《傅青主女科》“病-证-症”模式对高泌乳素血症导致排卵障碍性不孕的指导

Guiding significance of"disease-syndrome-symptom"mode in FU Qing-zhu′s Obstetrics and Gynecology(FU Qing-zhu Nyu Ke)for dealing with ovulation disorder infertility caused by hyperprolactinemia

该文基于《傅青主女科》“病-证-症”模式,探讨其对高泌乳素血症(HPRL)导致排卵障碍性不孕的指导意义。《傅青主女科》以病种提纲挈领,抓住主症,分析病机,辨证遣方,体现了“病-证-症”模式,核心在于“病证结合”。其《调经篇》《种子篇》对后世现代医家在不孕病的诊疗中具有重要的参考意义,其中诸多方药被沿用至今,效果颇佳。中医认为HPRL的发病机制主要在于肾虚、肝郁2个方面,其中肾虚为主要原因,肝郁加速高泌乳素血症发病,用药多以补肾疏肝为主。《傅青主女科》中“病-证-症”模式对HPRL导致排卵障碍性不孕的诊疗具有重要意义,即不拘泥于病种和证型,以“病-证-症”结合,突出患者主诉,抓住主要病机,病证结合,发挥整体观优势辨证施治。《傅青主女科》中诸多疾病如嫉妒不孕、肥胖不孕、经水后期、经水数月一行、经水先后无定期等,虽未提HPRL典型的泌乳症状,仍可根据主诉、证型、症状参考治法用药,弥补了现代中医过度依赖血清生化指标的缺陷,其重视肝脾肾心、整体观以及扶正祛邪的诊疗思想值得借鉴。

This paper discussed the guiding significance of"disease-syndrome-symptom"mode in FU Qing-zhu′s Obstetrics and Gynecology(FU Qing-zhu Nyu Ke)for dealing with ovulation disorder infertility caused by hyperprolactinemia(HPRL).FU Qing-zhu′s Obstetrics and Gynecology(FU Qing-zhu Nyu Ke)concentrates on the disease entities,main symptoms,pathogenesis,and syndrome differentiation,based on which the prescriptions are prescribed.This reflects the"disease-syndrome-symptom"mode,with the core lying in the"combination of disease with syndrome".The contained Discussion on Menstruation Regulation(Tiao Jing Pian)and Discussion on Getting Pregnant(Zhong Zi Pian)have important reference significance for later doctors in the diagnosis and treatment of inferti-lity,and many prescriptions are still in use due to good effects.It is believed in traditional Chinese medicine(TCM)that HPRL results from kidney deficiency and liver depression,among which kidney deficiency is the main cause.Liver depression accelerates the onset of HPRL,so the kidney-tonifying and liver-soothing herbs were mainly selected.The"disease-syndrome-symptom"mode in FU Qing-zhu′s Obstetrics and Gynecology(FU Qing-zhu Nyu Ke)sheds enlightenment on the diagnosis and treatment of ovulation infertility caused by HPRL,in that it is not confined to disease entity and syndrome type.The integration of"disease-syndrome-symptom"highlights the main complaint of patients and emphasizes the main pathogenesis,thus giving full play to the overall advantage of syndrome differentiation.For multiple diseases in FU Qing-zhu′s Obstetrics and Gynecology(FU Qing-zhu Nyu Ke)such as infertility due to liver depression,infertility due to obesity,delayed menstruation,and irregular menstruation,although the typical lactation symptom of HPRL is not mentioned,the medication can still be determined according to the chief complaint,syndrome type,and symptoms and signs,making up for the defects of excessive reliance on serum biochemical indicators in modern Chinese medicine.We should learn its diagnosis and treatment thoughts of paying attention to liver,spleen,kidney,and heart,holism,and strengthening body resistance to eliminate pathogenic factors.