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 observe the effect of Huayu Jiedu Yiqi principle on pathologic tissues of gastric mucosa and methylation status of p16 in rats with gastric precancerous lesion.Methods:Low concentration of MNNG with ranitidine were used to set up model of gastric precancerous lesion.After the model was succeeded at the 20th weekend,rats were randomly divided into model group,tretinoin group and Yiqi Tongluo Jiedu San group.After treatment,observed the rat gastric mucosa pathological changes,and methylation-specific technique was used to examine the methylation status of p16.Results:20 weeks after the rat model was built,the rats in the model set were diagnosed to have pathological changes including intestinal metaplasea and atypical hyperplasia.In terms of gastric mucosa pathological changes,Yiqi Tongluo Jiedu San group significantly improved.The positive rate of CpG island methylation of p16 tumor suppressor gene in Yiqi Tongluo Jiedu San group was 33.33％,compared with the model group 76.92％,the difference was statistically significant (P ＜ 0.05).24 cases of gastric mucosa pathological intestinal metaplasia or dysplasia in rats,there were 16 cases of p16 tumor suppressor gene promoter region CpG island hypermethylation;In 32 non gastric precancerous rats,there were 23 cases of p16 tumor suppressor gene promoter region CpG Island non methylation.By two variables correlation analysis,the Spearman coefficient was 0.383 67,and P =0.003 5 ＜ 0.01.Conclusion:Huayu Jiedu Yiqi principle can induce demethylation of p16 in gastric mucosa cells in rats with gastric precancerous lesion.The way can decrease methylation level of CpG island of promoter region of suppressor tumor gene p16 and improve the condition of gastric mucosa gland damage in rats so as to treat gastric precancerous lesion effectively.

Premature ovarian failure ( POF) is a premature failure of ovarian function caused by many etiological factors, of which the pathogenesis has not been clarified so far. POF patients suffer from perimenopause earlier than healthy women and develop symptoms like ovarian atrophy, persistent amenor-rhea and genital atrophy, and reproductive tract atrophy causing sexual disorders, anovulatory infertility, etc. , which affect the stability of family and society. Although the pathogenesis and treatment of POF are complicated and difficult, a great progress has been made by scholars on the study of the etiology of premature ovarian failure and the treatment with integrative Chinese medicine and western Medicine in recent years.

围绝经期综合征为临床常见病,在中医学里属于“经断前后诸症”、“绝经前后诸症”、“百合病”、“郁证”、“脏躁”等范畴.传统中医对经断前后诸证的认识多根据“肾主生殖”、“经水出诸肾”等理论,认为经断前后,肾气渐衰,天癸渐竭,冲任二脉逐渐亏虚,精血不足,脏腑失于濡养,易引起机体阴阳失衡,从而导致本病发生.笔者根据导师李云波老师临床经验及文献研究整理从调和五脏的观点出发围绕机、证、法、药来探讨围绝经期综合征的临床路径选择.依据五脏阴阳不调的病机,提出通过五行制化理论来调理五脏的治法,为临床治疗围绝经期综合征提供了参考.