从“虚、痰、瘀”探讨多囊卵巢综合征伴胰岛素抵抗

Discussion of polycystic ovarian syndrome with insulin resistance from“deficiency,phlegm and blood stasis”

多囊卵巢综合征(PCOS)作为育龄期女性常见的生殖内分泌代谢紊乱性疾病,其全球发病率高达20%,临床主要表现为月经紊乱、不孕、多毛、痤疮、脱发、肥胖、情志异常等。现代研究表明胰岛素抵抗(IR)及高雄激素血症是PCOS的核心病因及原发性内分泌特征,PCOS患者中IR患病率高达50%~70%。中医学认为PCOS的病机以脾肾两虚为本,气滞血瘀痰湿为标。IR在中医学属于脾瘅范畴,其病机为中满内热、脾不散精、脉络瘀损。通过梳理古代典籍资料以及现代医家对PCOS及IR的认识,总结出“虚、痰、瘀”的病机理论,即脾虚痰湿、肾精不足、气滞血瘀,最终导致PCOS及IR的发生,治法包括补肾健脾化痰、补肾疏肝化瘀。

Polycystic ovarian syndrome(PCOS)is a common reproductive endocrine and metabolic disorder in women of childbearing age,with a global incidence rate of up to 20%.The main clinical manifestations are menstrual disorders,infertility,hypertrichiasis,acne,alopecia,obesity,and emotional abnormalities.Modern studies have shown that insulin resistance(IR)and hyperandrogenism are the core causes and primary endocrine features of PCOS,and the prevalence of IR in PCOS is as high as 50%~70%.Traditional Chinese medicine believes that the pathogenesis of PCOS is both deficiency in spleen and kidney as the root cause,Qi stagnation,blood stasis and phlegm-dampness as the manifestation.IR belongs to the category of spleen-dan in traditional Chinese medicine,its pathogenesis is internal heat in middle energizer,the spleen′s failure of dissipating essence and damaged blood vessels due to the stasis.Through the collation of ancient literature and modern doctors′understanding of PCOS and IR,the pathogenesis theory of“deficiency,phlegm and blood stasis”is summarized.Spleen deficiency and phlegm dampness,insufficient kidney essence,Qi stagnation and blood stasis eventually lead to the occurrence of PCOS and IR.The treatment methods include tonifying kidney and strengthening spleen to remove phlegm,and tonifying kidney and dredging liver to remove blood stasis.