基于《黄帝内经》理论的女性不孕症研究

A Study on Female Infertility Based on the Theory of the Inner Canon of Huangdi

《黄帝内经》时期已经对人的生命起源和孕育机制有了全面而深刻的认识,认为精、气、神是构成人体生命的本源,是构成人体的物质基础。气,是构成世界的本源,天地之精气则可化生为人。同时,对人体孕育的过程有极为生动的描述,认为人之始生首先成精,精可化生脑、髓,此后逐渐形成人体。《黄帝内经》中也对女性孕育的生理机制进行较为系统的论述,认为女人14岁以后,肾气盛、天癸如期而至、任脉通、太冲脉盛,月经能按正常规律来潮,便可有子的生理机制。可见,肾气、冲脉、任脉、天癸、胞宫是女子孕育非常重要的因素,构筑了肾气-天癸-冲任-胞宫女性生殖轴。《黄帝内经》最早提出不孕症病名,并提出了通过人中沟的形态来判定有子与否,是最早记载以望诊的方法诊断女性不孕症,脉诊方面有肾脉微涩也为女子不孕之脉象的记载。《内经》中虽然未明确指出不孕症的病因,但其提出淫邪因素、生活所伤、情志内伤、体质因素等均可影响冲任而导致不孕。病机方面认为,与肾虚、肝血虚、肝郁、心脾两虚、气血两虚以及冲任督三脉损伤相关,但似乎更为强调女性不孕症的病机为肾虚、肝郁。同时,也认识到自然环境与五运六气对于孕育的影响。治疗方面明确提出了补肾活血法,方用四乌鲗骨一藘茹汤治疗。可见,《黄帝内经》较为系统地阐释了女性的孕育的生理机制,明确提出病名、病因病机、诊断、治疗方法、方药,为女性不孕症的治疗提供理论依据,对后世医家有着重要的指导意义。

At the times of The Inner Canon of Huangdi,a comprehensive and in-depth understanding of the origin and the conception mechanism of human life had already come into being,believing that essence,Qi and vitality constituted the origin of human life and the physical basis of human body. Qi constituted the origin of the world and the essence of the heaven and the earth could transform into a human body. Meanwhile,there is a very vivid description of the conception process of human body,believing that the beginning of human life starts with essence which can transform into brain and marrow,and hence form a human body gradually. The Inner Canon of Huangdi also makes a systematic elaboration on the physiological mechanism of female＇s conception,believing that after the age of 14,a female＇ s kidney Qi is strong,menstruation comes punctually,Ren channel is unblocked and Taichong channel is strong; with regular menstrual onsets,she can reproduce. It can be inferred that kidney Qi,Chong channel,Ren channel,menstruation and uterus are the key factors for female conception and they form the female＇ s kidney Qi-menstruation-Chong and Ren channels-uterus reproduction axis. The disease name of sterility was first brought forward by The Canon of Huangdi,which also put forward that the form of philtrum ditch can be used to judge whether a female is pregnant or not. This medical book is also the first recording of diagnosing female sterility by observation,and astringency of kidney pulse as the pulse manifestation regarding pulse diagnosis. Although the medical book doesn＇t specify the etiological factors for sterility,it mentions that lust,life damage,affection-mind internal injury,physical constitution,etc.,all influence Chong channel and Ren channel and cause sterility. As for pathogenesis,sterility is related to kidney deficiency,liver blood deficiency,liver depression,heart-spleen deficiency,Qi-blood deficiency,and damage of Ren-Chong-Du channels,however,probably with an emphasis on kidney deficiency and liver depression. Meanwhile,it also realizes the influence of natural environment and five movements and six Qi on conception and reproduction. As for the treatment,kidney invigorating and blood circulating method is put forward explicitly,with the prescription of squid bone and madder root decoction. It can be seen that The Inner Canon of Huangdi systematically explains the physiological mechanism of female gestation,and clearly puts forward the name,etiology,pathogenesis,diagnosis,treatment methods,prescriptions,and provides a theoretical basis for the treatment of female infertility. It is of great significance to the future physicians.