调肝法辨治辅助生殖反复种植失败经验采撷

Experience of Treating Recurrent Implantation Failure with Harmonizing Liver Method

反复种植失败是辅助生殖技术中的棘手问题之一,属于中医学“不孕”“滑胎”范畴,临床常从肾论治。然肝为女子先天,更为胎孕类疾病之枢纽,与肾心脾、冲任督带以及五志七情的关系密切。通过跟师刘雁峰教授总结其应用调肝法临证反复种植失败的辨治经验,并结合一则验案分析。治法上,配合患者移植周期——未移植时根据月经期、经后期、氤氲期、经前期的不同调经促排,预培其损;进入移植周期后根据促排卵、扳机、胚胎移植等各时期的不同,或滋肝肾之阴以育卵,或疏肝气畅泄冲任,或补肝血降肝冲而安胎;以肝为枢,兼顾他脏,病证互参。遣方用药上,需治肝体、养肝用并举,总体养重于疏;用药平和中正,培土助卵,以改善反复种植失败患者再次种植及妊娠结局。

Recurrent implantation failure(RIF)is one of the most thorny issue in assisted reproductive technology,which belongs to"infertility""habitual abortion"in traditional Chinese medicine,and the treatment is always based on kidney.However,liver is the congenital organ for women,especially the“hub”of pregnant and fetal diseases.Liver is closely related to other organs such as the kidney,heart and spleen,and collaterals such as Chong,Ren,Du and Dai channel,as well as five minds and seven emotions.Through studying at Professor Liu Yanfeng’s clinic,summarizing the clinical practice experience of her treating RIF with harmonizing liver method,and illustrating the theory by an effective case.While treating RIF,cooperation with patients’implantation cycle is needed.Before entering implantation cycle,adjust menstruation cycle and ovulation induction according to menstrual,post menstrual,ovulation and premenstrual period.After entering implantation cycle,focus on nourishing liver and kidney yin to culture embryo,or dredge liver qi as well as Chong and Ren channel,or supply liver blood and descend liver qi to tranquilizing fetus according to different stage such as controlled ovulation stimulation,trigger,embryo implantation,etc.See liver as the"hub"and take other organs into consideration,and refer to different diseases.For the decoction,simultaneously adjusting liver substance and nourishing liver function,and the overall herbal property should be nourishing overweight dispersing,with mild herbal medicine,to culture endometrium and embryos,then further improving embryo implantation and pregnancy outcome.