Xia Liangjun, Xia Youbing
Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
Nanjing Medical University, Nanjing 210029, Jiangsu Province, China; Nanjing University of CM, Nanjing 210023, Jiangsu Province.
Zhongguo Zhen Jiu. 2018 May 12;38(5):5653-70. doi: 10.13703/j.0255-2930.2018.05.031.
To review and collect the study achievements and the effect mechanism of acupuncture in the treatment of premature ovarian failure (POF) in recent 20 years so as to provide more references for the clinical treatment of POF with acupuncture.
Through retrieving PubMed, CNKI and VIP, the literature on acupuncture for POF was collected from January 1, 1998 through March 31, 2017 regarding the rule of acupoint selection and the therapeutic method. The potential effect mechanism was explored.
Finally, 26 papers on the clinical treatment for POF with acupuncture and 5 ones on the laboratory mechanism were obtained. The differentiated syndromes and the top 3 acupoints for the treatment of POF included syndrome [Taixi (KI 3), Sanyinjiao (SP 6) and Guanyuan (CV 4)], syndrome [Sanyinjiao (SP 6), Zusanli (ST 36) and Ciliao (BL 32)], syndrome [Taichong (LR 3), Shenting (GV 24), Guanyuan (CV 4)], the mixed syndrome of and [Sanyinjiao (SP 6), Ganshu (BL 18) and Shenshu (BL 23)], the mixed syndrome of and [Pishu (BL 20), Sanyinjiao (SP 6) and Zusanli (ST 36)] and the dysfunction of the thoroughfare vessel and the conception vessel [Guanyuan (CV 4), Zigong (EX-CA 1) and Huangshu (KI 16)]. The top 5 acupoints of the 14 meridians were Guanyuan (CV 4), Shenshu (BL 23), Sanyinjiao (SP 6), Zhongji (CV 3), Pishu (BL 20), Taixi (KI 3) and Ganshu (BL 18). The local extraordinary points were dominant. According to the use frequency of the acupoints, the first top 5 meridians were the bladder meridian of foot-, the governor vessel, the conception vessel, the spleen meridian of foot- and the kidney meridian of foot-. The most acupoints were distributed in the chest, the abdomen, the lumber region and the lower limbs. Many therapeutic methods were used, such as acupuncture with filiform needle, electroacupuncture, moxibustion and the acupoint thread-embedding therapy. The effect mechanisms possibly referred to the recovery of the sexual level through regulating the hypothalamus-pituitary gland-ovarian axle (HPOA) function, the improvement of the histological morphology of the uterine, the improvement of body immunity through affecting the nerve-endocrine-immune regulation system as well as the regulation of the genetic and protein expressions of the signal pathway relevant with POF.
Even though acupuncture has achieved the therapeutic effects in the clinical treatment of POF, the research on the effect mechanism is still limited. The exploration of acupuncture for POF in terms of mechanism may guide the clinical practice. In the future study, the clinical pathway should be specified and the effect mechanism be explored through the rigorous laboratory design and more objective and rational evaluation system.
回顾和收集近20年针灸治疗卵巢早衰（POF）的研究成果及作用机制，为临床运用针灸治疗POF提供更多参考。
通过检索PubMed、CNKI和维普数据库，收集1998年1月1日至2017年3月31日期间关于针灸治疗POF的文献，分析其选穴规律及治疗方法，并探讨其潜在作用机制。
最终获得26篇针灸治疗POF的临床研究文献和5篇作用机制的实验研究文献。POF辨证分型及常用前三穴位包括肾虚证[太溪（KI3）、三阴交（SP6）、关元（CV4）]，脾虚证[三阴交（SP6）、足三里（ST36）、次髎（BL32）]，肝郁证[太冲（LR3）、神庭（GV24）、关元（CV4）]，肾虚肝郁证[三阴交（SP6）、肝俞（BL18）、肾俞（BL23）]，脾肾两虚证[脾俞（BL20）、三阴交（SP6）、足三里（ST36）]，冲任失调证[关元（CV4）、子宫（EX - CA1）、肓俞（KI16）]。十四经中常用前五穴位为关元（CV4）、肾俞（BL23）、三阴交（SP6）、中极（CV3）、脾俞（BL20）、太溪（KI3）、肝俞（BL18）。以局部奇穴为主。按穴位使用频次，常用前五经脉为足太阳膀胱经、督脉、任脉、足太阴脾经、足少阴肾经。穴位多分布于胸、腹、腰及下肢。治疗方法多样，如毫针针刺、电针、艾灸、穴位埋线等。作用机制可能涉及通过调节下丘脑 - 垂体 - 卵巢轴（HPOA）功能恢复性腺水平，改善子宫组织形态学，通过影响神经 - 内分泌 - 免疫调节系统提高机体免疫力以及调节与POF相关信号通路的基因和蛋白表达。
针灸治疗POF临床取得了一定疗效，但作用机制研究仍较局限。对针灸治疗POF作用机制的探索可为临床实践提供指导。未来研究应规范临床路径，通过严谨的实验设计和更客观合理的评价体系探索其作用机制。
