补肾法治疗多囊卵巢综合征的理论探讨
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摘要
多囊卵巢综合征(polycystic ovary syndrome,PCOS)是常见的妇科生殖内分泌代谢紊乱性疾病,PCOS临床表现多样,以稀发排卵或无卵、胰岛素抵抗、高雄激素血症及卵巢多囊样改变为主要病理特征,可导致无排卵性不孕和排卵障碍性不孕,引起闭经、糖尿病、脂代谢和糖代谢紊乱等并发症,危及机体远期健康。中医学并无此病名,依其临床表现,可归属"闭经""不孕症"和"癥瘕"等范畴。相比西医,中医治疗该病具有独特的见解,认为肝、肾、脾三脏功能的紊乱共同影响此病的发生和发展,且肾虚证为本病的主要证型。查阅文献表明,中医临床上多采用补肾法治疗PCOS,且用药灵活多样、标本兼顾,取得了较好的疗效。但在临床应用过程中,由于"补肾药用于男科疾病"的思维模式的影响,在一定程度上影响了补肾法在PCOS中的应用。鉴于此,本文从肾虚与生殖的关系,PCOS的病因病机,PCOS临床研究和实验研究等几方面对补肾法治疗PCOS的机理和相关研究进行分析和论述,以期为补肾法更好地用于PCOS及其他妇科疾病的治疗提供理论与实践上的支撑。
Polycystic ovary syndrome( PCOS) is a common gynecological reproductive endocrine and metabolic disorder disease. The clinical manifestations of PCOS are diversified,with and no ovulation,insulin resistance,hyperinsulinemia and polycystic ovaries as the main pathological and physiological changes,which can lead to non-ovulation infertility and ovulatory dysfunction infertility,cause complications,such as amenorrhea,diabetes,lipid metabolism and glucose metabolism disorder,and endanger the long-term health of the body.Traditional Chinese medicine( TCM) does not have the name of this disease,and classifies PCOS to the category of " amenorrhea","infertility"and "abdominal mass kidney"according to its clinical manifestations. Compared with western medicine,TCM has a unique view in treating the disease,and believes that the disorders of liver,kidney and spleen functions jointly affect the occurrence and development of the disease. According to the literature review,kidney-deficiency syndrome is the main syndrome type of this disease,the kidney-tonifying method has achieved a good effect in clinic. Besides,the drug use is flexible and diversified,and both primary and secondary symptoms are taken into consideration. However,in the clinical application process,the application of kidneytonifying method in PCOS has been affected by the thinking mode of "kidney-tonifying medicine for male diseases"to some extent. In view of this,the therapeutic effect of kidney-tonifying drugs in the treatment of PCOS is preliminarily demonstrated from several aspects of the relationship between kidney deficiency and reproduction,pathogenesis of PCOS,clinical research and experimental research of PCOS,in the expectation of providing theoretical and practical supports for kidney-tonifying therapy for PCOS and other gynecological diseases.
Polycystic ovary syndrome( PCOS) is a common gynecological reproductive endocrine and metabolic disorder disease. The clinical manifestations of PCOS are diversified,with and no ovulation,insulin resistance,hyperinsulinemia and polycystic ovaries as the main pathological and physiological changes,which can lead to non-ovulation infertility and ovulatory dysfunction infertility,cause complications,such as amenorrhea,diabetes,lipid metabolism and glucose metabolism disorder,and endanger the long-term health of the body.Traditional Chinese medicine( TCM) does not have the name of this disease,and classifies PCOS to the category of " amenorrhea","infertility"and "abdominal mass kidney"according to its clinical manifestations. Compared with western medicine,TCM has a unique view in treating the disease,and believes that the disorders of liver,kidney and spleen functions jointly affect the occurrence and development of the disease. According to the literature review,kidney-deficiency syndrome is the main syndrome type of this disease,the kidney-tonifying method has achieved a good effect in clinic. Besides,the drug use is flexible and diversified,and both primary and secondary symptoms are taken into consideration. However,in the clinical application process,the application of kidneytonifying method in PCOS has been affected by the thinking mode of "kidney-tonifying medicine for male diseases"to some extent. In view of this,the therapeutic effect of kidney-tonifying drugs in the treatment of PCOS is preliminarily demonstrated from several aspects of the relationship between kidney deficiency and reproduction,pathogenesis of PCOS,clinical research and experimental research of PCOS,in the expectation of providing theoretical and practical supports for kidney-tonifying therapy for PCOS and other gynecological diseases.
引文
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[4]黄一鸣,康开彪,潘文,等.基于数据挖掘多囊卵巢综合征的中医辨证用药规律分析[J].新中医,2018,50(6):60-64.
[5]孔冬冬,邸莎,马淑然,等.中医药治疗多囊卵巢综合征方剂用药规律分析[J].中国实验方剂学杂志,2015,21(23):202-206.
[6]金炫廷,马堃,单婧.补肾活血中药治疗多囊卵巢综合征导致排卵障碍性不孕的临床研究[J].中国中药杂志,2014,39(1):140-143.
[7]黎辉.补肾法治疗多囊卵巢综合征研究进展[J].亚太传统医药,2016,12(1):49-51.
[8]王贵霞,潘文,王晓萍.补肾法治疗多囊卵巢综合征的中医临床研究现状[J].新中医,2013,45(2):123-125.
[9]张飒,高慧,徐文君,等.从肾论治卵巢储备功能低下[J].亚太传统医药,2018,14(3):51-53.
[10]郭梅珍.浅谈多囊卵巢综合症之中医研究[J].中国中医基础医学杂志,2012,18(10):1073-1074,1076.
[11]王根发,董竞成,段晓红.中医“肾”之概念暨补肾理法方药及应用[J].中华中医药杂志,2012,27(12):3112-3115.
[12]刘悦坡.肾主生殖探析[J].中国中医药现代远程教育,2012,10(12):107-108.
[13]周敏,叶进.汉唐时期中医肾虚概念的历史演变[J].中华中医药杂志,2018,33(5):1937-1940.
[14]吴苗敏,刘娜,韩璐.丹参酮胶囊对多囊卵巢综合征患者脂代谢及下丘脑-垂体-肾上腺轴的影响[J].山东医药,2016,56(32):94-96.
[15] Kurowska P,Barbe A,Rozycka M,et al. Apelin in reproductive physiology and pathology of different species:a critical review[J]. Int J Endocrinol,2018,doi:10. 1155/2018/9170480.
[16]王永炎,王耀庭.今日中医妇科[M].北京:人民卫生出版社,2000:403.
[17] Mehta R,Kaur M,Gandhi P,et al. Auditory and visual reaction time in polycystic ovarian syndrome[J]. J Clin Diagn Res,2018,12(6):11-13.
[18]闫巍,杨新鸣,侯丽辉,等.基于“冲任学说”评析针灸治疗多囊卵巢综合征的取穴规律和疗效机制[J].中华中医药杂志,2011,26(9):2165-2168.
[19]耿红玲,朱敏,钟秀驰.“补肾活血”治疗卵巢储备功能下降机理探析[J].贵阳中医学院学报,2018,40(4):4-6.
[20] Sasidevi A,Vellanki P,Kunselman A R,et al. Familial aggregation of circulating c-reactive protein in polycystic ovary syndrome[J]. Hum Reprod,2013,28(3):770-776.
[21] Rutkowska,A Z,Diamanti-Kandarakis E. Polycystic ovary syndrome and environmental toxins[J]. Fertil Steril,2016,106(4):948-958.
[22]王德军,李路凯,张辉.加味二陈汤对肾虚痰湿型多囊卵巢综合征患者卵巢多囊样改变、内分泌及代谢的影响[J].中国实验方剂学杂志,2017,23(24):190-195.
[23]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.
[24] SHI X,XIE X,JIA Y,et al. Associations of insulin receptor and insulin receptor substrates genetic polymorphisms with polycystic ovary syndrome:a systematic review and meta-analysis[J]. J Obstet Gynaecol Res,2016,42(7):844-854.
[25] Stewart D R,Dombroski B A,Urbanek M,et al. Fine mapping of genetic susceptibility to polycystic ovary syndrome on chromosome 19p13. 2 and tests for regulatory activity[J]. J Clin Endocrinol Metab,2006,91(10):4112-4117.
[26] WEI L N,XIN C L,WANG W J,et al. Microarray analysis of obese women with polycystic ovary syndrome for key gene screening,key pathway identification and drug prediction[J]. Gene,2018,661:85-94.
[27] Mantelli F,Moretti C,Macchi I,et al. Effects of sex hormones on ocular surface epithelia:lessons learned from polycystic ovary syndrome[J]. J Cell Physiol,2016,231(5):971-975.
[28] Vandenberg L N, Colborn T, Hayes T B, et al.Hormones and endocrinedisrupting chemicals:low-dose effects and nonmonotonic dose responses[J]. Endocr Rev,2012,33(3):378-455.
[29] Xita N, Tsatsoulis A. Review:fetal programming of polycystic ovary syndrome by androgen excess:evidence from experimental, clinical, and genetic association studies[J]. J Clin Endocr Metab,2006,91(5):1660-1666.
[30]张翌蕾,潘文,汪永娟.多囊卵巢综合征病因病机中西医研究进展[J].中国中医基础医学杂志,2016,22(7):1004-1006.
[31]冷芹,魏兆莲.多囊卵巢综合征病因、发病机制及治疗的最新研究进展[J].国际生殖健康/计划生育杂志,2018,37(1):57-61,75.
[32]汪梦洁,俞洁,黄娜,等.多囊卵巢综合征中医证素特点研究[J].云南中医学院学报,2017,40(5):27-29,48.
[33]闫朋宣,杜宝俊,郑瑗璟.中医多囊卵巢综合征病因病机探析[J].世界中医药,2013,8(10):1152-1153,1156.
[34]刘树春,刘洋,宋昊,等.基于文献共词分析的肾虚证候疾病谱研究[J].世界科学技术—中医药现代化,2012,14(2):1408-1412.
[35]柯印霞,王常松,吕绍光.多囊卵巢综合征中医病因病机临床分析[J].天津中医药大学学报,2016,35(3):156-159.
[36]刘宇新,侯丽辉,吴效科.多囊卵巢综合征中医病因病机[J].天津中医药,2009,26(2):123-124.
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