“课程思政”视阈下的中医妇科学教学思考与实践——以“不孕症”课程为例

《中医妇科学》是中医药教学体系中的一门重要的必修课程,也是中医药临床医学中具有丰富人文内涵的学科,尤其对于“课程思政”融入的探讨具有较为宽广的渠道和较强的代表性。本文以中医药文化中的“仁和精诚”和“以人为本”为切入点,以“不孕症”课程为具体示例,充分探讨了思政元素融入中医妇科学课程教学的方式和途径,以期为进一步促进中医妇科学教学改革实践提供有效参考。

腹针与神阙艾灸治疗痛经、不孕症、闭经

腹针疗法以独创腹部全息影像,以神阙为中心,调节脏腑、经络,扶正祛邪,针刺深度较浅,刺激强度较小,安全性高,患者易接受。在腹部形成一个具有多层次的神阙经络系统。腹针分调脏腑、调经络、调局部,取穴以任脉为主,调脏腑穴位一般深刺,结合八卦理论,调经络穴位中刺,取穴根据病位在全息影像中的投射区而定,常用于治疗久病、慢性病、妇科杂病。腹针疗法具有“处方标准化、操作规范化、辨证条理化”等特点,既具有传统针灸的特色,又有自身的诊治优势,痛苦小、见效快、疗效稳定、适应症广等,采用腹针疗法治疗妇科相关疾病,痛经、不孕症、闭经等,患者易于接受,效果显著,值得推广。气滞血瘀痛经,以气海、关元为主,配引气归元、中极等,神阙艾灸,3个疗程可愈。肝郁不孕以引气归元为主,辅以腹四关,配下风湿点、气穴,神阙艾灸,5个疗程后,基本良好,嘱定期产检。气滞血瘀闭经以引气归元为主,辅以腹四关,配大横、气穴、气旁、归来,神阙艾灸,3个疗程后,基本情况明显缓解。

CHANGES OF SOLUBLE FAS AND SOLUBLE FAS LIGANDIN SERUM AND PERITONEAL FLUID OF INFERTILEPATIENTS WITH ENDOMETRIOSIS

Objective To evaluate the relationship between levels of soluble Fas(sFas)and soluble Fas ligand(sFasL)in serum and peritoneal fluid of endometriosis-associated infertility. Methods The soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20 infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls. Results The sFasL levels were significantly higher in infertile patients with endometriosis(175.09 ± 80.55 pg/mL in serum and 284.50 ± 152.38 pg/mL in peritoneal fluid)than those of infertile controls (88.47 ± 43.55 pg/mL in serum and 17.30 ± 9.62 pg/mL in peritoneal fluid)and fertile controls(16.13 ± 11.75 pg/mL in serum and 8.84 ± 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis(828.60 ± 429.65 pg/mL in serum and 349.61 ± 288.89 pg/mL in peritoneal fluid)did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease(868.75 ± 570.48 pg/mL in serum and 181.76 ± 157.78 pg/mL in peritoneal fluid)and fertile control(822.26 ± 129.12 pg/mL in serum and 318.42 ± 145.16 pg/mL in peritoneal fluid). Conclusions Based upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.

Infertility and ovarian failure in celiac disease

Unexplained infertility in females may be a devastating event for the reproductive-aged female.However,infertility may be due to ovarian failure associated with celiac disease,an immune-mediated disorder that may have few or no symptoms and can be successfully treated.In some prospective serologically-based studies,over 4% of infertile females may prove to have celiac disease.Serological screening for celiac disease is relatively inexpensive and involves testing for antibodiesto tissue transglutaminase.If positive,a small intestinal biopsy should be done to confirm the diagnosis.The initial treatment for this disorder is a gluten-free diet.To date,a number of reports have indicated that this treatment for celiac disease may result in successful pregnancy,in spite of prolonged periods of infertility.Celiac disease,when untreated,may also lead to several adverse events following pregnancy including increased risk of recurrent abortions,low birthweight and impaired fetal growth.Recent molecular and pathological studies from different laboratories suggest that altered placental function may be due to binding to cells in the trophoblast by tissue transglutaminase antibodies impairing embryo implantation and leading to failure of early pregnancy or retarded intrauterine growth.

Visualization analysis of the research status of FU Qingzhu’s Obstetrics and Gynecology based on bibliometrics

Objective This study examined the research status and development process of FU Qingzhu’s Obstetrics and Gynecology(Fu Qing Zhu Nv Ke,《傅青主女科》,FQZNK)in the past 40 years with bibliometrics and visual analysis.Methods Retrieved all related literature in the research field of FQZNK from the domestic and foreign databases:China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),Wanfang Database,and Web of Science(WOS)core database,including Science Citation Index Expanded(SCIE),Social Sciences Citation Index(SSCI),and Arts&Humanities Citation Index(A&HCI).The search range was from January 1,1980 to March 10,2021.In addition,bibliometrics and CiteSpace 5.7.R2 software were used to analyze literature types,published journals,cited literature,the number of author publica-tions,co-author networks,co-institution networks,keyword co-occurrence networks,keyword clusters,and keyword bursts.Results A total of 678 valid records were included in the final dataset.Literature types,high publication journals,highly cited literature,high-yield institutions,high-yield research teams,and high-productivity scholars in this research field were found through bibliometrics.Liter-ature types can be divided into four categories,among which 451 are theoretical studies on academic thoughts of FQZNK,accounting for 66.5%of the included journals.The Journal of Shanxi Traditional Chinese Medicine had the largest volume of published articles(61),ac-counting for 9.0%of the total number of the included journals.The most cited literature was ZHOU Mingxin’s article“Using the quantitative method to discuss author’s authenticity and formula characteristics of FU Qingzhu’s Obstetrics and Gynecology”,which was cited 94 times.Hunan University of Chinese Medicine,the institution with the most publications,published 45 articles,and YOU Zhaoling,the most published author,published 33 articles.Moreover,it was found that most high-yield researchers came from high-yield institutions and that Hun-an University of Chinese Medicine had the most research on FQZNK.Keyword co-occur-rence analysis revealed that the keyword“FQZNK”had the highest frequency(597 times)and the highest centrality(1.00).Keyword cluster analysis used the Log-Likelihood Ratio(LLR)al-gorithm to form eleven important clusters:#0 treatment aiming at its root causes,#1 gynecopathy,#2 Siwu Decoction(四物汤),#3 FU Qingzhu,#4 post-partum,#5 infertility,#6 dysmenorrhea,#7 sterility,#8 coordinate the heart and kidney,#9 Danggui Buxue Decoction(当归补血汤),and#10 treatment.It was found that the prescriptions of FQZNK were studied mainly before 2000,the theoretical studies were mainly conducted before 2010,and its clinic-al application was mainly explored from 2010 until now.Diseases such as dysmenorrhea,morbid vaginal discharge,infertility,metrorrhagia,and polycystic ovarian syndrome(PCOS)have recently become popular topics in this field.Conclusion The current study provides more scientific,accurate,and comprehensive sci-entific support for further research and development of traditional Chinese medicine(TCM)in FQZNK.With this foundation,people can use burst detection to ascertain the current hot-spots in research,get their development trends,and forecast future research directions.In ad-dition,infertility,morbid vaginal discharge,flooding,and PCOS treatments based on TCM syndrome differentiation are currently popular research topics for FQZNK.

Endometrial stromal sarcoma:a case diagnosed during infertility treatment

The patient with irregular menstruation went to our Department(Gynecological Department,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou,China) with the complaint of no pregnancy at the age of 26 in 2007,and oral contraceptive pills were given when simple type of endometrial hyperplasia was pathologically diagnosed,and then ovulation induction was performed.But after nearly two years from the beginning of infertility treatment,endometrial stromal sarcoma was diagnosed and radical treatment was performed for the young patient.And the relative relationship between endometrial stromal sarcoma and infertility is worth discussing.

Infertility and gynaecological oncology

Infertility and gynaecological cancer are two major problems in the field of women's health, where both have serious implications on a woman's physical, social and emotional wellbeing. There are well established links between many aspects of infertility and different types of gynaecological malignancies, including etiology, pathogenesis and disease management. In this special issue there are valuable articles that highlight different aspects of the relationship between infertility and gynaecological oncology. The issue covers conditions that represent risk factors for both infertility and gynaecological neoplasia. There is emphasis on the role of the fallopian tube being a critical organ for both conditions. There is a review on the advances in cancer diagnosis and treatment with consideration of the preservation of patient fertility. The various technologies for fertility preservation are reviewed and their strengths and weaknesses discussed. One of the important fertility preservation techniques is cryopreservation of embryo oocytes or ovarian tissue. This special issue emphasises that fertility preservation is now an important consideration in oncology clinics, and the options available to patients are routinely offered. Future developments will offer women in this difficult situation more options for fertility preservation, with an individualised approach for each patient. Equally, for infertile patients it is important to assess the risk of malignancy so as to provide optimal and timely intervention.

Clinical Effects of Bushen Culuan Prescription on Infertility Due to Decreased Ovarian Reserve of Kidney Deficiency and Liver Depression Pattern

Objective The objective of this study was to explore the clinical effects of Bushen Culuan prescription on infertility due to decreased ovarian reserve of kidney deficiency and liver depression pattern.Methods Totally 100 infertile patients with ovarian hypofunction treated from October 2019 to January 2022 were selected and divided into the observation group and the control group by a random number table.The control group was treated with estrogen sequential therapy,and the observation group was treated with Bushen Culuan prescription.The clinical efficacy,sex hormone levels including(follicle-stimulating hormone[FSH],luteinizing hormone[LH],and estradiol[E_(2)]),ovarian function,ovarian blood flow status(peak systolic velocity[PSV],antral follicle count[AFC],arterial pulse index[PI],and resistance index[RI]),and pregnancy outcome in the two groups were compared and analyzed.Results The total effective rate of the observation group(96.00%)was significantly higher than that of the control group(80.00%).The difference was statistically significant(p<0.05).Before treatment,there was no significant difference in sex hormone levels(FSH,LH,E_(2),and FSH/LH),ovarian function(number of primary follicles,number of dominant follicles,ovulation number,and endometrial thickness),and ovarian blood flow(PSV,RI,PI,and AFC)between the two groups(p>0.05).After treatment,the levels of serum hormones FSH,LH,E_(2),and FSH/LH decreased significantly in both groups.The number of primary follicles,dominant follicles,and ovulation increased significantly,and the thickness of endometrium decreased significantly;the indexes of PSV,RI,and AFC of ovarian blood flow increased significantly,and the PI index decreased significantly.The levels of each index in the observation group were better than those in the control group(p<0.05).In the control group,32 cases were pregnant within 1 year after treatment,and the pregnancy rate was 64.00%;21 cases in the observation group were pregnant within 1 year after treatment,and the pregnancy rate was 42.00%;the pregnancy rate in the observation group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.014,p=0.045<0.05).Conclusion Bushen Culuan prescription has a definite effect on infertility due to ovarian hypofunction.The action mechanism may involve multicomponent and multitarget stimulation to improve patients'ovarian function,regulate the level of sex hormones,and improve the pregnancy outcome.

Efficacy observation on 40 cases of anovulatory infertility treated by acupuncture and moxibustion

Objective To observe clinical effect of acupuncture and moxibustion on inducing ovulation. Methods Forty cases of anovulatory infertility were treated with electroacupuncture and moxibustion at Zigong （子宫 EX-CA 1）, Guanyuan （元关 CV 4） and Zhongji （中极 CV 3） as well as Linggui Bafa therapy, 30 min each time, once a day for 15 days. One menstrual cycle made a session, and totally 3 sessions were required. The level of follicle stimulating hormone （FSH）, luteinizing hormone （LH） and estradiol （E2）, the growth and development situation of follicle and endometrium before and after treatment, spontaneous pregnancy rate during follow-up visit were observed and compared. Results After the treatment, the level of FSH, LH and Ez were signifiacntly increased （all P〈0.05）, the thickness of endometrium and diameter of follicle were obviously increased （both P〈0.05）. As for the spontaneous pregnancy rate during follow- up visit, 9 cases were cured, 25 cases were effective, 6 cases were failed and the total effective rate was 85.0%. Conclusion The acupuncture and moxibustion has better clinical efficacy for anovulatory infertility.

Clinical study on warming-needle moxibustion for infertility patients with thin endometrium

Objective： To explore the effect of warming-needle moxibustion on the endometrial thickness and pregnancy outcome.Methods： Forty infertility women, selected from those who visited the TCM department of Maternity and Child Care Centers in Fujian Province from October 2015 to October 2016, were enrolled in this study.These women had mature follicle and successful ovulation according to B ultrasound monitoring, but their endometrial thickness was thinner than 7 mm. The women were divided into warming-needle moxibustion group（group A. 20 cases） and medication group（group B, 20 cases）. In group A, acupuncture,warming-needle moxibustion and electroacupuncture were conducted at different clinical stage. In group B, progynova was given to the patients from the 7 th day of menstruation to the 14 th day after ovulation（2 tablets, bid oral administration in the morning and evening）. The treatment lasted for 3 menstrual cycles, and the endometrial thickness changes and pregnancy rate of the patients in the two groups were compared after treatment.Results： The endometrial thickness of patients in the two groups increased after treatment when compared with the thickness before treatment. The average endometrial thickness in group A increased from（5.23 ±1.57） mm before treatment to（8.31 ±2.80） mm after treatment, while the average endometrial thickness in group B increased from（5.27 士 0.99） mm before treatment to（8.32 ±1.97） mm after treatment, and the differences were statistically significant（both P〈0.05）. The increase of endometrial thickness of the patients in group A after treatment was slightly larger than that in group B, and the difference was not statistically significant（P〉0.05）. After treatment for 3 menstrual cycles, the pregnancy rate of infertility women in group A was 25%（5/20） and 15%（3/20） in group B.Conclusion： Warming-needle moxibustion can increase the endometrial thickness to a certain extent,thus improving the endometrial receptivity, enhancing the embryo implantation rate, and improving the pregnancy outcome.