney and soothing the liver is the treatment principle. Nourishing the water and clearing the liver is the commonly used prescription, and the clinical effect is quite good.
引文
[1]RAMEZANI TEHRANI F,MINOOEE S,AZIZI F.Comparison of various adiposity indexes in women with polycystic ovary syndrome and normo-ovulatory non-hirsute women:a population-based study[J].Eur J Endocrinol,2014,171(2):199-207.
[2]LI R,ZHANG Q,YANG D,et al.Prevalence of polycystic ovary syndrome in women in China:a large community-based study[J].Hum Reprod,2013,28(9):2562-2569.
[3]赵越,阮祥燕,崔亚美,等.不同亚型的多囊卵巢综合征患者临床及实验室指标特征的研究[J].首都医科大学学报,2015,36(4):567-572.
[4]董化芳,李新芳,杜晓霞.肥胖型与非肥胖型多囊卵巢综合征患者内分泌代谢的差异[J].山西职工医学院学报,2018,28(4):20-22.
[5]李灿东,高碧珍,黄熙理,等.不孕症肝郁病理与性腺轴功能变化的相关性研究[J].上海中医药大学学报,2005,19(3):36-38.
[6]清·高鼓峰.医宗己任编[M].北京:学苑出版社,2011.
[7]卓毅.滋水清肝饮方考及正误[J].中医文献杂志,1997,15(4):20-21.
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[13]BHATTACHARYA S M,JHA A.Prevalence and risk of depressive disorders in women with polycystic ovary syndrome(PCOS)[J].Fertility and Sterility,2010,94(1):357-359.
[14]石少权,姜芳芳,洪婷,等.二甲双胍治疗肥胖型和非肥胖型多囊卵巢综合征的疗效观察[J].中国慢性病预防与控制,2013,21(5):568-571.
[15]苑晓微,张燕萍,邓继红,等.二甲双胍用于改善非肥胖型多囊卵巢综合征患者糖、脂代谢的临床观察[J].中国计划生育学杂志,2014,22(4):252-254.
[16]宋亚南,邓艳芳,屈乐,等.基于数据挖掘的多囊卵巢综合征现代临床用药规律探析[J].世界中西医结合杂志,2014,9(1):1-4.
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[19]CANKAYA S,DEMIR B,AKSAKAL S E,et al.Insulin resistance and its relationship with high molecular weight adiponectin in adolescents with polycystic ovary syndrome and a maternal history of polycystic ovary syndrome[J].Fertil Steril,2014,102(3):826-830.
[20]王宝珍.维生素D与多囊卵巢患者胰岛素抵抗相关性及其机制研究[J].中国妇幼保健,2015,30(15):2336-2338.
[21]黄海平,李小芳.多囊卵巢综合征不同中医证型与胰岛素抵抗之间的关系[J].吉林中医药,2015,35(9):889-892.
[22]魏满霞,李喆,刘畅,等.韩延华教授益肾调肝汤治疗多囊卵巢综合征排卵障碍性不孕临床观察[J].长春中医药大学学报,2013,29(2):307-308.
[23]宋翠淼,杜惠兰,马爱蕊,等.补肾调经方对雄激素致不孕大鼠子宫转化生长因子及其受体的影响[J].中成药,2007,30(5):652-655.
[24]王莉,陆利民,俞瑾,等.补肾中药天癸方对雄激素致不孕大鼠胰腺及卵巢雄激素受体的影响[J].中华中医药杂志,2011,26(4):679-682.
[25]张亚琴.活血补肾方治疗子宫内膜生长不良性不孕症的疗效观察[J].现代诊断与治疗,2016,27(21):4028,4074.
[26]张其兰,肖丹,韩珍珍,等.补肾活血疗法对排卵障碍性不孕不育的临床疗效观察[J].中国性科学,2018,27(6):127-130.
[27]付静.活血补肾方辅治子宫内膜生长不良性不孕症疗效观察[J].实用中医药杂志,2019,35(2):194-195.
[28]李蕾.中药人工周期疗法治疗不孕体会[J].实用中医药杂志,2010,26(7):499.
[29]郑玫,连方,孙振高.补肾中药对肾虚不孕患者卵巢颗粒细胞基因表达干预的研究[J].辽宁中医杂志,2017,44(1):12-15.
[30]王海英.疏肝种玉汤治疗排卵障碍性不孕症43例[J].陕西中医学院学报,2010,33(4):57-58.
[31]刘国平,陈鹏飞,贺玉珍.中医治疗排卵功能障碍性不孕68例临床观察[J].吉林医学,2010,31(9):1225-1226.
[32]林玲莉,徐冠英,凌翠.疏肝补肾汤治疗多囊卵巢综合征不孕不育的效果研究[J].实用中西医结合临床,2018,18(7):79-80.
[33]王迪华,梁雪雯,周红.逍遥助卵煎对卵巢早衰患者血清性激素水平的影响[J].中国妇幼保健,2007,22(33):4687-4688.
[34]梁莹,赵胜男,常秀峰,等.逍遥丸对人卵巢壁颗粒细胞ALK5/Smads通路的影响[J].中医杂志,2013,54(9):754-757.
[35]孙忻,丁彩飞,杨欣,等.补肾调肝方对非肥胖型多囊卵巢综合征患者糖脂代谢的影响[J].中国中西医结合杂志,2017,37(5):530-533.
[36]张慧珍,张霄.补肾疏肝中药联合克罗米芬助进小卵泡发育治疗[J].世界科学技术-中医药现代化,2013,15(7):1616-1619.
[2]LI R,ZHANG Q,YANG D,et al.Prevalence of polycystic ovary syndrome in women in China:a large community-based study[J].Hum Reprod,2013,28(9):2562-2569.
[3]赵越,阮祥燕,崔亚美,等.不同亚型的多囊卵巢综合征患者临床及实验室指标特征的研究[J].首都医科大学学报,2015,36(4):567-572.
[4]董化芳,李新芳,杜晓霞.肥胖型与非肥胖型多囊卵巢综合征患者内分泌代谢的差异[J].山西职工医学院学报,2018,28(4):20-22.
[5]李灿东,高碧珍,黄熙理,等.不孕症肝郁病理与性腺轴功能变化的相关性研究[J].上海中医药大学学报,2005,19(3):36-38.
[6]清·高鼓峰.医宗己任编[M].北京:学苑出版社,2011.
[7]卓毅.滋水清肝饮方考及正误[J].中医文献杂志,1997,15(4):20-21.
[8]FAUSER B C,TARLATZIS B C,REBAR R W,et al.Consensus on women’s health aspects of polycystic ovary syndrome(PCOS):the Amsterdam ESHRE/ASRM-sponsored3rd PCOS consensus workshop group[J].Fertil Steril,2012,97(1):28-38.
[9]COBIN R H,GOODMAN N F.american association of clinical endocrinologists and american college of endocrinology position statement on menopause-2017update[J].Endocr Pract,2017,23(7):869-880.
[10]郁琦.多囊卵巢综合征诊治标准专家共识[J].中国实用妇科与产科杂志,2007,23(6):474.
[11]吴雏燕,张勤,吴玉霞,等.非肥胖型多囊卵巢综合征患者饮食运动行为研究与分析[J].中国妇幼保健,2016,31(20):4114-4116.
[12]CHAVARRO J E,RICH-EDWARDS J W,ROSNER BA,et al.Diet and lifestyle in the prevention of ovulatory disorder infertility[J].Obstetrics and Gynecology:Journal of the American College of Obstetricians and Gynecologists,2007,110(5):1050-1058.
[13]BHATTACHARYA S M,JHA A.Prevalence and risk of depressive disorders in women with polycystic ovary syndrome(PCOS)[J].Fertility and Sterility,2010,94(1):357-359.
[14]石少权,姜芳芳,洪婷,等.二甲双胍治疗肥胖型和非肥胖型多囊卵巢综合征的疗效观察[J].中国慢性病预防与控制,2013,21(5):568-571.
[15]苑晓微,张燕萍,邓继红,等.二甲双胍用于改善非肥胖型多囊卵巢综合征患者糖、脂代谢的临床观察[J].中国计划生育学杂志,2014,22(4):252-254.
[16]宋亚南,邓艳芳,屈乐,等.基于数据挖掘的多囊卵巢综合征现代临床用药规律探析[J].世界中西医结合杂志,2014,9(1):1-4.
[17]SPRITZER P M,LECKE S B,SATLER F.Morsch DM(2015)Adipose tissue dysfunction,adipokines,and owgrade chronic inflammation in polycystic ovary syndrome[J].Reproduction,2015(149):219-227.
[18]TING W,YANYAN Q,JIAN H,et al.The relationship between insulin resistance and CpG island methylation of LMNA gene in polycystic ovary syndrome[J].Cell Biochem Biophys,2013,67(3):1041-1047.
[19]CANKAYA S,DEMIR B,AKSAKAL S E,et al.Insulin resistance and its relationship with high molecular weight adiponectin in adolescents with polycystic ovary syndrome and a maternal history of polycystic ovary syndrome[J].Fertil Steril,2014,102(3):826-830.
[20]王宝珍.维生素D与多囊卵巢患者胰岛素抵抗相关性及其机制研究[J].中国妇幼保健,2015,30(15):2336-2338.
[21]黄海平,李小芳.多囊卵巢综合征不同中医证型与胰岛素抵抗之间的关系[J].吉林中医药,2015,35(9):889-892.
[22]魏满霞,李喆,刘畅,等.韩延华教授益肾调肝汤治疗多囊卵巢综合征排卵障碍性不孕临床观察[J].长春中医药大学学报,2013,29(2):307-308.
[23]宋翠淼,杜惠兰,马爱蕊,等.补肾调经方对雄激素致不孕大鼠子宫转化生长因子及其受体的影响[J].中成药,2007,30(5):652-655.
[24]王莉,陆利民,俞瑾,等.补肾中药天癸方对雄激素致不孕大鼠胰腺及卵巢雄激素受体的影响[J].中华中医药杂志,2011,26(4):679-682.
[25]张亚琴.活血补肾方治疗子宫内膜生长不良性不孕症的疗效观察[J].现代诊断与治疗,2016,27(21):4028,4074.
[26]张其兰,肖丹,韩珍珍,等.补肾活血疗法对排卵障碍性不孕不育的临床疗效观察[J].中国性科学,2018,27(6):127-130.
[27]付静.活血补肾方辅治子宫内膜生长不良性不孕症疗效观察[J].实用中医药杂志,2019,35(2):194-195.
[28]李蕾.中药人工周期疗法治疗不孕体会[J].实用中医药杂志,2010,26(7):499.
[29]郑玫,连方,孙振高.补肾中药对肾虚不孕患者卵巢颗粒细胞基因表达干预的研究[J].辽宁中医杂志,2017,44(1):12-15.
[30]王海英.疏肝种玉汤治疗排卵障碍性不孕症43例[J].陕西中医学院学报,2010,33(4):57-58.
[31]刘国平,陈鹏飞,贺玉珍.中医治疗排卵功能障碍性不孕68例临床观察[J].吉林医学,2010,31(9):1225-1226.
[32]林玲莉,徐冠英,凌翠.疏肝补肾汤治疗多囊卵巢综合征不孕不育的效果研究[J].实用中西医结合临床,2018,18(7):79-80.
[33]王迪华,梁雪雯,周红.逍遥助卵煎对卵巢早衰患者血清性激素水平的影响[J].中国妇幼保健,2007,22(33):4687-4688.
[34]梁莹,赵胜男,常秀峰,等.逍遥丸对人卵巢壁颗粒细胞ALK5/Smads通路的影响[J].中医杂志,2013,54(9):754-757.
[35]孙忻,丁彩飞,杨欣,等.补肾调肝方对非肥胖型多囊卵巢综合征患者糖脂代谢的影响[J].中国中西医结合杂志,2017,37(5):530-533.
[36]张慧珍,张霄.补肾疏肝中药联合克罗米芬助进小卵泡发育治疗[J].世界科学技术-中医药现代化,2013,15(7):1616-1619.