女子以血为本,以肝为先天,肝、血失调是妇科疾病的常见病机.郭志强教授认为女性肝郁致病,与男子肝气横逆之实证不同,多因阴血不足、血不柔肝而致肝失疏泄,故提出治疗时"柔肝胜于疏肝".郭志强教授独辟蹊径地以养血柔肝的代表方剂一贯煎为基础方进行随证加减,对于肝、血失调引起的妇科疾病疗效颇著,也充分体现了"异病同治"的中医辨证论治特色.本文所载郭志强教授运用一贯煎从肝、血论治妇科疾病验案四则:(1)滋阴养血柔肝,佐以补肾健脾,治疗肾虚肝郁型下丘脑性闭经;(2)滋阴养血、引火归元治疗虚阳上浮所致经行口糜;(3)滋阴养血,佐以引热下行,治疗经行衄血之虚热证;(4)滋阴养血,柔筋通络治疗阴血亏虚、筋脉失养所致产后身痛.并深入分析郭教授"妇人柔肝胜于疏肝"的学术思想在妇科疾病中的临床应用,以供借鉴.

目的 探讨不同温经汤加减外敷方法治疗慢性盆腔痛的疗效及成本-效果比,优化操作方案.方法 将2017年9月—2020年9月在北京中医药大学东方医院门诊就诊的144例慢性盆腔痛寒凝血瘀型患者随机分为4组各36例,30 min 14 d组给予温经汤加减外敷30 min/次,每个月经周期连续治疗14 d;30 min 21 d组给予温经汤加减外敷30 min/次,每个月经周期连续治疗21 d;60 min 14 d组给予温经汤加减外敷60 min/次,每个月经周期连续治疗14 d;60 min 21 d组给予温经汤加减外敷60 min/次,每个月经周期连续治疗21 d.治疗3个月经周期后,观察4组患者简化McGill疼痛评分、中医症状评分、局部体征积分、生活质量积分变化,比较4组慢性盆腔痛疗效、抑郁状况改善情况、不良反应发生情况及成本-效果比.结果 30 min 14 d组29例、30 min 21 d组28例、60 min 14 d组30例、60 min 21 d组28例完成研究.治疗后4组简化McGill疼痛评分、中医症状评分、局部体征积分均明显降低,60 min 14 d组明显低于30 min 14 d组,60 min 21 d组明显低于30 min 21 d组,差异均有统计学意义(P均<0.05);30 min 14 d组与30 min 21 d组、60 min 14 d组与60 min 21 d组比较差异均无统计学意义(P均>0.05).治疗后4组生活质量积分均明显增加(P均<0.05),但4组间比较差异均无统计学意义(P均>0.05).60 min 14 d组慢性盆腔痛及抑郁治疗总有效率最高,但与其他组比较差异均无统计学意义(P均>0.05);4组均无明显不良反应发生;60 min 14 d组成本-效果比最低.结论 温经汤加减外敷治疗寒凝血瘀型慢性盆腔痛疗效确切,其中每次敷药60 min、每个月经周期连续14 d为可优化操作方案.

目的 探讨延胡索-没药治疗慢性盆腔痛(Chronic Pelvic Pain,CPP)的作用机制.方法 通过TC-MSP数据库获取延胡索、没药的主要化学成分及其靶点,根据ADME筛选中药活性成分;通过GeneCards、OMIM、TTD数据库获取慢性盆腔痛的主要靶点,利用STRING平台进行蛋白质相互作用分析,构建PPI网络并挖掘网络中潜在的蛋白质功能模块;并通过Metascape平台对交集基因进行基因本体(Gene Ontolgy,GO)功能和基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)通路富集分析,最后采用Cytoscape 3.8.0软件构建"延胡索-没药—慢性盆腔痛-靶点"网络.结果 选出延胡索-没药活性成分92种,CPP疾病靶点214种,活性成分靶点与慢性盆腔痛靶点的交集基因共108个,延胡索-没药的槲皮素、二氢白屈菜红碱、豆甾醇及鞣花酸等多种活性成分可能通过流体剪切应力和动脉粥样硬化信号通路、AGE-RAGE信号通路、癌症信号通路、癌症蛋白聚酶通路作用于环加氧酶(Prostaglandin Endoperoxide Synthase-2,PTGS2)、雄激素受体(Androgen Receptor,AR)、雌激素受体α(Estrogen Receptor alpha,ERα)、丝裂原活化蛋白激酶14(Mitogen-Activated Protein Kinase-14,MAPK14)等靶点治疗慢性盆腔痛.结论 本研究初步揭示了延胡索-没药治疗慢性盆腔痛的多成分、多靶点、多通路的特点,为临床上延胡索-没药的应用提供基础生物学信息支持.

目的:评价灵莲花颗粒对不同睡眠质量更年期综合征(menopausal syndrome,MPS)(心肾不交证)患者的疗效.方法:选取2014年11月—2016年2月就诊于北京中医药大学东方医院、北京大学第一医院等11家医院门诊且符合MPS诊断属心肾不交证患者238例,其中睡眠质量良好者141例,质量较差者97例,根据不同治疗方法分为试验组及对照组,对照组给予坤泰胶囊,试验组给予灵莲花颗粒,比较两组疾病疗效、睡眠质量及激素水平[促卵泡生成激素(FSH)、雌二醇(E2)].结果:睡眠质量良好及较差者中试验组治疗后改良Kupperman评分、PSQI评分低于对照组,差异有统计学意义(P<0.05);试验组治疗后E2高于对照组,FSH低于对照组,且睡眠质量较差者疗效更佳,差异有统计学意义(P<0.05).结论:灵莲花颗粒可提高MPS心肾不交证患者的睡眠质量,改善其临床症状及激素水平,其整体疗效优于坤泰胶囊.

目的:基于AMPK信号通路蛋白及基因表达,进一步探讨乌萸汤改善初老小鼠卵巢功能的作用机制.方法:将24周龄C57BL/6J雌性小鼠随机分为初老组、治疗组和治疗+Compound C组,以6周龄C57BL/6J雌性小鼠为对照组.治疗组、治疗+Compound C组小鼠给予乌萸汤灌胃,对照组、初老组均用等量蒸馏水灌胃;治疗+Compound C组除每日中药灌胃外,每周腹腔注射一次Compound C 0.2mg·kg-1.灌胃8周后,促排卵并脱颈椎处死,取卵巢处理卵丘复合物,比较各组卵母细胞数、卵母细胞成熟率及卵母细胞ATP和线粒体含量,并用Western blot及PCR法检测卵巢内AMPK/PCG-1α通路蛋白及基因表达.结果:与对照组相比,初老组卵母细胞数目、成熟率及卵母细胞内ATP含量及线粒体荧光强度明显下降(P＜0.05),且AMPK/PCG-1α通路蛋白及基因表达相关分子均明显降低(P＜0.05);与初老组相比,治疗组卵母细胞数目、成熟率及卵母细胞内ATP含量及线粒体荧光强度明显升高(P＜0.05),且AMPK/PCG-1α通路蛋白及基因表达相关分子均明显升高(P＜0.05);与治疗组相比,治疗+Compound C组卵母细胞数目、卵母细胞内ATP含量及AMPK/PCG-1 α通路蛋白明显下降(P＜0.05),线粒体荧光强度及AMPK/PCG-1α通路基因表达相关分子均稍有降低(P＞0.05).结论:鸟萸沥可能主要通过调控AMPK通路的蛋白表达,促进卵母细胞内线粒体能量代谢,进一步改善初老小鼠的卵巢功能.

目的 探讨少腹逐瘀汤加减配合药袋热敷治疗对慢性盆腔炎患者的炎症因子的影响.方法 选择慢性盆腔炎患者60例,随机分为两组,各30例.两组患者均采用少腹逐瘀汤配合药袋热敷治疗,观察组热敷时间为60 min,对照组热敷时间为30 min.比较两组炎症因子水平、中医症状积分、不良反应.结果 治疗后,对照组TNF-α、IL-1β水平高于观察组,IL-4水平低于观察组,中医症状积分高于观察组(P<0.05);两组不良反应发生率相比,差异无统计学意义(P>0.05).结论 慢性盆腔炎患者采用少腹逐瘀汤配合药袋热敷治疗,热敷时间60 min治疗效果明显优于热敷30 min,利于降低炎症因子水平,改善临床症状.

目的 探讨中药外敷联合情志护理治疗盆腔炎性疾病的临床治疗效果.方法 选择盆腔炎性疾病患者60例,随机分为观察组与对照组,各30例.对照组进行中药外敷治疗,观察组给予外敷加情志治疗的方式进行护理治疗.两组疗程均为21d,对比两组患者的在的临床治疗效果,安全性及治疗依从性.结果 观察组临床治疗效果显著优于对照组患者.结论 桂棱双草止痛方联合情志护理对临床上治疗盆腔炎性疾病疗效显著,值得临床推广使用.

目的 评价灵莲花颗粒治疗更年期综合征心肾不交证的有效性和安全性.方法 采用前瞻性、阳性药平行对照、多中心临床研究方法,共纳入238例受试者,其中试验组119例,给予灵莲花颗粒(乌灵菌粉、栀子、女贞子、墨旱莲、百合、玫瑰花、益母草、远志,4 g/袋,含生药量13 g),每次1袋,每日2次;对照组119例,给予坤泰胶囊(熟地黄、黄连、白芍、黄芩、阿胶、茯苓,0.5 g/粒),每次4粒,每日3次.疗程12周.观察两组治疗前及治疗12周后改良Kupperman评分、匹兹堡睡眠质量指数量表(PSQI)以评价疗效,并比较两组雌二醇(E2)、促卵泡生成激素(FSH)水平及中医证候疗效.结果 试验组完成病例118例,对照组完成116例.试验组改良Kupperman评分为(11.59±6.43)分,下降程度高于对照组[(10.09±6.85)分];PSQI下降(9.45 ±7.30)分,高于对照组[(6.97±7.12)分],差异均有统计学意义(P＜0.01).两组均能升高性激素E2、降低FSH水平,且试验组略优于对照组,但差异无统计学意义(P＞0.05).试验组中医证候积分下降[(8.86±5.26)分],高于对照组[(7.21±4.55)分],差异有统计学意义(P＜0.05).且试验组中医证候疗效总有效率83.05％ (92/118),愈显率21.19％(26/118),均高于对照组[75％(87/116)和12.93％ (15/116)].试验组失眠、心烦不宁的有效率及显效率均高于对照组,差异均有统计学意义(P＜0.01).两组发生不良反应均为3例,未作特殊处理.结论 灵莲花颗粒在改善更年期综合征心肾不交证患者Kupperman评分、PSQI以及中医证候方面优于坤泰胶囊.

目的:探讨补肾养血法对超促排卵后孕鼠子宫内膜CD56+NK蛋白表达及NK1/NK2/NK3/NKr1细胞免疫应答平衡影响.方法:建立超促排卵后孕鼠模型,以补肾养血方干预孕鼠,提取子宫内膜中子宫自然杀伤(uNK)细胞上清液,应用ELISA法检测上清液中CD5+6NK细胞、干扰素-γ(INF-y)、肿瘤坏死因子-o(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-5(IL-5)、转化生长因子-β(TGF-β)、白细胞介素-10(IL-10)蛋白表达改变.结果:超促排卵可降低CD4-NK细胞及TGF-β、IL-10表达(P＜0.05),提高INF-γ、TNF-α、IL-4、IL-5的表达(P＜0.05),使蛋白表达从NK3、NKr1免疫营养向NK1、NK2细胞免疫损伤偏移;中药补肾养血方可显著提高CD56+NK细胞、TGF-β、IL-10蛋白表达(P＜0.05),显著降低INF-γ、TNF-α、IL-4、IL-5蛋白表达(P＜0.05),促进NK1、NK2免疫损伤向NK3、NKr1免疫营养方向偏移.结论:补肾养血法可以通过增加CD56+NK细胞表达,调节子宫内膜NK1/NK2/NK3/NKr1细胞免疫应答平衡,提高子宫内膜容受性从而保证早期的妊娠稳定.

This topic utilizes the double TBL teaching method(Team-based learning and Task-based learning union) on the gynecology of integrated traditional Chinese and Western Medicine; through data analysis, it solves the question synthesizing capacity, builds the solid rationale for the clinical practice, improves medicou0027s professional quality.

目的 探讨中医补肾养血法对超促排卵未孕大鼠子宫内膜微环境的影响.方法 建立大鼠超促排卵模型,以补肾养血方干预未孕大鼠,分析其子宫内膜形态、微血管密度、子宫容受性分子标志物的改变.结果 超促排卵可减小子宫内膜厚度,增加腺上皮高度使腺体密集,降低白血病抑制因子(LIF)蛋白及整合素α4蛋白的表达,改变子宫内膜微环境;补肾养血法可改善未孕超促排卵大鼠子宫内膜形态,升高整合素α4和LIF表达水平.结论 补肾养血法可以改善子宫内膜微环境,提高子宫内膜容受性,从而保证早期的妊娠稳定.

The purpose of this study was to explore the positive effects of Bu Shen Huo Xue Decoction (BSHXF) on assisted reproduction. The study aimed to evaluate whether BSHXD could improve endometrial morphology and increase the expression of LIF in a gonadotrophin-releasing hormone agonists (GnRHa) long protocol-induced rat model during metestrus, diestrus, proestrus, and oestrus. The BSHXD group presented significantly increased endometrium thickness and decreased MVD compared with the GnRHa long protocol group. In addition, the expression of LIF was significantly higher in the BSHXD group. There were no significant differences between the control group and the BSHXD group in terms of MVD and LIF expression. These results suggested that BSHXD can improve the endometrium development, reduce the abnormal angiogenesis, and increase the expression of receptivity markers in a GnRHa long protocol-induced rat model during the oestrous cycle, which might result in an endometrial environment better suited for female reproduction.

Objective To study Qingdu Suppository(QDS) and β-elemene on expression of class Ⅰ antigen of leukocyte antigen(HLA-I) of human cervical cancer cell line HeLa,and investigate the anti-viral mechanisms of QDS and β-elemene.Methods The extract of QDS was prepared by using water extraction-alcohol precipitation method,and human cervical cancer cell line HeLa was cultured in vitro and then divided into control group,QDS group,β-elemene group and interferon α-2b group(IFN α-2b group).The suitable concentration of QDS,β-elemene and IFN α-2b were determined by using MTT test.After the intervention for 48 hours,the fluorescent intensity of HLA-I on cell surface was detected by using flow cytometry,protein expression of HLA-I inside the cells was analysed by using Western blot method,and gene expression of HLA-I was detected by using real-time fluorescence quantitative polymerase chain reaction(RT-PCR) in all groups.Results Compared with control group,the protein expression of HLA-I on cell surface was up-regulated in other three groups(P0.05),which was more significant in QDS group and β-elemene group(P0.05) compared with IFN α-2b group.The protein expression of HLA-I inside the cells was up-regulated in three medicinal groups.Compared with control group,the expressions of HLA-A mRNA and HLA-B mRNA increased in QDS group and β-elemene group,and only expression of HLA-A mRNA increased in IFN α-2b group.Conclusion QDS and β-elemene can up-regulate the protein and gene expression of HLA-I to promote the antigen presentation on the surface of human cervical cancer cell line HeLa.It is a potential mechanism of these two medicinals in helping the body eliminate human papillomavirus and cancer cells.

<正>宫颈癌已被世界卫生组织(WHO)列为威胁女性生命的第二大恶性肿瘤,据WHO统计,全球范围每年新发CC病例约50万,当年死亡率高达60%(约30万例)。研究表明高危人乳头瘤病毒

Objective To discuss the syndrome distribution laws of hypomenorrhea.Methods A clinical questionnaire of TCM syndromes was established,and the patients according with the enclose standard were given the survey of TCM syndromes and were asked to fill the questionnaire.The database of SPSS13.0 was set up and the data from 159 patients were input in.The data was analyzed and syndrome distribution laws were determined by using clustering analysis combining clinical materials.Results There were 5 syndromes clustered including syndrome of kidney deficiency and blood stasis(30.2%),syndrome of kidney deficiency and liver depression(28.3%),syndrome of qi stagnation and blood stasis(17%),syndrome of liver depression and spleen deficiency(13.2%) and syndrome of spleen-kidney yang deficiency(11.3%).The characteristic of all syndromes were initially determined.Conclusion The distribution characteristics of TCM syndromes showed as follows: syndrome of kidney deficiency and blood stasissyndrome of kidney deficiency and liver depressionsyndrome of qi stagnation and blood stasissyndrome of liver depression and spleen deficiencysyndrome of spleen-kidney yang deficiency in the patients with hypomenorrhea.This study provides some evidences for further standardized syndrome differentiation and treatment of hypomenorrhea.

宫腔内人工授精(IUI)是辅助生殖技术的一线治疗方法,被广泛应用于辅助生殖技术领域中.从中医药应用于IUI的理论基础出发,根据月经不同时期体内阴阳消长、气血变化的规律特点,将月经周期分为月经期、经后期、经间期、经前期四期,在此基础上提出了中药调周序贯疗法.北京中医药大学东方医院将补肾调周四期用药与IUI相结合,总结中医药辅助夫精人工授精的治疗经验,通过中药调周治疗,达到调经促孕的目的.

目的 分析宫颈高危型HPV感染与行为危险因素的关系.方法 选择我院妇科250例患者为研究对象,其中高危型HPV(HR-HPV)阳性患者124例为阳性组,阴性患者126例为对照组,采取回顾性病例对照研究方法,收集患者的一般资料,调查宫颈HR-HPV感染患者行为危险因素,分析行为危险因素与宫颈HR-HPV感染的关系.结果 相关分析表明性伴侣个数、初次性行为时间、是否偏嗜生冷、辛辣及肥甘之品与HR-HPV感染有显著性相关(P均＜0.05),与年龄、民族教育程度、居住地、每周性生活次数、是否吸烟、饮酒无明显相关性(P均>0.05); Logistic回归分析结果表明:性伴侣个数、初次性行为时间、偏嗜辛辣及肥甘之品为HR-HPV感染的危险因素(OR值分别为2.264、1.736、12.445、3.856,P均<0.05).结论 性伴侣个数、初次性生活时间及嗜食辛辣、肥甘之品是HR-HPV的危险因素.

[Objective] To explore the effect of invigorating kidney and regulating method on success rate of intrauterine insemination(IUI) and complications.[Methods] The 47 patients with infertility,treating in IUI for 81 cycles were selected.According to different characteristics in the four natural menstrual cycle the therapy with traditional Chinese medicine was implemented in the natural cycle and in decorporation cycles combined with Western medicine ovulation induction.The pregnancy rates and the incidence of complications in ovulation induction cycle were analyzed.[Results] Cycle pregnancy rate was 13.58%.LUFS rate was 2.75%.OHSS rate was 3.44%.Multiple pregnancies rate was 1.72% and ectopic pregnancy rate was 1.72%.All of that was below than the reports in the literature.[Conclusion] IUI combined with traditional Chinese medicine can improve the safety of IUI.It is worth popularizing.

<正>孕育是人类社会繁衍的基础,也是中医妇产科研究的重要内容。古人认为人与天地相参,自然界的变化可以直接或间接地影响到人,对于孕育也是如此。如《灵枢.邪客》[1]记载":地有四时不生草,人有无子,此人与天地相应者也。"此外,内在环境的改变也

金哲教授治疗月经过少病具有独到的临证经验,金师认为该病病机以脾肾亏虚为本,临床治疗以补肾填精,健脾养血为大法,顺应月经周期的消长规律,遣方用药,因势利导,同时注重舌脉变化,灵活施治,取得显著疗效。