中医周期疗法治疗不孕症的现代临床文献研究
摘要
目的：
以关于“中医周期疗法治疗不孕症”的文献为研究对象,通过较全面地搜集翻查由1990年至2010年有关中医周期疗法治疗不孕症的文献综述及临床研究报道,运用、归纳及分析方法侧重证—法—方—药关联的角度,冀能探索归纳出各医家应用中医周期疗法对不孕症辩证方法的规律,不孕症不同证型、不同分期调治的核心用药,因证用药的规律,中医周期疗法对不孕症的疗效评价,为今后临床研究提供更多的客观资料,提高临床治疗水平和疗效。
方法：
以“中医周期疗法”、“中药人工周期”、“不孕症”、“中文文献”为关键词(KEY WORD)检索1990年1月至2010年12月的中国期刊全文数据库(CNKI)、中国医学科学院的中国生物医学光盘(CBM disc)、维普期刊数据库(中文科技期刊数据库VIP)、万方数据库和Pubmed医学文献检索服务系统、以及香港大学图书馆和香港中央图书馆中有关“中医周期疗法治疗不孕症”的文献资料。对纳入文献按文中所涉及的不孕症类型进行分类,并对所有纳入文献进行质量评价,将文献分为三组：优质组、中等组及质量较差组。将所有纳入文献中治则治法、代表方剂、具体药物等数据的规范化,并在EXCEL表格中建立数据库进行分析、统计,总结、归纳、比较各类型不孕症在不同月经周期阶段的治则治法、代表方剂、药物以及中医周期疗法的疗效。
结果：
1.各类型不孕症周期分治治法治则：
(1)排卵障碍所致各类型不孕其经后期治法多以滋阴养血,补肾填精、滋肾疏肝为主；经间期多以温阳滋阴、补肾益气、活血通络为主,以促进卵子排出；经前期多以补肾温阳,滋阴益精、益气养血为主,唯黄体功能不健／全性不孕本期除补肾温阳外,尚需疏肝解郁；而多囊卵巢综合症性不孕除温经活血外,另需燥湿化痰祛瘀。
(2)盆腔因素不孕治疗以活血化瘀为大法,四期治法中均以活血化瘀为重点,并于经后期佐以补肾益气,经间期佐以理气通络,经前期佐以补肾温阳；行经期佐以疏肝解郁,补肾调经。
(3)免疫性不孕经后期健脾补肾,益气养血；经间期平调阴阳；经前期补肾助阳、滋肾健脾；行经期温经养血,活血调经。
2.各类型不孕症各周期代表方剂：
(1)排卵障碍因素所致不孕
经后期肾虚型的代表方为左归丸、二至地黄汤、五子衍宗丸、十全济阴煎、归芍左归丸、八珍汤、六味地黄丸、金匮肾气丸、温经汤等；痰湿型代表方：苍附导痰丸；肝郁型代表方：开郁种玉汤；气血两虚型代表方：六五四二合剂。
经间期肾虚型代表方：右归饮、归芍左归丸合二至丸；痰湿型代表方：祛痰种玉汤；肝郁型代表方：一贯煎合化肝煎；气血两虚型代表方：补中益气汤、归脾汤。
经前期肾虚型代表方：二仙温经汤、毓麟珠、宽带汤、并提汤《傅青主女科》,知柏地黄丸合大补煎丸、寿胎丸、艾附养阴丸《济阴纲目》；痰湿型代表方：越鞠二陈汤；肝郁型代表方：丹栀逍遥散；气血两虚型代表方：毓麟珠加减。
行经期肾虚型代表方：益母草汤,少腹逐瘀汤、桃红四物汤；痰湿型代表方：越鞠丸、启宫丸、五味调经散；肝郁型代表方：逍遥散；气血两虚型代表方：桃红四物汤、失笑散、补中益气汤、香砂六君子汤、归脾汤。
(2)盆腔因素所致不孕
经后期肾虚血瘀型的代表方为肾气丸合桃红四物汤；气滞血瘀型代表方：行滞化瘀种子汤；气虚血瘀型代表方：理中汤合八珍汤；痰瘀互结型代表方：桂枝伕苓丸合归脾汤；寒凝血瘀型代表方：温经汤、失笑散。
经间期肾虚血瘀型的代表方为二仙路路汤；气滞血瘀型代表方：血府逐瘀汤；气虚血瘀型代表方：血府逐瘀汤合补中益气汤；痰瘀互结型代表方：桂枝茯苓丸合橘核丸；寒凝血瘀型代表方：少腹逐瘀汤。
经前期肾虚血瘀型的代表方为归脾汤和肾气丸；气滞血瘀型代表方：开郁种玉汤；气虚血瘀型代表方：补中益气汤；代表方：越鞠二陈汤；寒凝血瘀型代表方：艾叶暖宫汤合肾气丸。
行经期各型主要选用少腹逐瘀汤或桃红四物汤,唯痰瘀互结型兼用苍附导痰丸。
(3)免疫性不孕
3.不孕症中医周期疗法涉及中药16类,共152味,其中使用频数最多的是补虚药(46味),共3268次；第二位是活血化瘀药(29味)1205次；第三位是清热药(15味)330次。治疗不孕症的常用药物,多采用补肾养血、活血化瘀、清热凉血、温里散寒、理气调经之品,选药以味苦、甘、辛,性温及微温为多。以味苦和味甘的药物最多,各占32.52%,味苦之药物,多集中于活血化瘀药、清热药及理气药；味甘之药物,多集中于补虚药。味辛之药物居第二位,占19.90%,多集中于活血化瘀药、理气药及温里药；味咸之药物居第三位,占8.74%,多集中于活血化瘀药及补虚药。药物归经方面,取归属肝经的药物最多,占29.81%,多集中于活血化瘀药及补阳药；归属肾经之药物居第二位,占23.40%,多集中于补阳滋阴药；归属脾经之药物居第三位,占18.11%,多集中于理气药、活血化瘀药及补气药。
4.综合各不同类型不孕症原方中之用药,按药物使用频次,由高至低顺序排列首21位药物为：当归、菟丝子、熟地、香附、白芍、山药、仙灵脾、枸杞子、川芎、紫丹参、女贞子、赤芍、续断、山茱萸、茯苓、巴戟天、红花、泽兰、仙茅、益母草、牛膝等。21味常用药物在不同周期中使用频次,由高至低顺序排列,分别为：
(1)经后期：当归、熟地、菟丝子、山药、女贞子、白芍、枸杞子、山茱萸、仙灵脾、香附；
(2)经间期：当归、菟丝子、紫丹参、熟地、香附、红花、仙灵脾、赤芍、川芎、泽兰；
(3)经前期：菟丝子、当归、熟地、仙灵脾、川断、山药、白芍、枸杞子、仙茅、巴戟天；
(4)行经期：当归、香附、川芎、益母草、赤芍、紫丹参、泽兰、熟地、菟丝子。
5.中医周期疗法对于黄体功能不健/全性不孕、排卵功能障碍性不孕、卵巢早衰/卵巢功能减退性不孕、多囊卵巢综合症性不孕等,其妊娠率分别为62.16%、61.14%、58.08%、55.51%。对于子宫内膜异位性不孕、输卵管阻塞性不孕及免疫性不孕,其妊娠率分别为51.71%、39.39%及43.64%。各类型不孕的妊娠率均优于对照组(P<0.05),有显著的差异。其中,中医周期疗法对排卵障碍因素所致不孕的疗效优于盆腔因素及免疫因素所致不孕的疗效。各类性不孕症中,黄体功能不健／全及排卵功能障碍性不孕的疗效较佳,而输卵管阻塞性不孕的疗效则较差。
结论：
1、中医周期疗法对各种类型不孕症均有较好的疗效。其中,排卵因素所致不孕,如黄体功能不全、排卵功能障碍、卵巢早衰／卵巢功能减退、多囊卵巢综合征等,其妊娠率分别是62.16%、61.14%、58.08%及55.51%；盆腔因素所致不孕,如子宫内膜异位症和输卵管阻塞,其妊娠率分别为51.71%、39.39%；免疫性不孕,妊娠率为43.64%。各类型不孕症的妊娠率均优于对照组(P<0.05),有显著性差异。
2、不孕症中医周期疗法在经后期、经间期、经前期及行经期用药频数最高的药味,分别为：
经后期：当归、熟地、菟丝子、山药、女贞子、白芍、枸杞子、山茱萸；
经间期：当归、菟丝子、紫丹参、熟地、香附、红花、仙灵脾、赤芍；
经前期：菟丝子、当归、熟地、仙灵脾、川断、山药、白芍、枸杞子；
行经期：当归、香附、川芎、益母草、赤芍、紫丹参、泽兰、熟地。
3、各种类型不孕症在经后期、经间期、经前期及行经期的治法各有其特点：
排卵功能障碍：经后期滋肾养血,补肾益精；经间期补肾助阳,行气活血；经前期滋肾助阳,暖宫助孕；行经期活血化瘀,理气调经。
黄体功能不全：经后期滋肾养血,助阳补精；经间期滋肾温阳,活血通络；经前期补肾疏肝,暖宫助孕；行经期疏肝理行,活血调经。
多囊卵巢综合征：经后期补肾填精,滋阴养血；经间期益气活血,温肾通络；经前期补肾助阳,暖宫助孕；行经期燥湿化瘀,活血通经。
卵巢早衰/卵巢功能减退：经后期温肾填精,滋阴养血；经间期养血活血,疏调冲任；经前期温肾益精,补肾助阳行经期：疏肝理气,活血通经
子宫内膜异位症：经后期补肾益气,活血祛瘀,疏肝通络；经间期补肾活血通络,疏肝理气祛瘀；经前期温肾助阳,养血活血；行经期补肾活血,疏肝解郁,化瘀消癥。
输卵管阻塞：以活血祛瘀为大法,除经后期滋阴养血,补肾调经外,其余三期均以活血化瘀为主。经间期活血化瘀,清利通络；经前期活血化瘀,补肾助阳,益气养血；行经期疏肝理气,化瘀通络,活血调经。
免疫性不孕：经后期健脾补肾,养血活血,调冲为主,增强免疫力；经间期补肾养血,活血促排卵；经前期补肾助阳,滋肾健脾,益气养血,疏达调气；行经期温经养血,活血调经。
Object ive
On the basis of systematic review on the recent20years'clinical research literature about aciesis treatment with TCM Cycle Therapy, this thesis discusses the syndrome differentiation laws, the medication regulations for each syndrome type and phase and the curative efficacy from the holistic angle of syndrome, therapy, prescription and medicine.
Methods
Collect the literature about aciesis treatment with TCM Cycle Therapy from CNKI, CBM disc, VIP database, WANFANG Data, Pubmed, Hong Kong University Library and Hong Kong Central Library dated from January1990to December2010. Classify the literature according to the aciesis types. Conduct the quality analysis about the literature and classify them into three groups:good quality group, medium quality group and poor quality group. Standardize the data about treatment principle and method, representative prescription and medicine, etc. and establish a database to summarize and compare the treatment principles and methods, representative prescriptions, medicine and curative efficacy of TCM Cycle Therapy for aciesis of different types at different phases of menstruation cycle.
Results:
1. Treatment Principle and Method for Different Types of Aciesis at Different Phases
(1) For aciesis due to ovulation difficulties:the postmenstrual treatment is mainly to nourish yin and blood, reinforce the kidney and vital essence and nourish the kidney and sooth the liver; the intermenstruum treatment is mainly to warm yang and nourish yin, reinforce the kidney and qi as well as invigorate blood circulation and the collaterals so as to promote the ovulation; the premenstrual treatment is mainly to reinforce the kidney and warm yang, nourish yin and the vital essence as well as replenish qi and blood. In this phase, for aciesis due to luteal phase defect, soothing the liver and relieving the qi stagnation are required besides reinforcing kidney and warming yang; for aciesis due to polycystic ovarian syndrome, eliminating dampness, reducing phlegm and removing blood stasis is further required besides warming collaterals and invigorating blood circulation.
(2) For aciesis due to pelvic cavity factors, invigorating blood circulation and removing blood stasis is the major therapy which is the focus for four phases. Reinforcing kidney qi is added during the postmenstruation phase; regulating qi and activating channels for intermenstruum phase; reinforcing kidney and warming yang for the premenstruation phase; relieving depression by soothing liver and reinforcing the kidney qi to regulate menstruation for the menstruation phase.
(3) For immune aciesis, reinforcing spleen and kidney and replenishing qi and blood are required for the postmenstruation phase; balancing yin and yang for intermenstruum phase; replenishing kidney yang and nourishing kidney and spleen for premenstruation phase; warming collaterals, nourishing and invigorating blood and regulating menstruation for menstruation phase.
2. Representative Formulae for Different Phases of Different Types of Aciesis
(1) Aciesis due to Ovulation Difficulties
The representative prescriptions for the postmenstrual type of kidney deficiency are Kidney-yin Reinforcing Pill, Decoction of Glossy Privet Fruit, I'clipta and Rehmannia, Five Seeds Combo Pills, Ten-ingredient Reinforcing Yin Decoction, Kidney-yin Reinforcing Pill of Chinese Angelica and Red Peony, Eight-gem Decoction, Pill of Six Ingredients with Rehmannia, Golden-chamber Kidney-qi Pill, Decoction for Warming Channels, etc; the representative prescription for phlegmatic dampness is Atractylodes and Cyperus Phlegm-abducting Pill; the representative prescription for liver-qi stagnation is Conceptive Decoction by Soothing the Liver; the representative prescription for qi and blood deficiency is Six-five-four-two Composition.
The representative prescriptions for the intermenstruum type of kidney deficiency are Kidney-yang Reinforcing Decoction, Kidney-yin Reinforcing Pill of Chinese Angelica and Red Peony plus Glossy Privet Fruit and Eclipta Pill; the representative prescription for phlegmatic dampness is Conceptive Decoction by Removing Phlegm; the representative prescriptions for liver stagnation are Decoction for Nourishing the Liver and Kidney plus Decoction for Eliminating Pathogenic Heat from Liver; the representative prescriptions for qi and blood deficiency are Decoction for Reinforcing Middle-warmer and Replenishing Qi and Spleen-invigorating Decoction.
The representative prescriptions for the premenstruation type of kidney deficiency are Decoction for Warming Channels with Curculigo and Epimedium, Conceptive Pill, Decoction for Soothing the Belt Channel, Bing Ti Decoction for Replenishing Kidney Qi, Spleen and Stomach (Fu Qing-Zhu's Obstetrics and Gynecology), Pill of Anemarrhena, Phellodendron and Rehmannia plus Powerfully Tonifying Pill, Miscarriage Prevention Bolus, Pill of Argyi Leaf and Cyperus for Nourishing Yin (Synopsis of Treating Women's Diseases); the representative prescription for phlegmatic dampness is Decoction with Two Old Drugs for Relieving Stagnancy; the representative prescription for liver stagnation is Ease Powder Added with Moutan Bark and Cape jasmine Fruit; the representative prescription for qi and blood deficiency is modified Conceptive Pill.
The representative prescriptions for the type of kidney deficiency during menstruation are Motherwort Decoction, Decoction for Dissipating Blood Stasis in Lower Abdomen and Peach Kernel and Safflower Decoction of Four Ingredients; the representative prescriptions for the type of phlegmatic dampness are Pill for Relieving Stagnancy, Pill for Opening the Uterus and Five-flavor Powder for Regulating Menstruation; the representative prescriptions for the type of liver stagnation is Ease Powder; the representative prescriptions for the type of qi and blood deficiency are Peach Kernel and Safflower Decoction of Four Ingredients, Wonderful Powder for Relieving Blood Stagnation, Decoction for Reinforcing Middle-warmer and Replenishing Qi, Decoction with Six Ingredients Including Costus and Amomum and Spleen-invigorating Decoction.
(2) Aciesis due to Pelvic Factors
The representative prescription for the postmenstrual type of kidney deficiency and blood stagnation is Kidney-qi Pill plus Peach Kernel and Safflower Decoction of Four Ingredients; the representative prescription for the qi and blood stagnation is Decoction for Removing Blood Stasis; the representative prescription for the qi deficiency and blood stagnation is Decoction for Regulating the Function of the Middle-Warmer plus Eight-gem Decoction; the representative prescription for the phlegm and blood stagnation is Cinnamon Twig and Poria Pill plus Spleen-invigorating Decoction; the representative prescriptions for the blood stagnation due to cold accumulation are Decoction for Warming Channels and Wonderful Powder for Relieving Blood Stagnation.
The representative prescription for the intermenstruum type of kidney deficiency and blood stagnation is Decoction of Curculigo and Epimedium; the representative prescription for the qi and blood stagnation is Blood-mansion Stasis-dispelling Decoction; the representative prescription for the qi deficiency and blood stagnation is Blood-mansion Stasis-dispelling Decoction plus Decoction for Reinforcing Middle-warmer and Replenishing Qi; the representative prescription for the phlegm and blood stagnation is Cinnamon Twig and Poria Pill plus Tangerine Seed Pill; the representative prescription for the blood stagnation due to cold accumulation is Decoction for Dissipating Blood Stasis in Lower Abdomen.
The representative prescriptions for the premenstruation type of kidney deficiency and blood stagnation are Spleen-invigorating Decoction and Kidney-qi Pill; the representative prescription for the qi and blood stagnation is Conceptive Decoction by Soothing the Liver; the representative prescription for the qi deficiency and blood stagnation is Decoction for Reinforcing Middle-warmer and Replenishing Qi; the representative prescription for the phlegm and blood stagnation is Decoction with Two Old Drugs for Relieving Stagnancy; the representative prescription for the blood stagnation due to cold accumulation is Argyi Leaf Decoction for Warming Uterus plus Kidney-qi Pill.
Decoction for Dissipating Blood Stasis in Lower Abdomen or Peach Kernel and Safflower Decoction of Four Ingredients is adopted for each type during menstruation, except that for phlegm and blood stagnation, Atractylodes and Cyperus Phlegm-abducting Pill can be added.
(3) Immune Aciesis
3. The TCM Cycle Therapy for aciesis involves152varieties of herbal medicine, belonging to16categories. The most frequently used are tonifying-deficiency medicine (46varieties) used3286times; the second are medicine for invigorating blood circulation and removing blood stasis (29varieties) used1205times; the third are medicine for eliminating fever (15varieties) used330times. The common medicine for aciesis are mainly to replenish kidney and blood, invigorate blood circulation and relieve blood stasis, eliminate fever and cool blood, warm the internal to dissipate coldness and regulate qi and menstruation. They are mainly bitter, sweet, and pungent in flavor and warm or mild warm in nature. Medicines of bitter and sweet flavor are of the largest number, accounting for32.52%respectively. Medicines with bitter flavor are mainly for invigorating blood circulation and removing blood stasis, eliminating the fever and regulating qi. Medicines with sweet flavor are mainly for tonifying deficiency. Medicine of pungent flavor takes the second place, accounting for19.90%, including mainly the medicine for invigorating blood circulation and removing blood stasis, regulating qi and warming the internal. Medicine of salty flavor takes the third place, accounting for8.74%, including mainly the medicine for invigorating blood circulation, removing blood stasis and tonifying deficiency. About the attributive channels, medicine acting on the liver channel takes the largest percentage, accounting for29.81%of the total which is mainly for invigorating blood circulation, removing blood stasis and reinforcing yang. Medicine acting on the kidney channel takes the second place, accounting for23.40%which is mainly for reinforcing yang and nourishing yin. Medicine acting on spleen channel takes the third place, accounting for18.11%which is mainly for regulating qi, invigorating blood circulation, removing blood stasis and reinforcing qi.
4. Summarizing the herbal medicine in the original prescriptions for aciesis of different types, the author ranks the first21according to the frequency of usage:angelica, cuscuta seed, prepared rhizome of rehmannia, nutgrass galingale rhizome, white peony root, Chinese yam, herba epimedii, barbary wolfberry fruit, szechwan lovage rhizome, radix salviae miltiorrhizae, glossy privet fruit, paeoniae radix, radix dipsaci, red osier, hoelen, morinda root, flos carthami, eupatorium, rhizoma curculiginis, Motherwort, radix achyranthis, etc. According to the usage frequency in different cycles, the author ranks these21frequently used herbal medicines as follows:
(1) Postmenstrual phase:angelica, prepared rhizome of rehmannia, cuscuta seed, Chinese yam, glossy privet fruit, white peony root, barbary wolfberry fruit, red osier, herba epimedii, nutgrass galingale rhizome.
(2) Interstruum phase:angelica, cuscuta seed, radix salviae miltiorrhizae, prepared rhizome of rehmannia, nutgrass galingale rhizome, flos carthami, herba epimedi, paeoniae radix, szechwan lovage rhizome, eupatorium.
(3) Premenstruation phase:cuscuta seed, angelica, prepared rhizome of rehmannia, herba epimedii, radix dispaci from Sichuan of China, Chinese yam, white peony root, barbary wolfberry fruit, rhizome curculiginis, morinda root.
(4) Menstruation phase:angelica, nutgrass galingale rhizome, szechwan lovage rhizome, Motherwort, paeoniae radix, radix salviae miltiorrhizae, eupatorium, prepared rhizome of rehmannia, cuscuta seed.
4. It is observed that the pregnancy rates are62.16%,61.14%,58.08%and55.51%respectively for aciesis due to luteal phase defect, aciesis due to ovulation difficulties, aciesis due to premature ovarian failure/hypovaria, aciesis due to polycystic ovary, etc. The pregnancy rates are51.71%,39.39%and43.64%respectively for aciesis due to adenomyosis, aciesis due to salpingemphraxis, and aciesis due to immune factors. The pregnancy rates of different types of aciesis are superior to those of the Control Group and there's significant difference (P<0.05). The efficacy of TCM Cycle Therapy in the treatment of aciesis due to ovulation difficulties is superior to those due to pelvic or immune factors. Among all types of aciesis, TCM Cycle Therapy has better curative effect for aciesis due to luteal phase defect and ovulation difficulties, while it has poor effect for aciesis due to salpingemphraxis.
Conclusion
1. TCM Cycle Therapy has good curative effect for all types of aciesis. It is observed that the pregnancy rates are62.16%,61.14%,58.08%and55.51%respectively for aciesis due to ovulation factors, including luteal phase defect, ovulation difficulties, premature ovarian failure/hypovaria, and polycystic ovarian syndrome, etc. The pregnancy rates are51.71%and39.39%for aciesis due to pelvic factors including adenomyosis and salpingemphraxis. The pregnancy rate is43.64%for aciesis due to immune factors. The pregnancy rates of different types of aciesis are superior to those of the Control Group and there's significant difference (P<0.05).
2. The most frequently used herbal medicines in the postmenstrual, intermenstruum, premenstrual and menstruation phases with TCM Cycle Therapy are listed as follows: Postmenstrual phase:angelica, prepared rhizome of rehmannia, cuscuta seed, Chinese yam, glossy privet fruit, white peony root, barbary wolfberry fruit, red osier Intermenstruum phase:angelica, cuscuta seed, radix salviae miltiorrhizae, prepared rhizome of rehmannia, nutgrass galingale rhizome, flos carthami, herba epimedi, paeoniae radix Premenstrual phase:cuscuta seed, angelica, prepared rhizome of rehmannia, herba epimedii, radix dispaci from Sichuan of China, Chinese yam, white peony root, barbary wolfberry fruit Menstruation phase:angelica, nutgrass galingale rhizome, szechwan lovage rhizome, Motherwort, paeoniae radix, radix salviae miltiorrhizae, eupatorium, prepared rhizome of rehmannia
3. Unique features are demonstrated in the treatment of various types of aciesis at postmenstrual, intermenstruum, premenstrual and menstruation phases.
Ovulation difficulties:nourishing yin and blood and replenishing kidney and vital essence are prescribed for postmenstrual phase; replenishing kidney and yang and invigorating qi and blood circulation for intermenstruum phase; nourishing kidney and yang and warming the uterus for the premenstrual phase; invigorating blood circulation, dissipating blood stasis and regulating qi and menstruation for menstruation phase.
Luteal phase defect:nourishing kidney and blood and replenishing yang and vital essence are prescribed for postmenstrual phase; replenishing kidney, warming yang and invigorating blood circulation and collaterals for intermenstruum phase; nourishing kidney, soothing liver and warming the uterus for the premenstrual phase; soothing liver, invigorating blood circulation and regulating menstruation for menstruation phase.
Polycystic ovarian syndrome:replenishing kidney and vital essence and nourishing yin and blood are prescribed for postmenstrual phase; invigorating qi and blood circulation, warming kidney and activating collaterals for intermenstruum phase; nourishing kidney and yang and warming the uterus for the premenstrual phase; eliminating dampness, dissipating blood stasis, invigorating blood circulation, and promoting menstruation for menstruation phase.
Premature ovarian failure/hypovaria:warming kidney and vital essence and nourishing yin and blood are prescribed for postmenstrual phase; nourishing blood, invigorating blood circulation, and regulating Chong and Ren Collaterals for intermenstruum phase; warming kidney, reinforcing yang and replenishing kidney for the premenstrual phase; soothing liver, regulating qi, invigorating blood circulation and promoting menstruation for menstruation phase.
Endometriosis:replenishing kidney and qi, invigorating blood circulation, eliminating blood stasis, soothing liver and activating collaterals are prescribed for postmenstrual phase; invigorating blood circulation, activating collaterals, soothing liver, regulating qi and eliminating blood stasis for intermenstruum phase; warming kidney, reinforcing yang and replenishing blood and invigorating blood circulation for the premenstrual phase; replenishing kidney, invigorating blood circulation, soothing liver, dispersing the depressed qi, removing blood stasis and eliminating tumor for menstruation phase.
Salpingemphraxis:Invigorating blood circulation and dissipating blood stasis are the major therapy which is applied at the three phases except the postmenstrual phase. Nourishing yin and blood, reinforcing kidney and regulating menstruation are prescribed for the postmenstrual phase; invigorating blood circulation, dissipating blood stasis and activating collaterals for intermenstruum phase; invigorating blood circulation, dissipating blood stasis, replenishing kidney and yang, reinforcing qi and nourishing blood for premenstrual phase; soothing liver, regulating qi, dissipating blood stasis, activating collaterals, invigorating blood circulation and regulating menstruation for menstruation phase.
Immune aciesis:replenishing spleen and kidney, invigorating blood circulation, nourishing blood and regulating Chong collateral to improve the immunity are prescribed for postmenstrual phase; replenishing kidney, nourishing blood and invigorating blood circulation to improve ovulation for intermenstruum phase; reinforcing kidney and yang, nourishing kidney and spleen, replenishing qi and blood and regulating qi for the premenstrual phase; warming collaterals, nourishing blood, invigorating blood circulation and regulating menstruation for menstruation phase.
以关于“中医周期疗法治疗不孕症”的文献为研究对象,通过较全面地搜集翻查由1990年至2010年有关中医周期疗法治疗不孕症的文献综述及临床研究报道,运用、归纳及分析方法侧重证—法—方—药关联的角度,冀能探索归纳出各医家应用中医周期疗法对不孕症辩证方法的规律,不孕症不同证型、不同分期调治的核心用药,因证用药的规律,中医周期疗法对不孕症的疗效评价,为今后临床研究提供更多的客观资料,提高临床治疗水平和疗效。
方法：
以“中医周期疗法”、“中药人工周期”、“不孕症”、“中文文献”为关键词(KEY WORD)检索1990年1月至2010年12月的中国期刊全文数据库(CNKI)、中国医学科学院的中国生物医学光盘(CBM disc)、维普期刊数据库(中文科技期刊数据库VIP)、万方数据库和Pubmed医学文献检索服务系统、以及香港大学图书馆和香港中央图书馆中有关“中医周期疗法治疗不孕症”的文献资料。对纳入文献按文中所涉及的不孕症类型进行分类,并对所有纳入文献进行质量评价,将文献分为三组：优质组、中等组及质量较差组。将所有纳入文献中治则治法、代表方剂、具体药物等数据的规范化,并在EXCEL表格中建立数据库进行分析、统计,总结、归纳、比较各类型不孕症在不同月经周期阶段的治则治法、代表方剂、药物以及中医周期疗法的疗效。
结果：
1.各类型不孕症周期分治治法治则：
(1)排卵障碍所致各类型不孕其经后期治法多以滋阴养血,补肾填精、滋肾疏肝为主；经间期多以温阳滋阴、补肾益气、活血通络为主,以促进卵子排出；经前期多以补肾温阳,滋阴益精、益气养血为主,唯黄体功能不健／全性不孕本期除补肾温阳外,尚需疏肝解郁；而多囊卵巢综合症性不孕除温经活血外,另需燥湿化痰祛瘀。
(2)盆腔因素不孕治疗以活血化瘀为大法,四期治法中均以活血化瘀为重点,并于经后期佐以补肾益气,经间期佐以理气通络,经前期佐以补肾温阳；行经期佐以疏肝解郁,补肾调经。
(3)免疫性不孕经后期健脾补肾,益气养血；经间期平调阴阳；经前期补肾助阳、滋肾健脾；行经期温经养血,活血调经。
2.各类型不孕症各周期代表方剂：
(1)排卵障碍因素所致不孕
经后期肾虚型的代表方为左归丸、二至地黄汤、五子衍宗丸、十全济阴煎、归芍左归丸、八珍汤、六味地黄丸、金匮肾气丸、温经汤等；痰湿型代表方：苍附导痰丸；肝郁型代表方：开郁种玉汤；气血两虚型代表方：六五四二合剂。
经间期肾虚型代表方：右归饮、归芍左归丸合二至丸；痰湿型代表方：祛痰种玉汤；肝郁型代表方：一贯煎合化肝煎；气血两虚型代表方：补中益气汤、归脾汤。
经前期肾虚型代表方：二仙温经汤、毓麟珠、宽带汤、并提汤《傅青主女科》,知柏地黄丸合大补煎丸、寿胎丸、艾附养阴丸《济阴纲目》；痰湿型代表方：越鞠二陈汤；肝郁型代表方：丹栀逍遥散；气血两虚型代表方：毓麟珠加减。
行经期肾虚型代表方：益母草汤,少腹逐瘀汤、桃红四物汤；痰湿型代表方：越鞠丸、启宫丸、五味调经散；肝郁型代表方：逍遥散；气血两虚型代表方：桃红四物汤、失笑散、补中益气汤、香砂六君子汤、归脾汤。
(2)盆腔因素所致不孕
经后期肾虚血瘀型的代表方为肾气丸合桃红四物汤；气滞血瘀型代表方：行滞化瘀种子汤；气虚血瘀型代表方：理中汤合八珍汤；痰瘀互结型代表方：桂枝伕苓丸合归脾汤；寒凝血瘀型代表方：温经汤、失笑散。
经间期肾虚血瘀型的代表方为二仙路路汤；气滞血瘀型代表方：血府逐瘀汤；气虚血瘀型代表方：血府逐瘀汤合补中益气汤；痰瘀互结型代表方：桂枝茯苓丸合橘核丸；寒凝血瘀型代表方：少腹逐瘀汤。
经前期肾虚血瘀型的代表方为归脾汤和肾气丸；气滞血瘀型代表方：开郁种玉汤；气虚血瘀型代表方：补中益气汤；代表方：越鞠二陈汤；寒凝血瘀型代表方：艾叶暖宫汤合肾气丸。
行经期各型主要选用少腹逐瘀汤或桃红四物汤,唯痰瘀互结型兼用苍附导痰丸。
(3)免疫性不孕
3.不孕症中医周期疗法涉及中药16类,共152味,其中使用频数最多的是补虚药(46味),共3268次；第二位是活血化瘀药(29味)1205次；第三位是清热药(15味)330次。治疗不孕症的常用药物,多采用补肾养血、活血化瘀、清热凉血、温里散寒、理气调经之品,选药以味苦、甘、辛,性温及微温为多。以味苦和味甘的药物最多,各占32.52%,味苦之药物,多集中于活血化瘀药、清热药及理气药；味甘之药物,多集中于补虚药。味辛之药物居第二位,占19.90%,多集中于活血化瘀药、理气药及温里药；味咸之药物居第三位,占8.74%,多集中于活血化瘀药及补虚药。药物归经方面,取归属肝经的药物最多,占29.81%,多集中于活血化瘀药及补阳药；归属肾经之药物居第二位,占23.40%,多集中于补阳滋阴药；归属脾经之药物居第三位,占18.11%,多集中于理气药、活血化瘀药及补气药。
4.综合各不同类型不孕症原方中之用药,按药物使用频次,由高至低顺序排列首21位药物为：当归、菟丝子、熟地、香附、白芍、山药、仙灵脾、枸杞子、川芎、紫丹参、女贞子、赤芍、续断、山茱萸、茯苓、巴戟天、红花、泽兰、仙茅、益母草、牛膝等。21味常用药物在不同周期中使用频次,由高至低顺序排列,分别为：
(1)经后期：当归、熟地、菟丝子、山药、女贞子、白芍、枸杞子、山茱萸、仙灵脾、香附；
(2)经间期：当归、菟丝子、紫丹参、熟地、香附、红花、仙灵脾、赤芍、川芎、泽兰；
(3)经前期：菟丝子、当归、熟地、仙灵脾、川断、山药、白芍、枸杞子、仙茅、巴戟天；
(4)行经期：当归、香附、川芎、益母草、赤芍、紫丹参、泽兰、熟地、菟丝子。
5.中医周期疗法对于黄体功能不健/全性不孕、排卵功能障碍性不孕、卵巢早衰/卵巢功能减退性不孕、多囊卵巢综合症性不孕等,其妊娠率分别为62.16%、61.14%、58.08%、55.51%。对于子宫内膜异位性不孕、输卵管阻塞性不孕及免疫性不孕,其妊娠率分别为51.71%、39.39%及43.64%。各类型不孕的妊娠率均优于对照组(P<0.05),有显著的差异。其中,中医周期疗法对排卵障碍因素所致不孕的疗效优于盆腔因素及免疫因素所致不孕的疗效。各类性不孕症中,黄体功能不健／全及排卵功能障碍性不孕的疗效较佳,而输卵管阻塞性不孕的疗效则较差。
结论：
1、中医周期疗法对各种类型不孕症均有较好的疗效。其中,排卵因素所致不孕,如黄体功能不全、排卵功能障碍、卵巢早衰／卵巢功能减退、多囊卵巢综合征等,其妊娠率分别是62.16%、61.14%、58.08%及55.51%；盆腔因素所致不孕,如子宫内膜异位症和输卵管阻塞,其妊娠率分别为51.71%、39.39%；免疫性不孕,妊娠率为43.64%。各类型不孕症的妊娠率均优于对照组(P<0.05),有显著性差异。
2、不孕症中医周期疗法在经后期、经间期、经前期及行经期用药频数最高的药味,分别为：
经后期：当归、熟地、菟丝子、山药、女贞子、白芍、枸杞子、山茱萸；
经间期：当归、菟丝子、紫丹参、熟地、香附、红花、仙灵脾、赤芍；
经前期：菟丝子、当归、熟地、仙灵脾、川断、山药、白芍、枸杞子；
行经期：当归、香附、川芎、益母草、赤芍、紫丹参、泽兰、熟地。
3、各种类型不孕症在经后期、经间期、经前期及行经期的治法各有其特点：
排卵功能障碍：经后期滋肾养血,补肾益精；经间期补肾助阳,行气活血；经前期滋肾助阳,暖宫助孕；行经期活血化瘀,理气调经。
黄体功能不全：经后期滋肾养血,助阳补精；经间期滋肾温阳,活血通络；经前期补肾疏肝,暖宫助孕；行经期疏肝理行,活血调经。
多囊卵巢综合征：经后期补肾填精,滋阴养血；经间期益气活血,温肾通络；经前期补肾助阳,暖宫助孕；行经期燥湿化瘀,活血通经。
卵巢早衰/卵巢功能减退：经后期温肾填精,滋阴养血；经间期养血活血,疏调冲任；经前期温肾益精,补肾助阳行经期：疏肝理气,活血通经
子宫内膜异位症：经后期补肾益气,活血祛瘀,疏肝通络；经间期补肾活血通络,疏肝理气祛瘀；经前期温肾助阳,养血活血；行经期补肾活血,疏肝解郁,化瘀消癥。
输卵管阻塞：以活血祛瘀为大法,除经后期滋阴养血,补肾调经外,其余三期均以活血化瘀为主。经间期活血化瘀,清利通络；经前期活血化瘀,补肾助阳,益气养血；行经期疏肝理气,化瘀通络,活血调经。
免疫性不孕：经后期健脾补肾,养血活血,调冲为主,增强免疫力；经间期补肾养血,活血促排卵；经前期补肾助阳,滋肾健脾,益气养血,疏达调气；行经期温经养血,活血调经。
Object ive
On the basis of systematic review on the recent20years'clinical research literature about aciesis treatment with TCM Cycle Therapy, this thesis discusses the syndrome differentiation laws, the medication regulations for each syndrome type and phase and the curative efficacy from the holistic angle of syndrome, therapy, prescription and medicine.
Methods
Collect the literature about aciesis treatment with TCM Cycle Therapy from CNKI, CBM disc, VIP database, WANFANG Data, Pubmed, Hong Kong University Library and Hong Kong Central Library dated from January1990to December2010. Classify the literature according to the aciesis types. Conduct the quality analysis about the literature and classify them into three groups:good quality group, medium quality group and poor quality group. Standardize the data about treatment principle and method, representative prescription and medicine, etc. and establish a database to summarize and compare the treatment principles and methods, representative prescriptions, medicine and curative efficacy of TCM Cycle Therapy for aciesis of different types at different phases of menstruation cycle.
Results:
1. Treatment Principle and Method for Different Types of Aciesis at Different Phases
(1) For aciesis due to ovulation difficulties:the postmenstrual treatment is mainly to nourish yin and blood, reinforce the kidney and vital essence and nourish the kidney and sooth the liver; the intermenstruum treatment is mainly to warm yang and nourish yin, reinforce the kidney and qi as well as invigorate blood circulation and the collaterals so as to promote the ovulation; the premenstrual treatment is mainly to reinforce the kidney and warm yang, nourish yin and the vital essence as well as replenish qi and blood. In this phase, for aciesis due to luteal phase defect, soothing the liver and relieving the qi stagnation are required besides reinforcing kidney and warming yang; for aciesis due to polycystic ovarian syndrome, eliminating dampness, reducing phlegm and removing blood stasis is further required besides warming collaterals and invigorating blood circulation.
(2) For aciesis due to pelvic cavity factors, invigorating blood circulation and removing blood stasis is the major therapy which is the focus for four phases. Reinforcing kidney qi is added during the postmenstruation phase; regulating qi and activating channels for intermenstruum phase; reinforcing kidney and warming yang for the premenstruation phase; relieving depression by soothing liver and reinforcing the kidney qi to regulate menstruation for the menstruation phase.
(3) For immune aciesis, reinforcing spleen and kidney and replenishing qi and blood are required for the postmenstruation phase; balancing yin and yang for intermenstruum phase; replenishing kidney yang and nourishing kidney and spleen for premenstruation phase; warming collaterals, nourishing and invigorating blood and regulating menstruation for menstruation phase.
2. Representative Formulae for Different Phases of Different Types of Aciesis
(1) Aciesis due to Ovulation Difficulties
The representative prescriptions for the postmenstrual type of kidney deficiency are Kidney-yin Reinforcing Pill, Decoction of Glossy Privet Fruit, I'clipta and Rehmannia, Five Seeds Combo Pills, Ten-ingredient Reinforcing Yin Decoction, Kidney-yin Reinforcing Pill of Chinese Angelica and Red Peony, Eight-gem Decoction, Pill of Six Ingredients with Rehmannia, Golden-chamber Kidney-qi Pill, Decoction for Warming Channels, etc; the representative prescription for phlegmatic dampness is Atractylodes and Cyperus Phlegm-abducting Pill; the representative prescription for liver-qi stagnation is Conceptive Decoction by Soothing the Liver; the representative prescription for qi and blood deficiency is Six-five-four-two Composition.
The representative prescriptions for the intermenstruum type of kidney deficiency are Kidney-yang Reinforcing Decoction, Kidney-yin Reinforcing Pill of Chinese Angelica and Red Peony plus Glossy Privet Fruit and Eclipta Pill; the representative prescription for phlegmatic dampness is Conceptive Decoction by Removing Phlegm; the representative prescriptions for liver stagnation are Decoction for Nourishing the Liver and Kidney plus Decoction for Eliminating Pathogenic Heat from Liver; the representative prescriptions for qi and blood deficiency are Decoction for Reinforcing Middle-warmer and Replenishing Qi and Spleen-invigorating Decoction.
The representative prescriptions for the premenstruation type of kidney deficiency are Decoction for Warming Channels with Curculigo and Epimedium, Conceptive Pill, Decoction for Soothing the Belt Channel, Bing Ti Decoction for Replenishing Kidney Qi, Spleen and Stomach (Fu Qing-Zhu's Obstetrics and Gynecology), Pill of Anemarrhena, Phellodendron and Rehmannia plus Powerfully Tonifying Pill, Miscarriage Prevention Bolus, Pill of Argyi Leaf and Cyperus for Nourishing Yin (Synopsis of Treating Women's Diseases); the representative prescription for phlegmatic dampness is Decoction with Two Old Drugs for Relieving Stagnancy; the representative prescription for liver stagnation is Ease Powder Added with Moutan Bark and Cape jasmine Fruit; the representative prescription for qi and blood deficiency is modified Conceptive Pill.
The representative prescriptions for the type of kidney deficiency during menstruation are Motherwort Decoction, Decoction for Dissipating Blood Stasis in Lower Abdomen and Peach Kernel and Safflower Decoction of Four Ingredients; the representative prescriptions for the type of phlegmatic dampness are Pill for Relieving Stagnancy, Pill for Opening the Uterus and Five-flavor Powder for Regulating Menstruation; the representative prescriptions for the type of liver stagnation is Ease Powder; the representative prescriptions for the type of qi and blood deficiency are Peach Kernel and Safflower Decoction of Four Ingredients, Wonderful Powder for Relieving Blood Stagnation, Decoction for Reinforcing Middle-warmer and Replenishing Qi, Decoction with Six Ingredients Including Costus and Amomum and Spleen-invigorating Decoction.
(2) Aciesis due to Pelvic Factors
The representative prescription for the postmenstrual type of kidney deficiency and blood stagnation is Kidney-qi Pill plus Peach Kernel and Safflower Decoction of Four Ingredients; the representative prescription for the qi and blood stagnation is Decoction for Removing Blood Stasis; the representative prescription for the qi deficiency and blood stagnation is Decoction for Regulating the Function of the Middle-Warmer plus Eight-gem Decoction; the representative prescription for the phlegm and blood stagnation is Cinnamon Twig and Poria Pill plus Spleen-invigorating Decoction; the representative prescriptions for the blood stagnation due to cold accumulation are Decoction for Warming Channels and Wonderful Powder for Relieving Blood Stagnation.
The representative prescription for the intermenstruum type of kidney deficiency and blood stagnation is Decoction of Curculigo and Epimedium; the representative prescription for the qi and blood stagnation is Blood-mansion Stasis-dispelling Decoction; the representative prescription for the qi deficiency and blood stagnation is Blood-mansion Stasis-dispelling Decoction plus Decoction for Reinforcing Middle-warmer and Replenishing Qi; the representative prescription for the phlegm and blood stagnation is Cinnamon Twig and Poria Pill plus Tangerine Seed Pill; the representative prescription for the blood stagnation due to cold accumulation is Decoction for Dissipating Blood Stasis in Lower Abdomen.
The representative prescriptions for the premenstruation type of kidney deficiency and blood stagnation are Spleen-invigorating Decoction and Kidney-qi Pill; the representative prescription for the qi and blood stagnation is Conceptive Decoction by Soothing the Liver; the representative prescription for the qi deficiency and blood stagnation is Decoction for Reinforcing Middle-warmer and Replenishing Qi; the representative prescription for the phlegm and blood stagnation is Decoction with Two Old Drugs for Relieving Stagnancy; the representative prescription for the blood stagnation due to cold accumulation is Argyi Leaf Decoction for Warming Uterus plus Kidney-qi Pill.
Decoction for Dissipating Blood Stasis in Lower Abdomen or Peach Kernel and Safflower Decoction of Four Ingredients is adopted for each type during menstruation, except that for phlegm and blood stagnation, Atractylodes and Cyperus Phlegm-abducting Pill can be added.
(3) Immune Aciesis
3. The TCM Cycle Therapy for aciesis involves152varieties of herbal medicine, belonging to16categories. The most frequently used are tonifying-deficiency medicine (46varieties) used3286times; the second are medicine for invigorating blood circulation and removing blood stasis (29varieties) used1205times; the third are medicine for eliminating fever (15varieties) used330times. The common medicine for aciesis are mainly to replenish kidney and blood, invigorate blood circulation and relieve blood stasis, eliminate fever and cool blood, warm the internal to dissipate coldness and regulate qi and menstruation. They are mainly bitter, sweet, and pungent in flavor and warm or mild warm in nature. Medicines of bitter and sweet flavor are of the largest number, accounting for32.52%respectively. Medicines with bitter flavor are mainly for invigorating blood circulation and removing blood stasis, eliminating the fever and regulating qi. Medicines with sweet flavor are mainly for tonifying deficiency. Medicine of pungent flavor takes the second place, accounting for19.90%, including mainly the medicine for invigorating blood circulation and removing blood stasis, regulating qi and warming the internal. Medicine of salty flavor takes the third place, accounting for8.74%, including mainly the medicine for invigorating blood circulation, removing blood stasis and tonifying deficiency. About the attributive channels, medicine acting on the liver channel takes the largest percentage, accounting for29.81%of the total which is mainly for invigorating blood circulation, removing blood stasis and reinforcing yang. Medicine acting on the kidney channel takes the second place, accounting for23.40%which is mainly for reinforcing yang and nourishing yin. Medicine acting on spleen channel takes the third place, accounting for18.11%which is mainly for regulating qi, invigorating blood circulation, removing blood stasis and reinforcing qi.
4. Summarizing the herbal medicine in the original prescriptions for aciesis of different types, the author ranks the first21according to the frequency of usage:angelica, cuscuta seed, prepared rhizome of rehmannia, nutgrass galingale rhizome, white peony root, Chinese yam, herba epimedii, barbary wolfberry fruit, szechwan lovage rhizome, radix salviae miltiorrhizae, glossy privet fruit, paeoniae radix, radix dipsaci, red osier, hoelen, morinda root, flos carthami, eupatorium, rhizoma curculiginis, Motherwort, radix achyranthis, etc. According to the usage frequency in different cycles, the author ranks these21frequently used herbal medicines as follows:
(1) Postmenstrual phase:angelica, prepared rhizome of rehmannia, cuscuta seed, Chinese yam, glossy privet fruit, white peony root, barbary wolfberry fruit, red osier, herba epimedii, nutgrass galingale rhizome.
(2) Interstruum phase:angelica, cuscuta seed, radix salviae miltiorrhizae, prepared rhizome of rehmannia, nutgrass galingale rhizome, flos carthami, herba epimedi, paeoniae radix, szechwan lovage rhizome, eupatorium.
(3) Premenstruation phase:cuscuta seed, angelica, prepared rhizome of rehmannia, herba epimedii, radix dispaci from Sichuan of China, Chinese yam, white peony root, barbary wolfberry fruit, rhizome curculiginis, morinda root.
(4) Menstruation phase:angelica, nutgrass galingale rhizome, szechwan lovage rhizome, Motherwort, paeoniae radix, radix salviae miltiorrhizae, eupatorium, prepared rhizome of rehmannia, cuscuta seed.
4. It is observed that the pregnancy rates are62.16%,61.14%,58.08%and55.51%respectively for aciesis due to luteal phase defect, aciesis due to ovulation difficulties, aciesis due to premature ovarian failure/hypovaria, aciesis due to polycystic ovary, etc. The pregnancy rates are51.71%,39.39%and43.64%respectively for aciesis due to adenomyosis, aciesis due to salpingemphraxis, and aciesis due to immune factors. The pregnancy rates of different types of aciesis are superior to those of the Control Group and there's significant difference (P<0.05). The efficacy of TCM Cycle Therapy in the treatment of aciesis due to ovulation difficulties is superior to those due to pelvic or immune factors. Among all types of aciesis, TCM Cycle Therapy has better curative effect for aciesis due to luteal phase defect and ovulation difficulties, while it has poor effect for aciesis due to salpingemphraxis.
Conclusion
1. TCM Cycle Therapy has good curative effect for all types of aciesis. It is observed that the pregnancy rates are62.16%,61.14%,58.08%and55.51%respectively for aciesis due to ovulation factors, including luteal phase defect, ovulation difficulties, premature ovarian failure/hypovaria, and polycystic ovarian syndrome, etc. The pregnancy rates are51.71%and39.39%for aciesis due to pelvic factors including adenomyosis and salpingemphraxis. The pregnancy rate is43.64%for aciesis due to immune factors. The pregnancy rates of different types of aciesis are superior to those of the Control Group and there's significant difference (P<0.05).
2. The most frequently used herbal medicines in the postmenstrual, intermenstruum, premenstrual and menstruation phases with TCM Cycle Therapy are listed as follows: Postmenstrual phase:angelica, prepared rhizome of rehmannia, cuscuta seed, Chinese yam, glossy privet fruit, white peony root, barbary wolfberry fruit, red osier Intermenstruum phase:angelica, cuscuta seed, radix salviae miltiorrhizae, prepared rhizome of rehmannia, nutgrass galingale rhizome, flos carthami, herba epimedi, paeoniae radix Premenstrual phase:cuscuta seed, angelica, prepared rhizome of rehmannia, herba epimedii, radix dispaci from Sichuan of China, Chinese yam, white peony root, barbary wolfberry fruit Menstruation phase:angelica, nutgrass galingale rhizome, szechwan lovage rhizome, Motherwort, paeoniae radix, radix salviae miltiorrhizae, eupatorium, prepared rhizome of rehmannia
3. Unique features are demonstrated in the treatment of various types of aciesis at postmenstrual, intermenstruum, premenstrual and menstruation phases.
Ovulation difficulties:nourishing yin and blood and replenishing kidney and vital essence are prescribed for postmenstrual phase; replenishing kidney and yang and invigorating qi and blood circulation for intermenstruum phase; nourishing kidney and yang and warming the uterus for the premenstrual phase; invigorating blood circulation, dissipating blood stasis and regulating qi and menstruation for menstruation phase.
Luteal phase defect:nourishing kidney and blood and replenishing yang and vital essence are prescribed for postmenstrual phase; replenishing kidney, warming yang and invigorating blood circulation and collaterals for intermenstruum phase; nourishing kidney, soothing liver and warming the uterus for the premenstrual phase; soothing liver, invigorating blood circulation and regulating menstruation for menstruation phase.
Polycystic ovarian syndrome:replenishing kidney and vital essence and nourishing yin and blood are prescribed for postmenstrual phase; invigorating qi and blood circulation, warming kidney and activating collaterals for intermenstruum phase; nourishing kidney and yang and warming the uterus for the premenstrual phase; eliminating dampness, dissipating blood stasis, invigorating blood circulation, and promoting menstruation for menstruation phase.
Premature ovarian failure/hypovaria:warming kidney and vital essence and nourishing yin and blood are prescribed for postmenstrual phase; nourishing blood, invigorating blood circulation, and regulating Chong and Ren Collaterals for intermenstruum phase; warming kidney, reinforcing yang and replenishing kidney for the premenstrual phase; soothing liver, regulating qi, invigorating blood circulation and promoting menstruation for menstruation phase.
Endometriosis:replenishing kidney and qi, invigorating blood circulation, eliminating blood stasis, soothing liver and activating collaterals are prescribed for postmenstrual phase; invigorating blood circulation, activating collaterals, soothing liver, regulating qi and eliminating blood stasis for intermenstruum phase; warming kidney, reinforcing yang and replenishing blood and invigorating blood circulation for the premenstrual phase; replenishing kidney, invigorating blood circulation, soothing liver, dispersing the depressed qi, removing blood stasis and eliminating tumor for menstruation phase.
Salpingemphraxis:Invigorating blood circulation and dissipating blood stasis are the major therapy which is applied at the three phases except the postmenstrual phase. Nourishing yin and blood, reinforcing kidney and regulating menstruation are prescribed for the postmenstrual phase; invigorating blood circulation, dissipating blood stasis and activating collaterals for intermenstruum phase; invigorating blood circulation, dissipating blood stasis, replenishing kidney and yang, reinforcing qi and nourishing blood for premenstrual phase; soothing liver, regulating qi, dissipating blood stasis, activating collaterals, invigorating blood circulation and regulating menstruation for menstruation phase.
Immune aciesis:replenishing spleen and kidney, invigorating blood circulation, nourishing blood and regulating Chong collateral to improve the immunity are prescribed for postmenstrual phase; replenishing kidney, nourishing blood and invigorating blood circulation to improve ovulation for intermenstruum phase; reinforcing kidney and yang, nourishing kidney and spleen, replenishing qi and blood and regulating qi for the premenstrual phase; warming collaterals, nourishing blood, invigorating blood circulation and regulating menstruation for menstruation phase.
引文
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