中西医治疗青春期多囊卵巢综合征研究进展

Progress of Integrated Chinese and Western Medicine Treatment for Polycystic Ovary Syndrome at Puberty

多囊卵巢综合征(polycystic ovary syndrome,PCOS)发病机制复杂,中医理论认为,本病以脾肾虚损为本,尤以肾虚为主,痰湿、血瘀、肝火、气郁为标。治疗当以补肾健脾、化痰利湿、活血祛瘀、疏肝降火为法则。青春期PCOS的治疗分为近期目标及远期目标。近期目标为调整月经周期,控制多毛、痤疮,减轻体质量;远期目标为预防子宫内膜病变、糖尿病、肥胖、心脑血管疾病和不孕症等。临床常用的治疗方法为生活方式调整、西药治疗、中药治疗及针灸治疗等。目前,西医治疗有一定的局限性,只能对症治疗,但是见效较快。而中医疗法能够因人制宜、辨证论治,具有多靶点、多系统的特点,从"因"调节内分泌,弥补西医治疗的不足,并且疗效持久、副作用小。但是中医药及针灸疗法治疗青春期PCOS的临床试验较少,仍需要大样本、多中心、严谨的随机对照试验为其提供可靠的临床证据。

The pathogenesis of polycystic ovary syndrome（ PCOS） is complex. According to TCM theory,the primary cause of this disease is the deficiency of the spleen and kidney,especially kidney deficiency as the dominant,and the secondary cause lies in phlegm dampness,blood stasis,liver fire and qi depression. During the treatment,the principle should be tonifying the kidney and strengthening the spleen,resolving the phlegm and removing dampness,activating blood flow to eliminate blood stasis,dispersing the liver and clearing fire. The treatment of PCOS at puberty should have near-term goal and long-term goal. The near-term goal is to regulate menstrual cycles,control hirsutism and acne and lose body mass. The long-term goal is to prevent the pathological changes of endometrium,diabetes,obesity,cardiovascular and cerebrovascular diseases and infertility,etc. The commonly-applied treatment is the regulation of lifestyle,therapy of western medicine,treatment with Chinese medicine and acupuncture treatment,etc. At present,there’re some limitations of western medicine therapy which is merely symptomatic but with quick efficacy. While TCM therapy,based on syndrome differentiation and treatment,can be adjusted individually and has the features of multiple target point,multiple systems and few side effects. It regulates endocrine from the root cause to make up the shortage of western medicine,and the effects of it last long. However,there’re only a few clinical tests on the treatment of PCOS by Chinese medicine and acupuncture,so it needs large-sample,multicenter and rigorous randomized controlled trial to provide reliable clinical evidences.