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补肾活血法治疗子宫内膜异位症所致不孕症的临床经验

[Clinical experience of Bushen Huoxue therapy in treatment of infertility due to endometriosis].

作者信息

Ma Kun, Chen Yan-Xia, Li Min

机构信息

Xiyuan Hospital,China Academy of Chinese Medical Sciences Beijing 100091,China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2019 Mar;44(6):1094-1098. doi: 10.19540/j.cnki.cjcmm.20181225.003.

Abstract

Endometriosis is a common and difficult gynecological disease. The incidence of endometriosis has been increasing year by year. Because endometriosis mostly occurs in childbearing age,it can cause persistent damage to the fertility of patients,and is an important cause of infertility. Although endometriosis is a benign disease,it has malignant behavior,and is easy for relapse and metastasis and difficult to treat in clinic. Early diagnosis,comprehensive evaluation,formulation of programs and timely treatment play an important role in protecting patients' fertility. The pathogenesis of endometriosis is still unclear in modern medicine. Drugs,surgery and assisted reproductive technology are the main therapies. The author has achieved a good efficacy in the long-term treatment of infertility due to endometriosis. She believes that the disease is caused by kidney deficiency and blood stasis. They are cause and effect to each other,which form a vicious circle. In view of the basic pathogenesis of kidney deficiency and blood stasis,we should make good use of the method of Bushen Huoxue,and emphasize the treatment by stages: promoting blood circulation and removing blood stasis,and treating diarrhea with purgative in the menstrual stage; nourishing kidney and blood,and regulating thoroughfare and conception vessels in the postmenstrual stage; warming kidney and supporting Yang,and dredging collaterals and hastening excretion in the interval stage;and tonifying kidney and spleen,and managing Qi and activating blood in the premenstruum stage. Leech is commonly adopted in clinic prescriptions to remove accumulation of persistent blood stasis and regulate mood,and combined with enema of traditional Chinese medicine,hot compress and other external therapies to enhance the curative effect.

摘要

子宫内膜异位症是一种常见且棘手的妇科疾病。子宫内膜异位症的发病率逐年上升。由于子宫内膜异位症多发生于育龄期,会对患者的生育能力造成持续性损害,是导致不孕的重要原因。虽然子宫内膜异位症是一种良性疾病,但具有恶性行为,临床易于复发和转移,治疗困难。早期诊断、综合评估、制定方案并及时治疗对保护患者生育能力起着重要作用。现代医学中子宫内膜异位症的发病机制仍不清楚。药物、手术及辅助生殖技术是主要治疗方法。作者在长期治疗子宫内膜异位症所致不孕方面取得了良好疗效。她认为该病由肾虚血瘀所致。二者相互因果,形成恶性循环。针对肾虚血瘀这一基本病机,应善用补肾活血法,并强调分期论治:经期活血化瘀,通因通用;经后期补肾养血,调理冲任;间期温肾助阳,疏通经络,促其排泄;经前期补肾健脾,理气活血。临床方剂中常采用水蛭以祛瘀生新、调畅情志,并配合中药灌肠、热敷等外治法以提高疗效。

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