马堃教授运用补肾活血法辨治功能性下丘脑闭经经验  

Professor MA Kun′s Experience in Differentiating and Treating Functional Hypothalamic Amenorrhea Using Kidney-tonifying and Blood-activating Methods

作　　者：马堃[1] 钟观兰 王越 张涵 罗洁 李佳妮 孙立华[1] MA Kun;ZHONG Guanlan;WANG Yue;ZHANG Han;LUO Jie;LI Jiani;SUN Lihua(Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]天津中医药大学,天津301617

出　　处：《世界中医药》2025年第1期110-115,共6页World Chinese Medicine

基　　金：北京市科技计划项目(Z171100001017104)——首都特色—补肾促卵冲剂治疗排卵障碍性不孕(不育)“异病同治”的临床研究;北京市自然科学基金资助项目(7212193)——补肾促卵方调控氧化应激反应信号通路治疗卵巢早衰的分子机制研究;中国中医科学院科技创新工程项目(CI2021A02406)——基于血管新生探讨补肾促卵方调控SDF-1/CXCR4信号通路治疗早发性卵巢功能不全的作用机制;北京中医药薪火传承“新3+3”工程示范案例项目(2023-ZYSF-21)——运用“以证统病”构建孙立华诊治排卵障碍不孕症传承研究。

摘　　要：功能性下丘脑闭经(FHA)是一种排除下丘脑、垂体的器质性病变,多发于年轻女性的中枢性闭经,特征为循环中低促性腺激素水平和低雌激素水平。马堃教授认为FHA属于排卵障碍性疾病,发病与肾-天癸-冲任-胞宫轴的失调密切相关,以肾虚血瘀为主要病理过程,以肾精不足,冲任不充为基本病机,瘀血阻络,胞脉不通贯穿始终。临证治疗以补肾益精,充养冲任为基本治法,用药须注意平补肾中阴阳,使肾中精气旺盛,善用阴中求阳,阳中求阴,配伍行气、温阳之法以活血化瘀,通利胞脉,兼以疏肝健脾,调和气血,并根据月经周期的气血阴阳变化情况,分期论治,调理冲任。卵泡期以经验方补肾促卵方补肾益精,活血通路,促进卵泡发育成熟和排出,黄体期以寿胎丸合五子衍宗丸加减补肾益精,活血调经,随症加减,效果显著。Functional hypothalamic amenorrhea(FHA)is a type of central amenorrhea characterized by the exclusion of organic lesions in the hypothalamus and pituitary,commonly occurring in young women.It is marked by low levels of gonadotropins and estrogen in the circulation.Professor MA Kun believes that FHA is an ovulatory disorder,closely related to the dysfunction of the kidney-reproduction-stimulating essence-thoroughfare and conception vessels-uterus axis.The main pathological process is kidney deficiency and blood stasis,with the fundamental pathogenesis involving insufficient kidney essence and inadequate filling of the thoroughfare and conception vessels.Blood stasis obstructs the collaterals,and the obstruction of the uterine vessels is persistent throughout the course.The clinical treatment focuses on nourishing the kidney,benefiting essence,and filling thoroughfare and conception vessels.The treatment should emphasize balancing and tonifying the yin and yang of the kidney to invigorate the kidney essence and qi.The approach is to use yin to stimulate yang and vice versa,combining methods to promote qi,warm yang,activate blood circulation,resolve blood stasis,and unblock the uterine vessels.Additionally,liver and spleen function should be regulated,and qi and blood should be harmonized.Treatment is staged based on the changes in the yin,yang,qi,and blood of the menstrual cycle,with adjustments made to regulate the thoroughfare and conception vessels.During the follicular phase,the proved formula Bushen Culuan Formula focuses on tonifying kidney,benefiting essence,activating blood circulation,and promoting follicle development,maturation,and discharge.During the luteal phase,Shoutai Pills combined with Wuzi Yanzong Pills are used with modifications to nourish the kidney,benefit essence,activate blood,and regulate menstruation.The treatment is adjusted according to symptoms,yielding significant results.

关 键 词：功能性下丘脑闭经 肾虚血瘀 补肾益精 活血化瘀 补肾促卵方 分期论治 @马堃 经验 

分 类 号：R271.11[医药卫生—中医妇科学]