基于仝小林院士“态靶辨证”诊疗模式探析输卵管性不孕症诊疗思路  被引量:1

An Analysis of the Diagnosis and Treatment Approaches for Tubal Infertility Based on the"State-Target Differentiation"Model by Academician Tong Xiaolin

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作  者:陈硕硕 岳斌 郭佩 王颐轩 靳灵 武权生 CHEN Shuoshuo;YUE Bin;GUO Pei;WANG Yixuan;JIN Ling;WU Quansheng(Gansu University of Chinese Medicine,Lanzhou,Gansu,China,730000;Affiliated Hospital of Gansu University of Chinese Medicine,Lanzhou,Gansu,China,730000)

机构地区:[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃中医药大学附属医院,甘肃兰州730000

出  处:《河南中医》2024年第12期1836-1840,共5页Henan Traditional Chinese Medicine

基  金:国家自然科学基金项目(17339851758);西北环境与营养相关疾病中医药防控协同创新中心开放基金项目(ZYXT-20-06);甘肃省中医药科研课题项目(GZKG-2020-49)。

摘  要:湿热、寒湿、气滞、肾中精气亏虚为输卵管性不孕症的致病因素,其病机发展过程呈现出三期进阶性特点:外邪湿热、热毒与内生湿、郁、瘀邪相合,共同壅滞胞脉为先;进而内外合邪搏结胞脉日久而成癥瘕,致气血阻滞、胞脉闭塞为本;最终瘀阻胞脉日久导致肾精亏损,加重病情。从“态靶辨证”病证结合模式分析,输卵管性不孕症的发生发展可分为三期五态:初期(湿热态、寒湿态、郁态)、中期(瘀态)及后期(虚态)。输卵管性不孕症的核心病机为瘀血内阻,临证应以活血化瘀通络为主。临证时,治疗湿热态以清热利湿、化瘀通络为主,方选蒲丁藤酱消炎汤;寒湿态以温经散寒、祛瘀通络为主,方选少腹逐瘀汤;郁态以行气止痛、化瘀通络为主,方选膈下逐瘀汤;瘀态以活血祛瘀、宣导通络为主,选用养血通脉汤、桃红四物汤加丹参、皂角刺、路路通、鳖甲、制附子等;虚态以补益肾气、祛瘀通络为主,选用金匮肾气丸合血府逐瘀汤、峻竣煎。Dampness-heat,cold-dampness,qi stagnation,and deficiency of kidney essence are pathogenic factors for tubal infertility.The disease mechanism presents a progressive process in three phases:the initial stage involves external dampness-heat and internal accumulation of dampness,depression,and stasis obstructing the uterine vessels.This leads to prolonged blockage,causing qi and blood stagnation and vessel obstruction.Ultimately,chronic obstruction results in kidney essence deficiency,worsening the disease.From the perspective of"state-target differentiation,"the occurrence and development of tubal infertility can be categorized into three phases and five states:early phase(dampness-heat state,cold-dampness state,stagnation state),mid-phase(stasis state),and late phase(deficiency state).The core pathology of tubal infertility is internal blood stasis;thus,the clinical treatment should focus on promoting blood circulation and resolving stasis and dredging collaterals.In clinical practice,for treating the dampness-heat state,the main approach is to clear heat and eliminate dampness,resolve blood stasis and dredge collaterals,using formulas like Pudingteng Anti-Inflammatory Decoction.For cold-dampness state,warming the meridians and dispelling cold is key,using Lower Abdominal Stasis-Expelling Decoction.For stagnation state,moving qi and alleviating pain,resolving blood stasis and dredging collaterals is essential,using Expelling Stasis Below the Diaphragm Decoction.For the stasis state,the focus is on invigorating blood and dispelling stasis and dredging collaterals,utilizing such formulas as Blood-Nourishing and Channel-Unblocking Decoction,Peach Kernel and Carthamus Four Substances Decoction,with additional drugs such as Zaojiaoci(Spina Gleditsiae),Lulutong(Fructus Liquidambaris),Biejia(Carapax Trionycis)and Zhifuzi(Radix Aconiti Lateralis Praeparata),etc.For the deficiency state,the treatment should focus on tonifying kidney qi and promoting blood circulation to resolve stasis,using Golden Cabinet′s Kidney Qi Pil

关 键 词:输卵管性不孕症 “态靶辨证” “三期五态” 湿热态 寒湿态 郁态 瘀态 虚态 仝小林 

分 类 号:R271.911.6[医药卫生—中西医结合]

 

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