崩漏的病因多端,病机复杂,是妇科临床疑难证之一.刘红梅医师遵循治崩漏三原则,灵活应用子宫针法,根据患者具体情况选择针刺深度、手法,对症结合方药调理冲任,标本同治,临床疗效肯定.

目的 分析20余年来中医疗法在早发性卵巢功能不全(Premature ovarian insufficiency,POI)领域的发展状况、研究热点,探索该领域的动态前沿.方法 以"卵巢早衰""早发性卵巢功能不全"为研究主题,检索知网(China National Knowledge Infrastructure,CNKI)核心数据库建库至2021年6月相关文献,应用CiteSpace进行作者、机构、关键词共现分析,并绘制相关可视化图谱进行分析.结果 中医治疗POI相关文献发文量逐年上升,共获得文献1143篇,最高文献量记载为2019年发表134篇;其中核心作者6位,针灸领域的房鋢恭最突出,是针灸领域的代表人物,主要研究机构主要是北京中医药大学、辽宁中医药大学、新疆医科大学等,各核心作者及大学机构之间合作不密切;热点关键词多为中医药、针灸、临床观察、研究进展、性激素、中西医结合、中医周期疗法等,研究热点集中在病因病机、治法及机制探索上.结论 中医疗法在诊治POI领域特点,优势明显,但还需要更高质量的基础医学和循证医学研究证实其功效和机制;结合现代医学机制通路的研究,及对POI的肾虚根本病机更深入的探讨,应用针药结合等综合手段治疗POI是未来的研究热点.

早发性卵巢功能不全(premature ovarian insufficiency, POI)是一种身心疾病,不仅导致卵巢功能减退、生育力下降、不孕、骨质疏松、心血管疾病等,与之伴随的还有认知障碍、焦虑抑郁等负性情绪,严重影响患者生活质量 [1-2].目前中西医治疗方法对该病的治疗各有优势与不足,如激素补充治疗并不能从根本上恢复卵巢功能;单一的中药或者针刺治疗或可能改善疾病某一阶段或相对较轻的病症,遇病情复杂或严重时疗效或不尽满意 [3-4].

目的 观察补肾活血通络法治疗薄型子宫内膜肾虚血瘀证的临床疗效.方法 选取68例薄型子宫内膜患者,采用随机数字表法将入组患者随机分为治疗组34例、对照组34例.剔除脱落病例后,治疗组30例、对照组30例.治疗组予补肾活血通络方加减治疗,对照组予口服戊酸雌二醇加黄体酮胶囊治疗.观察子宫内膜厚度、子宫内膜类型、子宫内膜血流类型、子宫内膜血流阻力指数(RI)和搏动指数(PI)值、子宫动脉RI和PI值、中医症状评分.结果 治疗后2组子宫内膜厚度均较治疗前增厚,差异均有统计学意义(P＜0.05).治疗后治疗组A型内膜比例高于对照组、C型内膜比例低于对照组,差异均有统计学意义(P＜0.05),治疗组优于对照组.治疗后2组子宫内膜血流类型均较治疗前改善(P＜0.05),治疗组优于对照组,差异均有统计学意义(P＜0.05).治疗后,治疗组患者子宫内膜血流RI,PI较治疗前降低(P＜0.05),治疗后2组患者子宫动脉血流RI,PI较治疗前降低(P＜0.05).治疗后2组月经量、行经时间评分较本组治疗前均降低,差异均有统计学意义(P＜0.05).治疗后,治疗组月经色质、腰膝酸软、头晕耳鸣、行经腹痛评分较本组治疗前均降低,差异均有统计学意义(P＜0.05).治疗后,治疗组各症状及总积分较对照组降低明显,治疗前后症状评分差值比较,差异均有统计学意义(P＜0.05).结论 补肾活血通络法治疗薄型子宫内膜肾虚血瘀证具有较好的临床效果.

文章为总结经络诊察在临床疾病中的应用与作用机制研究进展,查阅整理近现代有关经络诊察的文献.经络诊察发源于《内经》,经脉—脏腑相关是经络诊察的理论基础,经络、腧穴的"缝隙结构"是经络诊察的解剖基础.目前经络诊察应用与研究以王居易经络诊察法为主流方向,参与了临床多种疾病的诊断与治疗,效果让人满意,但医家运用经络诊察时操作不规范且含较大主观性是临床需要解决的问题.现代研究以经脉—脏腑相关为基础,从脑、脊髓、基因水平方面探讨其作用机制,在一定程度上证实了经脉与脏腑间存在着相对特异性联系,但尚未有运用经络诊察所得变动经脉或异常反应点与病变脏腑间作用机制的实验研究.经络诊察在针灸学占有重要地位,提示我们针灸临床应将此作为重点进行深入研究.

妊娠纹是一种萎缩性条索状的皮肤改变,主要发生于腹部皮肤,有些人在胸部、腹部、臀部和大腿部位也会生长. 妊娠纹的形态随时期变化 妊娠纹形成的主要原因与妊娠期女性内分泌的改变有关.受激素的影响,妊娠期女性的皮内弹力(纤维)减弱、脆性增加,皮下毛细血管及静脉壁变薄、扩张.

目的 基于中医传承辅助平台分析金哲教授对体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)失败后调理的用药规律,旨在为继承其学术经验提供相关量化数据支持.方法 收集整理2018年10月—2019年10月期间金哲教授门诊不孕症患者行IVF-ET失败后调理的处方150首,共涉及中药136味,运用中医传承辅助系统建立相应数据库,以挖掘高频药物、核心用药集群、新方分析等来总结金哲教授对IVF-ET失败后调理用药的配伍规律.结果 频次≥44次的中药有20味,高频药物组合中前5位分别是川芎、桑寄生,续断、桑寄生,菟丝子、枸杞子,月季花、川芎,丹参、桑寄生.结论 经数据挖掘统计分析得出金哲教授对IVF-ET失败后调理在补益肝肾的基础上,使用健脾养血通络的药物,能够改善子宫内膜环境和卵巢功能,从而提高IVF-ET的成功率,为临床IVF-ET失败调理提供思路.

目的 观察补肾活血通络方联合人工周期治疗促进宫腔粘连术后内膜恢复的效果.方法 选取2018年1月—2019年12月就诊于北京中医药大学第三附属医院妇科门诊的宫腔粘连分离术后恢复期患者60例,随机分为对照组和观察组各30例,对照组患者给予人工周期治疗,观察组则在对照组治疗基础上联合应用补肾活血通络方治疗,2组均治疗3个周期.比较2组患者治疗前后子宫内膜厚度以及子宫内膜血流搏动指数、阻力指数,中医症状及粘连程度评分、月经状况(月经量、月经周期、月经色质)评分,评价2组临床疗效.结果 治疗后2组子宫内膜厚度均明显增加(P均<0.05),子宫内膜血流搏动指数、阻力指数均明显下降(P均<0.05),观察组各检测指标变化幅度均明显高于对照组(P均<0.05);治疗后2组中医症状及粘连程度评分均明显下降(P均<0.05),观察组各项评分均明显低于对照组(P均<0.05);治疗后2组月经量、月经周期和月经色质评分均较治疗前明显下降(P均<0.05),观察组下降幅度明显高于对照组(P均<0.05);观察组治疗总有效率为93.3％(28/30),对照组为83.3％(25/30),观察组明显高于对照组(P<0.05).结论 补肾活血通络方联合人工周期应用于宫腔粘连术后可有效促进子宫内膜功能恢复,改善粘连状态及中医症状,疗效确切.

月经过少是妇科临床常见病、多发病,既可以作为独立的疾病存在,也是闭经、卵巢早衰等多种疾病的早期症状.若不及时治疗,可发展为闭经、反复流产、不孕、卵巢早衰等疾病,且大多数患者伴有焦虑、睡眠障碍,严重影响患者身心健康,同时增加患者家庭经济负担.因此应及早防治月经过少,不仅有利于维持患者正常的女性生理功能,延缓女性衰老,而且能减轻女性的生活困扰,提高生活质量.李云波教授从事临床工作20余年,对月经过少等月经病的治疗颇有心得,临床疗效显著.文中举出李云波教授治疗肝郁肾虚型月经量少的一些临床经验,以供同道参习.

目的:系统评价保妇康栓治疗宫颈人乳头瘤病毒(HPV)感染的临床疗效,为宫颈HPV感染患者的临床治疗决策提供依据.方法:计算机检索CNKI、VIP、CBM、Wanfang、EMCC、PubMed、EMBASE、SPRINGER(从建库至2015年5月),纳入以宫颈感染HPV患者为研究对象的随机对照临床试验,使用Cochrane手册评价纳入研究的方法学质量,用Revman 5.0进行统计分析.结果:共15篇文献,2437例患者被纳入本研究,Meta分析结果显示保妇康栓治疗宫颈HPV感染的总有效率[RR=1.72,95％CI(1.5,1.96),P<0.00001],转阴率[RR=2.05,95％CI(1.79,2.35),P<0.00001].结论:保妇康栓治疗宫颈HPV感染临床有效,由于纳入研究质量不高,需要更多高质量、低偏倚风险的随机对照试验加以证实.

Previous studies have shown that circRNA may be involved in the progression of cervical carcinoma, but direct evidence in this regard is still unknown. In this study, we aimed to investigate whether Circ-Protein kinase C iota type (circ-PRKCI) plays a vital role in the progression of cervical carcinoma. RT-PCR was performed to evaluate the expression of circ-PRKCI, miR-765, and HMGA1 in cervical carcinoma and matched normal tissues. Transwell assay demonstrated that circ-PRKC promotes cervical carcinoma cell migration and invasion. Luciferase reporter and miRNA target sequence analysis assay showed that miR-765 was targeted by circ-PRKCI, and HMGA1 was targeted by miR-765. We found that circ-PRKCI could promote the migration and invasion of cervical carcinoma cells. Furthermore, we proved that HMGA1 is a target of miR-765. circ-PRKCI was found to promote cell migration and invasion by suppressing the expression of miR-765 and upregulating the expression of HMGA1. Our work exhibited that circ-PRKCI-miR-765-HMGA1 regulatory network promotes the migration and invasion of cervical carcinoma cells.

目的:探讨多囊卵巢综合征(PCOS)中医证型与性激素及卵巢体积、腰臀比、体质量指教、饮食偏好的相关性,为多囊卵巢综合征的中医辨证分型提供客观指标.方法:对98例PCOS患者进行中医辨证分型、检测性激素6项、妇科超声、应用方差分析、Logistic回归模型探讨不同中医证型PCOS与性激素、卵巢体积、腰臀比、体质量指数、饮食偏好的相关性.结果:肾虚型LH较高,痰瘀互结型FSH较高,肾虚型E2较高,脾虚痰湿型T较高但差异无统计学意义;肾虚型LH /FSH比值较高,脾虚痰湿型BMI、WHR值较高,卵巢体积较大差异有统计学意义;肾虚型PCOS与LH/FSH比值具有相关性,脾虚痰湿型PCOS与BMI、WHR、卵巢体积、饮食偏好具有相关性,痰瘀互结型与饮食偏好、BMI具有相关性.结论:肾虚型PCOS与黄体生成素/卵泡刺激素具有相关性,与黄体生成素、卵泡刺激素、雌二醇、孕酮、睾酮、卵巢体积无相关性,脾虚痰湿型与卵巢体积、体质量指数、腰臀比、饮食偏好具有相关性,痰瘀互结型与饮食偏好、BMI具有相关性.

This study reported a 35-year-old female case with DOR was referred to this study and had a 3-year history of infertility. This case had failed three times to be pregnant by the treatment of multiple clomid cycles and IVF. Then, she came to the clinic in The Third Affiliated Hospital of Beijing traditional Chinese medicine University for seeking the TCM therapy. The Traditional Chinese Medicine (TCM) treatment-Chinese herbs combined with acupuncture-lasted from April 2014 to July 2014. The main outcome was the improvement of the patient's reproductive hormone panel, including FSH level, estradiol level, and AFC amount; in addition a pregnancy outcome was desired. After receiving the 3-month TCM treatment, the patient had great improvement in her reproductive hormone panel, the level of FSH was decreased from 12.3 mIU/mL to 6.7 mIU/mL and the amount of AFC was improved from 1-2 to 6-8 total. When she returned to receive the treatment of IVF auxiliary fertility technology, she was successfully pregnant. The therapy of Chinese medicine combined with acupuncture was effective and practicable in IVF auxiliary fertility.

[目的]系统评价中医药治疗卵巢储备功能减退的临床疗效.[方法]运用循证医学的方法,全面检索从建库至今发表的国内及国外文献库关于中医药治疗卵巢储备功能减退的临床随机对照试验.运用偏倚风险测量工具对纳入文献的质量进行评价.应用RevMan 5.1统计软件对纳入文献的结局指标进行Meta分析.[结果]最终纳入18项临床随机对照研究,分为中药对照西药激素及中药联合西药激素对照西药激素两个组别分别进行研究.同时采用辨证论治进行亚组分析,Meta分析结果显示中药联合西药激素在降低促卵泡生成激素(FSH)、改善中医证候疗效方面效果显著优于西药激素;在降低FSH/促黄体生成激素(LH)、升高抗苗勒管激素(AMH)方面,中药联合西药激素与西药激素的效果,无统计学意义.[结论]中药联合西药激素在改善卵巢储备功能减退方面具有一定的疗效.当然,本研究纳入文献的质量较低,因此,需要大量高质量的随机对照试验予以验证,提高其科学性及客观性.

[Objective] To observe the effect of kidney nourishing ventilating depression therapy with Yijing Zigui yin for the treatment of the kidney deficiency and liver stagnation of decline in ovarian reserve. [Methods] According to the diagnosis of Western medicine and Chinese medicine meet of decline in ovarian reserve of the liver kidney deficiency in patients with a total of 70 cases, the computer randomly divided into treatment group and control group with 35 cases in each group, respectively, by Yijing Zigui yin treatment group and Kunbao pill control group. Patients were instructed to start taking from the menstrual period fifth days, morning and evening and lasting for 3 months for a course of treatment, next menstrual period withdrawal. To observe the treatment group and the control group clinical symptom score changes, the determination of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2) level, safety index and pregnancy rate. [Results] Serum FSH and LH levels in both groups decreased after treatment (P＜0.05 or P＜0.01), serum E2 level decreased after treatment in patients in the control group (P＜0.05), there was no statistical difference in serum FSH, LH, E2 between the two groups after treatment (P＞0.05), the clinical efficacy of the treatment group was better than the control group (P＞0.05). [Conclusion] The treatment effect of decline in ovarian reserve of the kidney deficiency and liver stagnation in treatment of kidney nourishing ventilating depression therapy Yijing Zigui yin was better than Chinese patent medicine Kunbao pills.

卵巢储备功能下降(DOR)导致的不孕主要是因为内分泌紊乱,表现为40岁前促卵泡生成素(FSH)上升,窦卵泡计数(AFC)下降,妊娠率＜5％,流产率＞75％.中药及针灸治疗可以改善DOR患者的FSH及窦卵泡数量,提高妊娠率,降低流产率.虽然试管婴儿即体外受精-胚胎移植技术(ⅣF-ET)作为辅助生殖技术为广大不孕女性带来希望,但成功率仍不是很理想,并且反复促排卵及胚胎移植会过度刺激卵巢而出现竭泽而渔现象,导致卵巢储备功能急剧下降.通过对一例应用中医补肾宣郁法配合指针疗法治疗反复IVF三次失败后导致卵巢储备功能下降患者成功妊娠的病例进行分析,提出中医药及针灸干预在IVF辅助生育技术中的有效性和可行性.

Objective To discuss the syndrome distribution rules in patients with decline in ovarian reserve (DOR)in Beijing.Methods 160 DOR patients in Beijing were included as the subjects,and through literature retrospective survey and prospective cross-sectional survey,Proc LCA module of SAS sofiware was used with the help of latent class analysis technology to explore the establishment of the latent class model of TCM syndromes of DOR and study the rules.Results TCM syndromes of DOR in 160 cases were divided into 3 categories,respectively liver depression and kidney deficiency syndrome in 117 cases (73.1％),kidney yang deficiency syndrome in 35 cases (21.9％),and yin deficiency of liver and kidney syndrome in 8 cases (5％).Conclusion The latent class variable model of TCM syndrome of DOR is closely related to the kidney,which complies with the clinical syndromes.

目的 探讨“发现法”教学方法在中医妇科教学中应用的效果.方法 对象为北京中医药大学中医本科留学生班2011级学生.用“发现法”结合传统教学方法教学,教学完成后对全班同学进行问卷调查,进行满意度评估.结果 “发现法”教学模式在激发学生学习兴趣,提高自学能力、解决问题能力、沟通能力、团队合作精神、提高临床思维能力等方面的作用明显.结论 发现法较传统教学方法具有明显的优势,可以加以推广.

Vulvar carcinoma is a rare tumor occurring in female patients. Though more than 40% of vulva cancers are due to the infection of human papillomavirus (HPV), understanding of HPV and vulvar carcinoma is insufficient. HPV expression is regulated by cellular and viral transcription factors that bind to specific elements within the ligase chain reaction. These proteins bind with different affinity to host cell proteins and disrupt normal epithelial differentiation and apoptosis. Immunotherapy does not target tumors, but instead targets the host immune system. Active immunotherapy is tumor-targeting or immune-targeting monoclonal antibodies and vaccines. Nonspecific active immunotherapy is mainly cytokine therapy. In the treatment and prevention of HPV, the most popular research projects were regarding peptide, recombinant protein and DNA-based vaccines, recombinant virus and other targets in HPV infection. Since the cervix and vulva are both susceptible areas, these studies may be able to help reduce prevalence of vulvar precancerous lesions and prevent all cancers caused by HPV.

崩漏的病因多端，病机复杂。多数妇科医师认为其常见病因为肾虚、脾虚、血热、血癖，病机则主要为冲任损伤，不能制约经血，致子宫藏泻失常。在治疗上灵活运用“塞流、澄源、复旧”三法但不拘泥初、中、末之“次第”，相互为用。出血期以活血化癖法为主塞流，同时探究不同致癖原因而治之；血止之后注重求因治本，复旧善后，再结合女性月经周期不同阶段的生理特点，在经后期滋肾养血，以使血海充盈；经前期理气活血，以使气血通调，从而使患者恢复正常的月经周期，在临床上收到良好的疗效。