基于“女子以血为本”思想论治薄型子宫内膜不孕症

Treatment of Thin Endometrium in Infertility Based on Thought of"Blood Being Basis of Women"

不孕症是妇产科临床常见病、疑难病,我国育龄女性不孕症的发生率已高达25%,严重影响着社会和谐与人民幸福。由于现代女性生活方式的改变,薄型子宫内膜逐渐成为不孕症、胚胎移植失败的重要原因。反复的宫腔操作、口服激素类药物等原因使子宫内膜局部血管破坏,血流减少,腺上皮细胞生长受损,进而出现局部血供较少,子宫内膜生长迟缓,容受性降低,内膜接受孕囊种植的能力降低,从而不利于受精卵的着床而导致不孕症的发生。中医药治疗不孕症历史悠久,古今医家在长期的临床实践过程中已获得较为丰富的诊疗经验。"女子以血为本"思想萌芽于春秋战国,确定于两宋,是贯穿女性各生理时期的重要指导思想,强调了妇科疾病"调血"的治疗方法,使血脉充盛、运行通畅,从而发挥其滋润、濡养的功能,作用于冲任胞宫,充养子宫内膜以利于妊娠。以血为基,从探讨五脏、冲任与血的生理病理联系,到针对血瘀、血寒、血热、血虚不同病机、证型的治疗;从古代文献记载的以"血和"为目的治不孕,到现代医家强调补肾养血、补肾活血、补肾健脾、补肾疏肝而助孕,再到中西医结合以促排调激素、改善血运、营养内膜而助孕,可以为多角度、多层次治疗薄型子宫内膜不孕症的临床与科研提供新的方向。

Infertility is commonly seen but difficult to treat in the department of obstetrics and gynecology.The incidence of infertility in women of childbearing age has reached as high as 25%in China,which seriously affects social harmony and people’s happiness.As the lifestyle of modern women changes,thin endometrium has gradually become an important reason for infertility and embryo transfer failure.Such factors as repeated operations in uterine cavity and oral intake of hormones have resulted in destructed blood vessels and reduced blood flow in endometrium,impaired growth of glandular epithelial cells,insufficient local blood supply,retarded development of endometrium,reduced receptivity,and therefore poor acceptance of endometrium to the implanted gestational sac,which is not conducive to the implantation of fertilized eggs.As a result,the infertility will occur.Traditional Chinese medicine(TCM)has a long history of treating infertility.During the long-term clinical practice,physicians of ancient and modern times have gained rich experience in the diagnosis and treatment of infertility.The idea of"blood being the basis of women"sprouted in the Spring and Autumn and Warring States Periods and determined in the Song Dynasty as an important guiding principle that can be applied in various physiological periods of women.It emphasizes"blood regulation"for gynecological diseases to ensure sufficient blood in blood vessels and its normal circulation,thus allowing the thoroughfare and conception vessels and endometrium to be nourished and the pregnancy to be facilitated.With blood as the basis,the paper explored the physiopathological correlations of five zang organs and thoroughfare and conception vessels with blood,pointed out the preference for"blood harmonization"in ancient literature based on the differentiation of infertility into blood stasis,blood cold,blood heat,and blood deficiency syndromes,reviewed the key methods of modern physicians in assisting pregnancy including tonifying kidney and nourishing blood,tonifying kidney and activating blood,tonifying kidney and invigorating spleen,as well as invigorating kidney and soothing liver,and summarized the efficacy of integrated TCM and western medicine in promoting ovulation,regulating hormones,improving blood supply,and nourishing endometrium to assist pregnancy.All these would contribute to the clinical treatment and scientific research of thin endometrium in infertility from multiple angles.