基于心肾交济理论辨治卵巢低反应
Differentiation and treatment of poor ovarian response based on the theory of intercourse of heart and kidney
邵婧怡 1史云 1蔡凯璇 2闫菲 1刘秦扬 1李西钰 1甘小金1
作者信息
- 1. 北京中医药大学东直门医院 北京 100700
- 2. 深圳市宝安纯中医治疗医院
- 折叠
摘要
卵巢低反应是卵巢对促性腺激素刺激反应不良的一种病理状态,是体外受精-胚胎移植结局不理想的主要因素.卵泡的生长、发育、成熟、排出均有赖于心肾阴阳平衡、升降交济.若心肾精血不足、水火不济、气机不畅则卵巢刺激周期中募集和获取的优质卵泡减少,从而可移植胚胎率低,故妊娠结局不满意.在治疗方面,体外受精-胚胎移植周期不同阶段均当以交济心肾为根本治疗原则,在进周期前应补益心肾精血,养精蓄锐助卵生长;降调节期应滋肾水、清心火,减少降调药物的不良反应;取卵期应调畅心、肝、脾、肾四经之郁,促进卵子顺利排出;移植期应温煦心肾之火,改善子宫内膜容受性.本文运用心肾交济理论阐明卵巢低反应的病因病机,对临床制定助孕策略具有重要意义,也为中医药在生殖领域的临床应用提供新思路.
Abstract
Poor ovarian response (POR) is a pathological condition in which the ovary responds poorly to gonadotropins,and is a major constraint on the unsatisfactory outcome of in vitro fertilization-embryo transfer (IVF-ET). Follicular growth,development,maturation,and expulsion are all affected by the yin-yang balance between heart and kidney,as well as the elevation exchange. If the heart and kidney essence and blood are insufficient,water and fire are out of harmony,and qi movement is not smooth,fewer high-quality follicles will be recruited and acquired during the ovarian stimulation cycle,resulting in a low transferable embryo rate and unacceptable pregnancy result. Sympathetic treatment of heart and kidney should be based on the following principles at different stages of the IVF-ET cycle:replenishing the heart,kidney,essence,and blood before entering the cycle,in order to nourish the essence and assist in the growth of the follicles;nourishing renal water,and clearing heart fire during the pituitary down-regulation period,in order to lessen the negative effects of the down-regulation medicinals;regulating the depression of the heart,liver,spleen,and kidney meridians during the follicle's retrieval period,in order to encourage the smooth release of the ova;and warming heart and kidney fire to improve endometrial tolerance during the implantation period. The application of the theory of intercourse of heart and kidney to elucidate the pathogenesis of POR is critical to the development of clinical strategies for fertility enhancement,as well as providing new ideas for the clinical application of traditional Chinese medicine in the field of reproduction.
关键词
心肾交济/卵巢低反应/体外受精-胚胎移植/病机/治疗Key words
intercourse of heart and kidney/poor ovarian response/in vitro fertilization-embryo transfer/pathogenesis/treatment引用本文复制引用
基金项目
北京市中医药科技发展项目(BJZYZD-2023-08)
出版年
2024
国家科技期刊平台
NSTL
万方数据