罗志娟治疗复发性流产经验撷萃

Summary of Luo Zhijuan′s Experience in Treating Recurrent Miscarriage

罗志娟教授认为,复发性流产的基本病机是脾肾两虚,以肾虚为根本病因,以肝脾脏腑功能失调为要。罗教授强调在补肾的基础上,结合中医证型和中药调周法辨证施治,临证中分阶段、分证型、分周期治疗,并将其归纳为“三分法”,还强调中西医结合,临床辨证施治中不仅需要四诊合参,也应善于利用现代医学检测手段系统检查,积极地筛查出确切的病因,辨证与辨病相结合。罗教授认为,复发性流产多因冲任损伤,胎元不固,临证常从脏腑辨证论治,尤重调理肝肾脾,并将病情的发展过程分为两个阶段-孕前和孕后,孕前预培其损,孕后未病先防,已病防变。孕前:肾虚者予补肾益气固冲丸加减;兼脾虚者予毓麟珠加减;兼气血亏虚者予泰山磐石散加减;兼肝郁气滞者予逍遥散与六味地黄丸加减;兼瘀血内阻者予血府逐瘀汤与左归丸加减。若发现受孕时应及时进行保胎,使着床期和保胎期能顺利衔接,临床上常拟寿胎丸合胎元饮化裁之培土固肾汤为基础方,予以健脾补肾,固冲安胎。罗教授主张种子必先调经,故备孕期期证结合,调经助孕,辨证论治的基础上也要结合月经周期不同的时段分期论治,辨证施治过程中谨守病机,谨察阴阳,整体论治。

Professor Luo Zhijuan believes that the basic pathogenesis of recurrent miscarriage is spleen-kidney deficiency,with kidney deficiency as the fundamental cause and liver and spleen dysfunction as important factors.Professor Luo emphasizes the combination of kidney tonification with syndrome differentiation and the regulation of menstrual cycles using TCM methods.She advocates a staged,syndrome-specific,and cycle-specific treatment approach,summarizing it as the "three-classification method." She also emphasizes the integration of traditional Chinese and Western medicine,advocating the use of modern medical diagnostic techniques alongside traditional TCM diagnostics to accurately identify causes and combine disease differentiation with syndrome differentiation.Professor Luo believes recurrent miscarriage often results from injury to thorough vessel(TV) and conception vessel(CV),leading to unstable fetal qi.In clinical practice,she focuses on regulating the liver,kidney,and spleen,dividing the treatment process into two stages:pre-pregnancy and post-pregnancy.Pre-pregnancy treatment aims to restore and nourish,while post-pregnancy treatment focuses on prevention and stabilization.Pre-pregnancy:For kidney deficiency,Modified TV-Securing Pill is used for tonifying the kidney and supplementing qi.For the cases complicated with spleen deficiency,Modified Yulin Pill is used.For the cases combined with qi and blood deficiency,Modified Taishan Pansi Powder is used.For the cases complicated with liver qi stagnation,Modified Free Wanderer Powder combined with Six-Ingredient Rehmannia Pill is used.For the cases complicated with blood stasis,Modified Blood Mansion Stasis-Expelling Decoction combined with Yin-restoring Pill is used.Upon detection of pregnancy,timely fetal protection measures should be taken to ensure smooth implantation and early pregnancy.In clinical practice,Modified Decoction for Banking Up Earth and Consolidating the Kidney from self-made Shoutai Pill combined with Taiyuan Decoction is commonly used to invigorate the spleen and tonify the kidney and stabilize the fetus.Professor Luo advocates for the regulation of menstruation before pregnancy,so during the preparation for pregnancy,it is necessary to combine syndrome differentiation with menstrual cycle stages based on syndrome treatment.It is also needed to adhere to disease mechanisms,observe yin and yang,and treat holistically.