基于《黄帝内经》“因时制宜”理论探析不孕症之诊治

郑凌歆; 谈勇

doi:10.14148/j.issn.1672-0482.2024.0109

基于《黄帝内经》“因时制宜”理论探析不孕症之诊治

doi: 10.14148/j.issn.1672-0482.2024.0109

郑凌歆^{1, 2,},
谈勇^{1, 2, ,}

1.
南京中医药大学第一临床医学院，江苏南京 210023
2.
南京中医药大学附属医院，江苏南京 210029

基金项目:

国家自然科学基金面上项目 82330125

详细信息

作者简介:
郑凌歆，女，硕士研究生，E-mail: lingxin9912@126.com

通讯作者:
谈勇，女，岐黄学者，教授，主任中医师，主要从事生殖内分泌疾病的研究，E-mail: xijun1025@163.com

中图分类号: R271.14
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- 文章访问数: 154
- HTML全文浏览量: 17
- PDF下载量: 29
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-28
- 网络出版日期: 2024-02-26
- 发布日期: 2024-02-10

Analysis of the Diagnosis and Treatment of Female Infertility in The Yellow Emperor's Inner Classic Based on Time Rhythm

ZHENG Lingxin^{1, 2
,},
TAN Yong^{1, 2
, ,}

1.
The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
2.
The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

摘要

摘要: 从天人相应的角度阐述“因时制宜”的理论内涵，从日节律、月节律、年节律、超年节律等层面探析女性不孕症机制，论证女性生育能力以及辅助生殖技术实施受时间节律影响。认为经水不调为不孕症发病的关键，治疗当以调经为主，通过择时调摄、辨期调周、分季论治、因龄施治等方式进一步细化中医药治疗女性不孕症的诊疗方案，为临床诊治不孕症及完善其选方用药提供思路和方法。
- 因时制宜 /
- 黄帝内经 /
- 女性不孕症
Abstract: Based on the theory of harmony between man and nature, this article systematically elaborates on the theoretical connotation of "adapt to the time" and emphasizes the significant role of daily rhythm, monthly rhythm, annual rhythm and super annual rhythm in female infertility. This paper proposes that female fertility and the implementation of assisted reproductive technology are influenced by time rhythms. It is recognized that irregular menstruation is the key to the onset of female infertility, and the treatment should focus on regulating menstrual cycle. This article further refines the diagnosis and treatment plan of traditional Chinese medicine for female infertility through methods such as hourly, weekly, seasonal and age adjustment, which provides ideas and methods for clinical diagnosis and treatment of female infertility and the enlightenment of its medication therapy.
- adapt to the time /
- The Yellow Emperor's Inner Classic /
- female infertility

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参考文献(49)

[1]	谢幸, 孔北华, 段涛. 妇产科学[M]. 北京: 人民卫生出版社, 2018. XIE X, KONG B H, DUAN T. Obstetrics and gynecology[M]. 9th ed. Beijing: People's Medical Publishing House, 2018.
[2]	QIAO J, WANG Y Y, LI X H, et al. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China[J]. Lancet, 2021, 397(10293): 2497-2536. doi: 10.1016/S0140-6736(20)32708-2
[3]	龚廷贤. 龚廷贤医学全书[M]. 北京: 中国中医药出版社, 1999. GONG T X. Gong Tingxian's complete book of medicine[M]. Beijing: China Press of Traditional Chinese Medicine, 1999.
[4]	灵枢经[M]. 北京: 人民卫生出版社, 2012. The spiritual pivot[M]. Beijing: People's Medical Publishing House, 2012.
[5]	黄帝内经素问[M]. 北京: 人民卫生出版社, 2005. The yellow emperor's inner classic: Basic questions[M]. Beijing: People's Medical Publishing House, 2005.
[6]	张子和. 儒门事亲[M]. 北京: 人民卫生出版社, 2005. ZHANG Z H. Confucians' duties to their parents[M]. Beijing: People's Medical Publishing House, 2005.
[7]	易玉娟, 孙康, 唐红, 等. 昼夜节律与健康: 中医与现代医学的对话[J]. 中国中药杂志, 2023, 48(21): 5681-5689. YI Y J, SUN K, TANG H, et al. Circadian rhythm and health: Dialogue between traditional Chinese medicine and modern medicine[J]. China J Chin Mater Med, 2023, 48(21): 5681-5689.
[8]	SCIARRA F, FRANCESCHINI E, CAMPOLO F, et al. Disruption of circadian rhythms: A crucial factor in the etiology of infertility[J]. Int J Mol Sci, 2020, 21(11): 3943. doi: 10.3390/ijms21113943
[9]	张愉婕, 马倩雯, 谈勇. 持续光照对雌性大鼠生殖内分泌的影响及滋阴补阳方序贯疗法干预作用的研究[J]. 南京中医药大学学报, 2017, 33(4): 386-390. http://xb.njucm.edu.cn/article/id/zr20170416 ZHANG Y J, MA Q W, TAN Y. The research of continuous illumination on reproductive endocrine of rats and the intervention effect of Nourishing Yin and Tonifying Yang Fang sequential traditional Chinese medicine[J]. J Nanjing Univ Tradit Chin Med, 2017, 33(4): 386-390. http://xb.njucm.edu.cn/article/id/zr20170416
[10]	王子昕, 宋佳怡, 夏天. 昼夜节律紊乱对女性卵巢功能的影响[J]. 国际生殖健康/计划生育杂志, 2022, 41(4): 317-321. WANG Z X, SONG J Y, XIA T. Effect of circadian rhythm disorder on ovarian function[J]. J Int Reprod Health/family Plan, 2022, 41(4): 317-321.
[11]	PIMOLSRI C, LYU X R, GOLDSTEIN C, et al. Objective sleep duration and timing predicts completion of in vitro fertilization cycle[J]. J Assist Reprod Genet, 2021, 38(10): 2687-2696. doi: 10.1007/s10815-021-02260-8
[12]	WILLIS S K, HATCH E E, WISE L A. Sleep and female reproduction[J]. Curr Opin Obstet Gynecol, 2019, 31(4): 222-227. doi: 10.1097/GCO.0000000000000554
[13]	刘炽鉴, 赵博. 《黄帝内经》睡眠理论相关物质基础探讨[J]. 中华中医药杂志, 2020, 35(4): 1774-1776. LIU C J, ZHAO B. Discussion on the related material basis of sleep theory in The yellow emperor's inner classic[J]. China J Tradit Chin Med Pharm, 2020, 35(4): 1774-1776.
[14]	魏文静, 仝立国, 仲启明, 等. 生物钟基因与睡眠障碍的研究进展[J]. 实用医药杂志, 2018, 35(5): 455-457. WEI W J, TONG L G, ZHONG Q M, et al. The research progress on bioclock genes and sleep disorders[J]. Pract J Med Pharm, 2018, 35(5): 455-457.
[15]	张乃文, 李梦媛, 李小黎, 等. 基于阴阳、营卫学说探讨生物钟基因对睡眠昼夜节律的影响[J]. 北京中医药大学学报, 2022, 45(4): 376-381. ZHANG N W, LI M Y, LI X L, et al. Effects of the circadian clock genes on circadian rhythm based on Yin-Yang and Ying-Wei theory of sleep[J]. J Beijing Univ Tradit Chin Med, 2022, 45(4): 376-381.
[16]	张介宾. 类经[M]. 北京: 人民卫生出版社, 1965. ZHANG J B. The classified classic[M]. Beijing: People's Medical Publishing House, 1965.
[17]	夏桂成. 妇科方药临证心得十五讲[M]. 北京: 人民卫生出版社, 2006. XIA G C. Fifteen lectures on clinical experience of gynecological prescriptions[M]. Beijing: People's Medical Publishing House, 2006.
[18]	田雪梅, 张淼, 徐晓娟, 等. 徐晓娟教授从时间节律治疗不孕症的经验拾萃[J]. 世界最新医学信息文摘, 2018, 18(A5): 264-265. TIAN X M, ZHANG M, XU X J, et al. Professor Xu Xiaojuan's experience in treating infertility from the perspective of time rhythm[J]. World Latest Med Inf, 2018, 18(A5): 264-265.
[19]	李时珍. 本草纲目: 校点本[M]. 北京: 人民卫生出版社, 2004. LI S Z. The grand compendium of materia medica: Corrected and punctuated edition[M]. Beijing: People's Medical Publishing House, 2004.
[20]	罗颂平, 罗元恺. 月经节律与月相的联系初探[J]. 上海中医药杂志, 1984, 18(12): 42-44. LUO S P, LUO Y K. A preliminary study on the relationship between menstrual rhythm and moon phase[J]. Shanghai J Tradit Chin Med, 1984, 18(12): 42-44.
[21]	万全. 万氏妇人科[M]. 武汉: 湖北人民出版社, 1983. WAN Q. Wan's gynecology[M]. Wuhan: Hubei People's Press, 1983.
[22]	李佶, 杨溢铎. 月相与不孕症女性妊娠早期流产发生率的关系[J]. 中医杂志, 2020, 61(19): 1721-1724. LI J, YANG Y D. The relationship between moon phase and the incidence of miscarriage of infertile women in early pregnancy[J]. J Tradit Chin Med, 2020, 61(19): 1721-1724.
[23]	楼毅云, 傅萍. 基于《黄帝内经》阳气理论探析不孕不育证治[J]. 浙江中医杂志, 2022, 57(9): 628-630. LOU Y Y, FU P. Exploration on infertility based on theory of "Sun be the spirit" in The yellow emperor's inner classic[J]. Zhejiang J Tradit Chin Med, 2022, 57(9): 628-630.
[24]	李梴. 医学入门[M]. 北京: 中国中医药出版社, 1995. LI C. Introduction to medicine[M]. Beijing: China Press of Traditional Chinese Medicine, 1995.
[25]	BURGESS H J, HAN P S, BERTRAM H, et al. Daily ratings of mood and sleep duration over 3.3 years are associated with the lunar illumination cycle in a rapid cycling bipolar patient[J]. Bipolar Disord, 2021, 23(6): 640-643. doi: 10.1111/bdi.13080
[26]	陈自明. 妇人大全良方[M]. 北京: 人民卫生出版社, 2006. CHEN Z M. The complete compendium of fine formulas for women[M]. Beijing: People's Medical Publishing House, 2006.
[27]	永福氏. 求嗣指源[M]. 北京: 中国中医药出版社, 2016. YONG F S. The source of seeking for the offspring[M]. Beijing: China Press of Traditional Chinese Medicine, 2016.
[28]	吴昆. 医方考[M]. 北京: 中国中医药出版社, 1998. WU K. Investigations of medical formulas[M]. Beijing: China Press of Traditional Chinese Medicine, 1998.
[29]	陈修园. 女科要旨[M]. 北京: 人民卫生出版社, 1959. CHEN X Y. Essentials of gynecology[M]. Beijing: People's Medical Publishing House, 1959.
[30]	王静, 夏桂成. 国医大师夏桂成教授月经周期分期分时法探析[J]. 江苏中医药, 2022, 54(8): 24-27. WANG J, XIA G C. Menstrual cycle staging and timing invented by professor XIA Guicheng, master of Chinese medicine[J]. Jiangsu J Tradit Chin Med, 2022, 54(8): 24-27.
[31]	夏桂成. 经间排卵期是妇科未病论治的最佳时期[J]. 南京中医药大学学报, 2010, 26(3): 161-163. http://xb.njucm.edu.cn/article/id/20100301 XIA G C. Ovulation period between menstruation is the best time for preventing gynecological diseases[J]. J Nanjing Univ Tradit Chin Med, 2010, 26(3): 161-163. http://xb.njucm.edu.cn/article/id/20100301
[32]	谈勇, 任青玲, 王玉荣, 等. 滋阴补阳方序贯调控子宫内膜异位症"3A程序" 的思路与方法[J]. 中华中医药学刊, 2008, 26(2): 234-235. TAN Y, REN Q L, WANG Y R, et al. The thoughs and method of controlling Endometriosis's "Proceeding 3A" by Yin-nourishing and Yang-invigorating prescription's orderly linking therapy[J]. Chin Arch Tradit Chin Med, 2008, 26(2): 234-235.
[33]	唐培培, 赵娟, 谈勇, 等. 滋阴补阳方序贯法联合促排卵治疗肾虚型多囊卵巢综合征不孕症临床疗效[J]. 中华中医药杂志, 2022, 37(12): 7531-7534. TANG P P, ZHAO J, TAN Y, et al. Clinical study on the effects of sequential method of Ziyin Buyang Formula combined with ovulation induction in the treatment of polycystic ovary syndrome with kidney deficiency symptom[J]. China J Tradit Chin Med Pharm, 2022, 37(12): 7531-7534.
[34]	张景岳. 妇人规[M]. 北京: 中国医药科技出版社, 2017. ZHANG J Y. Women's rules[M]. Beijing: China Medical Technology Press, 2017.
[35]	曾妮, 施庆武, 吴承艳. 清代名医魏祖清论治不孕症的学术思想及用药特点[J]. 中国中医基础医学杂志, 2023, 29(3): 367-370. ZENG N, SHI Q W, WU C Y. Academic thought and characteristics of drug use on treatment of infertility by Qing dynasty famous doctor Wei zuqing[J]. J Basic Chin Med, 2023, 29(3): 367-370.
[36]	陈雯玥, 洪丹丹, 刘歆玥, 等. 基于国医大师夏桂成"心宁肾实" 理论的卵巢储备功能低下的膏方防治[J]. 中华中医药杂志, 2021, 36(3): 1408-1411. CHEN W Y, HONG D D, LIU X Y, et al. Treatment and prevention of diminished ovarian reserve by paste formula based on the theory of TCM master XIA Gui-Cheng "inner peace helps sthenia nephropathy"[J]. China J Tradit Chin Med Pharm, 2021, 36(3): 1408-1411.
[37]	方晓红, 夏桂成. 清心滋肾汤辅助西药治疗卵巢早衰疗效探讨[J]. 中国实验方剂学杂志, 2016, 22(9): 158-161. FANG X H, XIA G C. Clinical effects of traditional Chinese medicine experienced prescription in assisting western medicine for premature ovarian failure[J]. Chin J Exp Tradit Med Formulae, 2016, 22(9): 158-161.
[38]	夏桂成. 略论运气学说基本精神及与妇科学的关系[J]. 南京中医药大学学报, 2003, 19(1): 5-7. XIA G C. On the basic spirit of luck theory and its relationship with gynecology[J]. J Nanjing Univ Tradit Chin Med, 2003, 19(1): 5-7.
[39]	瞿晓竹. 蔡小荪189例不孕症治愈病人年节律现象初探[J]. 中医文献杂志, 2003, 21(1): 39-41. QU X Z. A preliminary study on the annual rhythm of 189 cases of infertility cured in Cai Xiaosun[J]. J Tradit Chin Med Lit, 2003, 21(1): 39-41.
[40]	陈文俊, 盛文洁, 谈勇. 褪黑素对妊娠相关节律影响的研究进展[J]. 医学研究生学报, 2015, 28(9): 984-988. CHEN W J, SHENG W J, TAN Y. Advance in the influence of melatonin to pregnancy related rhythm[J]. J Med Postgrad, 2015, 28(9): 984-988.
[41]	DRESSLER N, CHANDRA A, AGUIRRE DAVILA L, et al. BMI and season are associated with vitamin D deficiency in women with impaired fertility: A two-centre analysis[J]. Arch Gynecol Obstet, 2016, 293(4): 907-914. doi: 10.1007/s00404-015-3950-4
[42]	MAAHERRA ARMSTRONG P, AUGUSTIN H, BAREBRING L, et al. Prevalence of vitamin D insufficiency and its determinants among women undergoing in vitro fertilization treatment for infertility in Sweden[J]. Nutrients, 2023, 15(12): 2820. doi: 10.3390/nu15122820
[43]	王哲, 师伟. 《景岳全书·妇人规》不孕证治导读[J]. 中医文献杂志, 2008, 26(5): 28-30. WANG Z, SHI W. A guide to the treatment of infertility in The complete works of Zhang Jingyue: Women's rules[J]. J Tradit Chin Med Lit, 2008, 26(5): 28-30.
[44]	谈勇. 国医大师夏桂成妇科临证心悟[M]. 北京: 人民卫生出版社, 2021. TAN Y. Xia Guicheng, a master of traditional Chinese medicine, realized the clinical experience of gynecology[M]. Beijing: People's Medical Publishing House, 2021.
[45]	夏桂成, 谈勇. 中医药治疗排卵障碍性不孕症临床研究进展述评[J]. 江苏中医药, 2019, 51(9): 1-7. XIA G C, TAN Y. A progress review of clinical study of TCM treatment to anovulatory infertility[J]. Jiangsu J Tradit Chin Med, 2019, 51(9): 1-7.
[46]	潘志强. 从全生命周期解析天癸的相关物质基础[J]. 上海中医药大学学报, 2022, 36(2): 83-88. PAN Z Q. Analysis on the related material basis of Tiangui from the whole life cycle[J]. Acad J Shanghai Univ Tradit Chin Med, 2022, 36(2): 83-88.
[47]	罗倩倩, 夏桂成, 谈勇. 高龄妇女生育力减退之备孕策略[J]. 中华中医药杂志, 2021, 36(10): 5926-5929. LUO Q Q, XIA G C, TAN Y. Fertility reduction strategies in elderly women[J]. China J Tradit Chin Med Pharm, 2021, 36(10): 5926-5929.
[48]	贾志诚, 郭颖, 赖昊, 等. 基于线粒体功能揭示《黄帝内经》"七七" 理论内涵及高龄IVF-ET患者的中药干预机制[J]. 中国实验方剂学杂志, 2023, 29(12): 128-134. JIA Z C, GUO Y, LAI H, et al. Mitochondrial function reveals connotation of "seven-seven" theory of The yellow emperor's inner classic and mechanism of herbal intervention for elderly women undergoing IVF-ET[J]. Chin J Exp Tradit Med Formulae, 2023, 29(12): 128-134.
[49]	李丽, 蔡靓, 宗道宽, 等. 补肾法对高龄女性IVF-ET妊娠结局影响的Meta分析[J]. 中国中医基础医学杂志, 2020, 26(3): 357-361. LI L, CAI L, ZONG D K, et al. Meta-analysis of the effect of kidney tonifying method on the pregnancy outcome of IVF-ET in elderly women[J]. Chin J Basic Med Tradit Chin Med, 2020, 26(3): 357-361.