尤昭玲“巢泡膜”三位一体诊治多囊卵巢综合征经验

You Zhao-ling′s Experience of Treating Polycystic Ovary Syndrome with the Trinity of"Ovarian Vesicle"

尤昭玲教授认为多囊卵巢综合征(polycystic ovary syndrome,PCOS)发病实质是"巢泡膜"异变,具有遗传、"三多两难"(病因多因性、发病多发性、病态多态性;病势难控制、病局难料)"四性"(症状多变性、病程长期性、病情隐匿性、治疗难治性)"四高一低"(生化妊娠率高、稽留流产率高、早产率高、妊娠并发症高、妊娠率低)等基本特性。其中医病因病机以肾虚血瘀为主,发病在女性生殖系统主要与卵巢、卵泡、子宫内膜密切相关。尤教授认为,四维彩超检查应关注检测时间、卵巢、卵泡、内膜四个环节,最佳检查时间段是月经周期第11天至第15天及月经周期第16天至第21天,对比发现病变症结之所在。临证时,要动态精准比较、观察双侧卵泡数目,判断卵巢与内膜是否同步兼容,发现卵巢、子宫、子宫内膜等相关病变,重视"巢泡膜"三位一体的病变本质,精准施治。尤教授认为,PCOS患者"巢泡膜"在四维彩超下有独特的影像学表现,临证应恪守"四论"(勿治论、应治论、自然调理法、三勿论),注重"巢泡膜"三位一体,遵循"论治七法"(分流论治、分段论治、分型论治、分类论治、分式论治、分序论治、分期论治)的调治原则。基于PCOS患者妊娠具有"四高一低"的特点,尤教授主张保胎要早介入治疗、早安胎,倡导安胎二步法:第一步以健脾为主,第二步以补肾为主的脾肾同治法,选用安胎方加减治疗。

According to Professor You Zhao-ling,the pathogenesis of polycystic ovary syndrome(PCOS)is essentially"ovarian vesicle"mutation,which has the following basic characteristics:heredity,"three mores and two difficulties"(multiple causes of disease,multiple onset,pathological polymorphism;difficult to control disease situation,difficult to predict disease situation),"four features"(multiple symptoms,long-term course,hidden disease condition,and difficulty in treating),"four high and one low"(high rate of biochemical pregnancy,high rate of missed abortion,high rate of premature delivery,high rate of pregnancy complications,low rate of pregnancy),etc.The main pathogenesis of the disease is kidney deficiency and blood stasis.The disease is closely related to ovary,follicle and endometrium in female reproductive system.According to Professor You,four-dimensional ultrasound examination should focus on the detection time,ovary,follicle and endometrium.The best examination time is from the 11 th to the 15 th day of the menstrual cycle and from the 16 th to the 21 st day of the menstrual cycle.In clinical practice,it is necessary to dynamically and accurately compare and observe the number of follicles on both sides,judge whether the ovary and endometrium are compatible synchronously,find out the relevant diseases of ovary,uterus,endometrium,etc.,pay attention to the trinity of the disease essence of"ovarian vesicle",and treat accurately.Professor You believes that the"ovarian vesicle"of PCOS patients has a unique imaging performance under the four-dimensional color Doppler ultrasound.The clinical treatment should adhere to the"four theories"(no need to treat,need to treat,natural conditioning,three don′ts),pay attention to the trinity of"ovarian vesicle",and follow the"seven methods"of adjustment:the treatment of alternation,the treatment of segmentation,the treatment of type,the treatment of classification,the treatment of form,the treatment of order,and the treatment of staging.Based on the characteristics of"four high and one low"in pregnancy of PCOS patients,Professor You advocate early intervention and early miscarriage prevention,and two steps of miscarriage prevention:The first step is to strengthen the spleen,the second step is treat the spleen and kidney together with focus on the kidney,and Formula for Miscarriage Prevention is often adopted.