从“阴未盛-阳先至”探析多囊卵巢综合征中医病机

Discussion on Traditional Chinese Medicine Pathogenesis of Plycystic Ovary Syndrome with Theory of“Yin Being Not Abundant-Yang Arriving First”

多囊卵巢综合征(Polycystic ovary syndrome,PCOS)是常见女性生殖内分泌疾病,严重影响女性排卵及生育。目前约75%PCOS卵泡早期黄体生成素(Luteinizing hormone,LH)异常升高,94%PCOS存在黄体生成素/卵泡刺激素(Luteinizing hormone/Follicle stimulating hormone,LH/FSH)≥2。中医认为阴阳消长转化对排卵至关重要。卵巢在排卵前后存在“重阴化阳”的转化。卵泡期的“重阴”实现了物质积累,为排卵期的“化阳”提供质变的必要条件。若阴无法达到极盛,则不能完成向阳的转化,也无法完成排卵。PCOS阴阳转化失常的原因:一是“阴”生成不足,始终无法蓄积达到极限;二是在“阴”蓄积过程中,一小部分“阴”提前转化成微弱的“阳”。提前转化的“阳”阻碍了“阴”进一步充盛到足以发生质变的最大量,进而无法完成“重阴化阳”,造成排卵障碍。根据两细胞两促性腺激素学说,LH精准调控可诱发排卵,且LH作用于卵泡膜细胞可以促进雄激素分泌,均符合“阳”的属性。PCOS普遍存在卵泡早期的高LH,即是促进排卵的激素提前出现在卵泡的发育期,阻碍优势卵泡发育并诱导非优势卵泡群体性增多,造成排卵障碍,这与中医“阴未盛-阳先至”理论相符合。基于上述观点,提出“阴未盛-阳先至”为PCOS中医新病机,建立卵泡期(滋阴潜阳)-排卵期(引阴入阳)的分阶段-调阴阳的中医方案治疗PCOS。

Polycystic ovary syndrome(PCOS)is a common female reproductive endocrine disease that seriously affects ovulation and fertility.At present,about 75%of PCOS have abnormally elevated luteinizing hormone(LH)levels in early follicles,and 94%of PCOS have LH/follicle stimulating hormone(FSH)≥2.Traditional Chinese medicine believes that the transformation of Yin and Yang is crucial for ovulation.The ovaries undergo a transformation of“heavy Yin to Yang”before and after ovulation.The“heavy Yin”during the follicular phase achieves material accumulation,providing necessary conditions for qualitative transformation of“transforming Yang”during ovulation.If Yin cannot reach its maximum,it cannot complete the transformation to Yang and ovulation cannot be completed.The reasons for the abnormal conversion of Yin and Yang of PCOS:One is insufficient generation of“Yin”and inability to accumulate to the limit.The second is during the accumulation process of“Yin”,a small portion of“Yin”transforms into the weak“Yang”in advance.The early transformation of“Yang”hinders the further filling of“Yin”to the maximum extent necessary for qualitative transformation,thereby preventing the completion of“heavy Yin to Yang”and causing ovulation disorders.According to the theory of two cells and two gonadotropins,precise regulation of LH can induce ovulation,and LH acting on follicular membrane cells can promote androgen secretion,both of which conform to the attribute of“Yang”.PCOS generally has high LH in the early stages of follicles,which refers to the hormone that promotes ovulation appearing early in the development stage of follicles,hindering the development of dominant follicles and inducing a population increase of non dominant follicles,resulting in ovulation disorders.This is consistent with the traditional Chinese medicine theory of“Yin being not abundant-Yang arriving first”.Based on the above viewpoint,a new TCM pathogenesis of PCOS is proposed,which is“Yin being not abundant-Yang arriving first”.A phased TCM treatment plan for PCOS is established,which includes follicular phase(nourishing Yin and suppressing Yang)and ovulation phase(introducing Yin into Yang)and regulates Yin and Yang.