马堃教授运用补肾活血法治疗盆腔炎性不孕症的临证经验

Kidney-tonifying and blood-activating in treatment of infertility due to pelvic inflammatory disease:clinical experience of Professor MA Kun

盆腔炎性疾病已成为女性不孕症的主要原因之一,近年来发病率有升高趋势。现代医学认为盆腔炎性因子会影响卵子的形成、受精、胚胎的植入等环节,对配子的相遇、受精及受精卵向宫腔输送的影响最为重要。治疗包括药物、输卵管通液和造影术、手术以及辅助生殖技术等。马堃教授认为其病位在胞宫胞脉,主要病机为肾虚血瘀,血瘀为病理基础,肾虚为根本病机,多属虚实夹杂,肾虚日久必致血瘀,血瘀又加重肾虚,两者互为因果,使盆腔炎性不孕症缠绵难愈。临证以补肾活血、化瘀通络、调理冲任为基本治则,运用中药口服,配合灌肠、外敷、外洗等治法,在治疗盆腔炎性不孕症中,改善了盆腔微环境,提高妊娠率及妊娠成功率等方面取得了较好的疗效。

Pelvic inflammatory disease(PID) has become one of the leading causes of female infertility, with an increasing incidence in recent years. Modern medicine believes that risk factors of PID will affect the formation of eggs and embryo implantation, especially on the encounter of gametes, fertilization, and transport of fertilized eggs to the uterine cavity. Therapies for infertility due to PID include medication, sonographic hydrotubation, surgery, and assisted reproductive technology. Professor Ma Kun believes that the disease is located in the uterus with appendages with the main pathogenesis of kidney deficiency and blood stasis. Blood stasis is the pathological basis, and kidney deficiency is the fundamental pathogenesis, which exhibits deficiency-excess in complexity. Kidney deficiency will cause blood stasis over time, while blood stasis will aggravate kidney deficiency in turn, making PID-induced infertility refractory. In clinical practice, basic therapies follow the principles of kidney-tonifying and blood-activating, removing blood stasis, dredging collaterals, and coordinating thoroughfare and conception vessels. The oral administration of Chinese medicine combined with enema, external application, and external washing displays better efficacy in improving the pelvic microenvironment and increasing the pregnancy rate and pregnancy success rate in the treatment of PID-induced infertility.