临床上常用促排卵药物治疗小卵泡排卵,但仍有部分患者表现出卵巢低反应或对促排卵药物的耐药性,常规促排卵方案难以治疗顽固性小卵泡排卵.本文报道了 1例顽固性小卵泡排卵的患者,通过中医药联合低剂量克罗米芬(CC)+人绝经期促性腺激素(HMG)微刺激治疗,并配合八段锦锻炼,成功获得临床妊娠.

目的:系统评价桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的疗效和安全性.方法:运用计算机检索国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库、PubMed、The Cochrane Library、The Web of Science、Springer等中英文数据库从建库至2020年5月关于桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病的随机对照试验和临床对照试验.应用Revman5.3软件进行Meta分析.结果:经筛选,纳入12篇文献,共1206例患者.Meta分析结果显示:桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病临床总有效率更高(OR=3.31,95％Cl为2.12～5.18,P<0.00001),并能减轻痛经程度:慢性疼痛分级问卷法评分方法(MD=-0.46,95％CI为-0.62～-0.29,P<0.00001)和VAS评分方法(MD=-1.75,95％CI为-2.01～-1.49,P<0.00001),减少月经量(MD=-15.47,95％CI为-20.20～-10.73,P<0.00001),使子宫内膜厚度变薄(MD=-15.47,95％CI为-2.14～-2.38,P<0.00001),子宫体积缩小(MD=-16.23,95％CI为-19.45～-13.02,P<0.00001),降低血清促卵泡素(FSH)(MD=-1.30,95％CI为-1.86～-0.74,P<0.00001)、黄体生成素(LH)(MD=-1.18,95％CI为-1.37～-1.00,P<0.00001)和血清CA125水平(MD=-9.68,95％CI为-12.83～-6.54,P<0.00001),降低不良反应发生率(OR=0.53,95％CI为0.29～0.94,P=0.03).结论:桂枝茯苓胶囊(丸)联合曼月乐治疗子宫腺肌病疗效优于单用曼月乐组,不良反应发生率低于单用曼月乐组.受纳入文献的数量和质量的限制,将来需要更大样本和高质量的研究文献,对二者联合治疗子宫腺肌病有更精确的评估.

总结金哲教授临证运用虫类药治疗妇科疾病的经验.认为诸多迁延不愈的妇科疾病多与瘀、痰有关,虫类药多走窜,具有活血化瘀、引经通络、解毒散结的功效,可增强草木类药物剔除痰瘀顽邪之效.临证以全蝎、蜈蚣、穿山甲、土鳖虫、九香虫、乌梢蛇、蜂房等虫类药,治疗痛经、盆腔炎性疾病后遗症、经行头痛等妇科痛症,以及薄型子宫内膜、高危型人乳头瘤病毒(HR-HPV)感染等妇科疾病,并以蜈蚣、蜂房为君药创制外用中药"清毒栓".

金哲教授对绝经前后诸证病因病机的认识主要为肾亏为本,病因繁多;气机逆乱,气血失调;精血亏耗,多虚多瘀;虚火上炎,心神失养.治疗以益脾胃、补肝肾、调气血、散瘀滞、清虚热、安神志为法,并根据兼症加减用药.金哲教授尤其注重滋后天在治疗绝经前后诸证中的地位,同时关注调理气与血,并灵活运用药对加减以辨证治疗绝经前后诸证,收效显著.

目的:利用文献数据分析和探讨国家知识基础设施数据库(CNKI)中以中医药治疗卵巢储备功能下降的辨治规律.方法:检索筛选CNKI中运用中医药处方治疗卵巢储备功能下降的文献,构建中医药治疗卵巢储备功能下降的数据库,运用中医传承辅助平台软件(V2.5)集成的数据挖掘方法,分析近11年治疗卵巢储备功能下降的方剂组方规律.结果:筛选出治疗卵巢储备功能下降的文献187篇,处方327个,其中中药190味,处方中药物出现频次≥30次的药物39味,得出常用药物组合42个,演化得到核心组合14个,新处方7个.结论:DOR的根本病因为肾虚,肝失调达、气血失调是其发病的重要因素.中医药治疗卵巢储备功能下降用药以补益肝肾为主,同时可伍以疏肝解郁、化瘀通络、健脾祛湿、交通心肾、清热化痰等治法,为临床用药提供新思路.

目的 探讨自拟固胎煎对复发性流产小鼠蜕膜组织中叉头/翼状螺旋转录因子3(forkhead/pterygoid spiral transcription factor 3,Foxp3)、维甲酸相关核孤儿受体(retinoic acid related nuclear orphan receptor,RORγt)表达的影响.方法 将CBA/J雌鼠与BALB/c雄鼠2∶1合笼,建立正常妊娠模型(CBA/J×BALB/c组)作为对照组.CBA/J雌鼠与DBA/2雄鼠2∶1合笼,建立复发性流产模型(CBA/J× DBA/2组),并随机分为中药高、中、低剂量组、西药组以及模型组,HE染色观察各组蜕膜细胞形态,免疫组化法及Western Blot法分别检测各组小鼠蜕膜组织中Foxp3和RORγt的表达.结果 与模型组相比,自拟固胎煎中、高剂量组小鼠蜕膜组织内细胞数量及血管数量增多,胞质丰富,胞浆水肿减轻,核仁大而明显.且Foxp3表达均显著增加(P＜0.05),RORγt的表达均显著降低(P＜0.05).结论 自拟固胎煎能增加蜕膜组织Fox1p3的表达,减少RORγt的表达,改善小鼠蜕膜组织细胞局部环境,提示自拟固胎煎治疗复发性流产可能与其参与免疫调节,改善蜕膜环境作用机制相关.

目的 观察自拟固胎煎对复发性流产模型小鼠外周血白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-17(IL-17)、转化生长因子-β1(TGF-β1)表达及对妊娠结局的影响.方法 选取SPF级CBA/J雌鼠(n=48)、BALB/C雄鼠(n=4)、DBA/2雄鼠(n=20)作为研究对象.采用CBA/J雌鼠×BALB/c雄鼠建立正常妊娠模型,以CBA/J雌鼠×DBA/2雄鼠建立复发性流产模型,复发性流产模型孕鼠随机分为中药组、地屈孕酮组和复发性流产组,且将中药组分为高剂量亚组、中剂量亚组、低剂量亚组,正常妊娠组和复发性流产组给予生理盐水,中药高剂量亚组、中剂量亚组、低剂量亚组依次给予28.5 g/kg、14.25 g/kg、7.125g/kg自拟固胎煎汤剂,地屈孕酮组给予3.0mg/kg地屈孕酮溶液,连续灌胃2周,每天1次.给药结束后处死并解剖小鼠,观察子宫胚胎数量并计算胚胎丢失率,酶联免疫吸附试验(ELISA)法检测外周血IL-6、IL-10、IL-17及TGF-β1的表达水平.结果 与复发性流产组比较,中药中剂量亚组、高剂量亚组和地屈孕酮组胚胎丢失率均显著降低,差异具有统计学意义(P<0.05);与复发性流产组比较,中药中剂量亚组、高剂量亚组和地屈孕酮组的IL-6和IL-17的表达均显著降低,IL-10和TGF-β1的表达均显著升高,差异具有统计学意义(P<0.05).结论 自拟固胎煎可能通过上调IL-10、TGF-β1的表达水平,下调IL-6、IL-17的表达水平,诱导免疫耐受,减少胚胎丢失率,从而改善妊娠结局.

目的:研究参芪扶正汤对盆腔炎性疾病后遗症(sequelae of pelvic inflammatory disease,SPID)模型小鼠上生殖道炎症因子的影响.方法:SPF级BALB/c雌性小鼠60只,随机分为正常组、模型组、阿司匹林组(0.2 g·kg-1)、参芪扶正汤灌胃组(17 g·kg一)、参芪扶正汤灌肠组(17 g·kg-1)、参芪扶正汤灌胃灌肠联合组(灌胃17 g·kg-1+灌肠17 g·kg-1).除正常组外,其余组小鼠采用宫颈注射"盐酸(hydrochloric acid,HCL)+脂多糖(lipopolysaccharide,LPS)"的方法建立SPID小鼠模型.造模后第6周开始给予相应药物干预,正常组、模型组给予等体积的5‰羧甲基纤维素钠溶液灌胃,每天1次,连续15 d.给药结束后,检测各组小鼠脸谱疼痛评分(mouse grimace score,MGS);Western Blot检测上生殖道(子宫、输卵管及卵巢)组织中白细胞介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、IL-4、IL-10的蛋白表达水平.结果:与正常组比较,模型组MGS显著升高(P＜0.05),上生殖道组织IL-8、TNF-α、IL-10的蛋白表达水平显著升高(P＜0.05);与模型组比较,参芪扶正汤灌胃组、参芪扶正汤灌肠组及参芪扶正汤灌胃灌肠联合组MGS显著降低(P＜0.05),抗炎因子IL-4、IL-10的蛋白表达水平显著升高(P＜0.05),促炎因子IL-8、TNF-α的蛋白表达水平显著降低(P＜0.05).结论:参芪扶正汤可有效缓解SHD小鼠盆腔疼痛症状,调节上生殖道炎症因子表达,改善上生殖道炎症.

金哲教授基于"治未病"理论,顺应天人相应,因时防治;善用药食同源,因人施治;施以五行音乐,调志防病.其认为卵巢储备功能下降(DOR)的基本病机为肾精不足、冲任虚衰,证属虚中夹实;基于长期临床经验,将其辨为肾虚血瘀证、肾虚肝郁证、脾肾两虚证、心肾不交证,肾虚肝郁型居多;遵循"益肾填精,养肝健脾"为大法.通过分析"治未病"在肾虚肝郁型卵巢储备功能下降中的具体运用,根据DOR的病因病机及发病特点,治疗上应重视控制高危因素的发生,强调从自身防护出发做到未病先防,已病者防止进一步传变,积极地给予中医药干预,进行中医养生预防知识的临床宣教,改善预后,可在一定程度上缓解DOR给广大妇女带来的生殖能力低下和低雌激素水平造成的困扰.

目的 初步探讨多囊卵巢综合征(PCOS)中医证候要素评判标准,为PCOS的中医辨证标准的建立提供一定的循证依据.方法 采集518例PCOS患者临床资料;采用隐变量分析法构建模型.并进行一致性检验.结果 模型拟合优度指数及校正拟合优度指数均接近1,模型拟合较好.近似误差均方根为0.0637,≤0.08,模型可以接受.一致性检验结果显示:肾、肝、脾3个病位类证候要素,具备一个模型中的症状(腰骶酸痛、夜尿多、耳鸣;心情抑郁、急躁易怒、善太息;食少纳呆、食后腹胀、泄泻)即可诊断,与医生辨证相同的概率分别为71.6％、88％及77％.气虚、气滞、痰湿3个病性类证候要素,具备两个模型中的症状(神疲、乏力、自汗;胸闷、胸胁胀痛、乳房胀痛;嗜睡、头蒙如裹、咯痰)即可诊断,与医生辨证一致的概率分别为86.3％、83.2％、80.5％.结论 初步制定PCOS证候要素评判标准:在满足PCOS诊断标准的基础上,肾、肝、脾,具备一个模型中的症状即可诊断,气虚、气滞、痰湿,具备两个模型中的症状即可诊断.

[目的]观察自拟固胎煎对自然流产模型小鼠脾脏Th17/Treg细胞及对妊娠结局的影响.[方法]采用CBA/J雌鼠×BALB/c雄鼠建立正常妊娠模型,以CBA/J雌鼠×DBA/2雄鼠建立自然流产模型,自然流产孕鼠分为自然流产组、地屈孕酮组、中药低、中、高剂量组,正常妊娠组和自然流产组给予生理盐水,中药低、中、高剂量组分别给予7.125、14.25、28.5 g/kg自拟固胎煎汤剂,地屈孕酮组给予3.0 mg/kg地屈孕酮溶液,连续2周灌胃,每日1次.给药结束后处死并解剖小鼠,观察子宫胚胎数量并计算胚胎丢失率,流式细胞法检测脾脏中Th17细胞、Treg细胞含量及Th17/Treg细胞比例.[结果]1)与自然流产组相比,中药低剂量组胚胎丢失率差异无统计学意义(P>0.05);中药中剂量组、高剂量组和地屈孕酮组胚胎丢失率均显著降低(P<0.05),且中药中剂量组、中药高剂量组、地屈孕酮组3组间比较,胚胎丢失率差异均无统计学意义(P>0.05).2)与自然流产组相比,中药低剂量组Th17细胞数、Treg细胞数及Th17/Treg细胞百分率比值均无统计学差异(P>0.05);中药中剂量组、高剂量组和地屈孕酮组,Th17细胞数及Th17/Treg细胞百分率比值均显著降低(P<0.05),Treg细胞数均显著升高(P<0.05);且中药中剂量组、中药高剂量组、地屈孕酮组3组间比较,Th17细胞数、Treg细胞数及Th17/Treg细胞百分率比值差异均无统计学意义(P>0.05).[结论]自拟固胎煎可降低Th17/Treg比例,诱导免疫耐受,减少胚胎丢失率,改善妊娠结局.

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.

Objective To observe the effect of Chaiyujisheng decoction on hyperprolactinemia ( hPRL) model rat o-varian tissue PRL/PRLR-JAK2-STAT5 signaling pathway and improvement of the ovarian function mechanism.Methods Wistar rats were injected with dopamine receptor blockers to cause a high level of prolactin (60 rats).The model group was randomly divided into model group, bromocriptine group, large dose group, middle dose group, small dose group, and the normal group with 10 rats in each group.Traditional Chinese medicine high dose group’ s Chaiyujisheng decoction’ s amount was 18 g· kg-1 · d-1 ,medium dose group was 9 g· kg-1 · d-1 , and low dose group was 4.5 g· kg-1 · d-1 .Each time, the amount of each rat were fed with 2 ml.Bromocriptine group were given bromocriptine 2 mg· kg-1 · d-1;model group and normal group according to body mass were given equal volume of distilled water by gavage.Each group administered once dai-ly, continuous administration of 30 d.At the end of treatment, rats were sacrificed, rat ovarian volume were measured;detec-ted serum estradiol ( E2 ) , luteinizing generated hormone ( FSH) , through the method of Western blot and PCR to detect ovari-an’ s STAT and PRLR expression level to observe the effects of hyperprolactinemia environment on PRL/PRLR-JAK2-STAT5 signaling pathway and ovarian function, and to explore its possible mechanism.Results Compared with the normal group, model group rats’ serum PRL level increased significantly, E2 , FSH levels were significantly decreased ( P <0.05);ovari-an’s STAT and PRLR protein expression level were significantly decreased ( P <0.05).Compared with model group,in the treatment group, the serum PRL levels were significantly decreased and serum E2 , FSH levels and ovarian’ s STAT and PRLR expression levels were significantly increased.Between the different treatment groups, middle dose of traditional Chinese medi-cine group rats’ serum E2 and FSH levels improvement were the most obviously, and ovarian’ s STAT and PRLR protein ex-pression was the highest(P<0 ?.05), and differences in the level of PRL had no statistical significance ( P >0.05).Conclu-sion It demonstrated that the Chaiyujisheng decoction could improve ovarian function in hyperprolactinemia, its mechanism maybe due to regulate the expression of ovarian PRL/PRLR-JAK2-STAT5 signaling pathway related factors, so as to improve E2 , FSH’ s level.

国家级名老中医金哲教授积40余年临床经验，总结出诊治卵巢储备功能下降的有效辨治思路与方法。金哲教授认为此病以肾虚肝郁证多见；治疗时以滋补肝肾为大法，用药重在平和，兼顾调理气血，把握时机，注重“养”与“促”的关系。临床取得较好的疗效。

<正>慢性盆腔炎目前又被称为盆腔炎性疾病的并发症、后遗症,多因急性盆腔炎未能得到及时、正确的处理,或患者体质较差,使病情迁延,并出现后遗症或并发症,包括复发性盆腔炎、慢性盆腔痛、输卵管积水、不孕等,症见下腹冷痛,腰骶酸坠,白带增多,

Objective Through the study of cervical lesions vagina inmage to investigate the micro-syndrome identified methods for cervical lesions. Methods Through the methods of retrospective study, collecting cases of HR-HPV infection (HC Ⅱ positive) and colposcopy detection, the objective evaluation of micro-syndrome differentiation was primarily established. Results RGB mode quantitative analysis for colposcopy images showed category 3 (the purple samples) occupied 44.4％, category 2 (the red samples)occupied 12.6％; category 1 (the white samples) occupied 43％. Conclusions RGB mode quantitative analysis for colposcopy images was appropriate exploration of micro-differentiation in cervical lesions. There is a close relationship between traditional Chinese medicine syndrome and mucosai color differentiation by colposcopy.

益母革 方药组成益母草. 作用功效活血化淤,调经止痛.用于血淤所致的月经不调、痛经、产后恶露不尽,症见经水量少、色暗、淋漓不净,产后出血时间过长,产后子宫恢复不全见上述证候者.目前人流术、药流术后均可常规口服益母草以达到帮助子宫收缩、缩短出血时间、减少药流不全发生率的功效.