针灸治疗女性肥胖症合并月经后期或闭经的临床研究

目的：评价并比较针灸及药物疗法对女性肥胖合并月经后期或闭经患者的疗效。方法：选取女性肥胖症合并月经后期或闭经患者52例,随机分为针灸治疗组和药物治疗组,观察两组患者治疗前后的体重、腰围、臀围、腰臀比、月经周期、闭经情况。结果：针灸治疗组对肥胖、月经后期和闭经均有显著的改善作用（P〈0．05）,其临床疗效显著优于药物治疗组（P〈0．05）。结论：针灸疗法治疗女性肥胖合并月经后期或闭经疗效显著,值得临床推广应用。     

中药人工周期疗法对无排卵性月经不调之基础体温的影响

目的观察中药人工周期疗法对无排卵性月经不调之基础体温(BBT)的影响。方法对90例无排卵性月经不调(包括月经过少、月经过多、月经后期、月经前期、崩漏、闭经,排卵障碍性不孕症)应用中药人工周期按经后期、经间期、经前期、月经期进行分期加辨证治疗,疗程为1～4个月。结果痊愈57例(63.33%),有效20例(22.22%),无效13例(14.44%)。结论中药周期疗法治疗排卵障碍性月经不调可以执简驭繁,把基础体温的测定作为中医传统诊疗方法的延伸,既可指导临床分期辩证用药,又可以反过来通过客观数据评判治疗效果。     

An overview of Kampo medicine: Toki-Shakuyaku-San (TJ-23)

Toki-Shakuyaku-San (TJ-23) is one of the most popular Kampo medicines in Japan and it is used for the treatment of ovarian dysfunction and menopausal syndrome in women. We have demonstrated that TJ-23 has a neuroendocrine effect and facilitates hypothalamic-controlled pituitary and ovarian functions. Furthermore, we have also observed that TJ-23 has a stimulatory effect for the synthesis and release of neurotransmitters, such as acetylcholine, dopamine and norepinephrine by activating related enzymes in the brain. Furthermore, TJ-23 increases the synthesis of nicotine acetylcholine receptors in the brain. Administration of TJ-23 facilitates memory related behaviour in experimental animals. In addition TJ-23 has a neuroprotective effect for neuron death. The clinical application of TJ-23 in open trials for patients with Alzheimer's disease improved their memory related behaviour and intellectual function. Moreover, treatment with TJ-23 provides motivation for daily life in Alzheimer-type patients with dementia. Basic research and clinical trials suggest strongly that TJ-23 has a therapeutic efficacy for the treatment of dementia of the Alzheimer type.     

活血补肾法加宫腔镜分离术治疗宫腔粘连所致月经过少、继发性闭经、继发不孕57例临床观察

目的观察活血补肾法加宫腔镜分离术治疗宫腔粘连(IUA)所致月经过少、继发性闭经、继发不孕的临床疗效。方法将89例IUA患者随机分组,中药组57例,其中月经过少29例,继发性闭经17例,继发不孕11例。以活血补肾法为主加减,结合月经周期中月经后期滋肾益阴,补肾填精,经间期加重活血化瘀,以疏通冲任气血,经前期温肾助阳,活血通经进行治疗。对照组32例,其中月经过少17例,继发性闭经9例,继发不孕6例,采用雌—孕激素人工周期疗法,均用药3～12个月。结果IUA不同病情程度、IUA导致月经过少、继发性闭经两组疗效相当,差异无显著性意义(P>0.05)。继发性不孕中药组优于对照组,两组比较,差异有显著性意义(P<0.05)。结论活血补肾法治疗宫腔粘连宫腔镜术后月经过少、继发性闭经、继发不孕病症有较好的疗效,体现了中医药治疗本病的综合作用和特色优势。     

电针促排卵和血β-EPIS、手部皮肤温度变化的关系

<正> 电针刺激可以促进排卵,可以治疗排卵功能障碍性月经失调和不孕症,我们在电针后手部皮肤温度上升者针麻效果较好,和针刺可引起人体β-内啡肽在血中水平变化报道的启示下,曾报道电针促排卵的效果和体内雌激素作用水平及电针后手部皮肤温度变化(Hand Lempertuve changes after dec-tro-acupuncture、简称HTCEA),血β-内啡肽样免疫活性物质(β-Endorphin-like immunoreaactive substtamces,简称β-EpIS)变化有一定关系。本文对以上结果作进一步探讨。材料和方法     

安坤种子丸对卵巢储备功能下降致不孕症AFC和OV的影响

目的:观察安坤种子丸对卵巢储备功能下降致不孕症患者卵巢窦卵泡数目(AFC)和卵巢体积(OV)的影响。方法:卵巢储备功能下降致不孕患者32例,于月经干净后第3日口服安坤种子丸,10粒/次,3次/d,经前1周及经期、急性炎症期停药(闭经者除外);服用3个月经周期为1个疗程,连续治疗6月,采用自身对照法观察治疗后AFC和OV变化情况,血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)及月经、妊娠及中医症状积分等改善情况。结果:中医症状积分较治疗前明显下降,E2水平明显上升,FSH水平明显下降,差异有统计学意义(P0.05);LH无明显变化,差异无统计学意义(P0.05)。基础窦卵泡数目较治疗前增加(P0.05),差异有统计学意义(P0.05);卵巢体积(纵径、横径、前后径)较治疗前增大,差异有统计学意义(PO.05)。治疗后6月10例患者妊娠,且月经周期、经量恢复正常,2例患者月经及其兼证等无明显改善。结论:安坤种子丸能改善卵巢储备功能下降致不孕患者的卵巢功能,减轻临床症状,可能与促进AFC和OV正常反应有关。     

秦月好“止血、固本、调经”三步法治疗无排卵型功能性子宫出血

目的：总结秦月好医师＂止血、固本、调经＂三步法治疗无排卵型功能性子宫出血的经验。方法：通过跟师学习,收集、整理治疗无排卵型功能性子宫出血最有效方法。结果：秦月好医师经验方法＂止血、固本、调经＂三步疗法治疗无排卵型功能性子宫出血,疗效显著。结论：秦月好医师＂止血、固本、调经＂三步法治疗无排卵型功能性子宫出血的经验,值得推广。     

丙酸睾丸素和米非司酮联合治疗绝经过渡期功能性子宫出血的临床效果观察

目的：探索丙酸睾丸素和米非司酮联合治疗绝经过渡期功能性子宫出血的临床疗效。方法：将64例确诊为无排卵型功能性子宫出血患者进行药物治疗。从月经期第一天开始每天肌注丙酸睾丸素25mg,共5天。每天口服米非司酮12.5mg,连续服用三个月。治疗期间如出现药物性闭经则停用丙酸睾丸素。治疗前后均检测血常规、肝功能、卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、孕酮（P）、泌乳素（PRL）和雄激素（T）。结果：64例中有28例患者出现药物性绝经,30例患者在服药期间出现暂时性药物性闭经,停药后月经逐步恢复正常。贫血得以纠正。6例停药半年后复发,改用其他方法治疗,治愈率90.62%,治疗后血FSH、LH、E2、P平均水平较用药前下降,其中E2和P的下降差异具有非常显著性（P〈0.01）,用药后PRL变化不明显,而T轻度升高。结论：丙酸睾丸素和米非司酮治疗绝经过渡期功能性子宫出血效果好,副反应小,复发率低,是一种理想的药物治疗方法。     

中西药结合促排卵治疗PCOS不孕患者的临床观察和实验研究

随机对89例PCOS不孕患者采用两种不同的促排卵治疗,西药组45例,促排卵成功26例,6例妊娠;中西药组44例,促排卵成功29例,9例妊娠.两组排卵率比较无统计学差异,妊娠例数因较少,未行统计学比较.用RT-PCR技术检测促排卵后的子宫内膜降钙素的表达,设正常月经周期妇女为对照组,结果显示分别与对照组与中西药组比较,西药组表达明显减弱,对照组与中西药组表达无统计学差异.本研究提示西药的排卵率较高,加用中药后无明显的进一步提高,但使促排卵后的子宫内膜容受性明显改善,提示中西药结合促排卵可提高PCOS不孕患者临床妊娠率.     

马堃运用补肾活血法治疗排卵障碍性不孕

排卵障碍性不孕发病率逐年增高,成为妇科疾病治疗研究的热点。马堃主任医师在治疗排卵障碍性不孕临床中,认为与肾虚是根本病机,血瘀是一直贯穿于始终的重要因素,临床中灵活运用补肾活血法治疗排卵障碍性不孕,取得了显著疗效。治疗时马主任强调分期调经,注重患者心理调节,兼顾调整睡眠,逐渐形成了自己运用补肾活血法个体化治疗排卵障碍性不孕的特色。     

The role of acupuncture-moxibustion in ovulation induction based on the <Emphasis Type="Italic">Chinese Medicine</Emphasis> and <Emphasis Type="Italic">Acupuncture-moxibustion Databank</Emphasis>

Ovulatory dysfunction refers to absent ovulation or luteal insufficiency. It is commonly seen in women with irregular menstruation or menstrual cycles, especially in those with oligomenorrhea or amenorrhea. Ovulatory dysfunction is considered the single-most frequent cause of female infertility. Clinically, the two major causes of ovulatory dysfunction are polycystic ovarian syndrome (PCOS) and luteinized unruptured follicle syndrome (LUFS). Acupuncture-moxibustion improves ovulation and helps with infertility. Through a systematic review and analysis on relevant literatures in Chinese Medicine and Acupuncture-moxibustion Databank over the last decade, this paper summarized the characteristics and pattern of acupuncture-moxibustion points for improving ovulation in order to provide an optimal acupuncture-moxibustion protocol in this regard.     

Effects of Unkei-to on FSH, LH and estradiol in anovulatory young women with hyper- or hypo-functioning conditions

Eight weeks treatment with Unkei-to induced a significant increase in plasma follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol levels in hyper- (robust) and hypo- (asthenia) functioning patients with first- and second-grade amenorrhea. We observed no significant differences in the rate of change of these hormones between hyper- and hypo-functioning patients. Ovulation occurred in 61.3% and 66.7% of patients with first-grade amenorrhea, and in 27.3% and 22.4% of patients with second-grade amenorrhea, respectively. No significant difference was observed in the ovulation rate after an 8-week treatment with Unkei-to between hyper- and hypo-functioning patients. These results indicate that Unkei-to is effective in improving gonadotropin and estradiol secretion in the treatment of either hyper- or hypo-functioning anovulatory women.     

Effects of hachimijiogan, tokishakuyakusan and keishibukuryogan on progesterone secretions by corpus luteum

27-day-old rats received 20 IU of PMS subcutaneously, and 56 hours later, 40 IU of hCG to induce superovulated ovaries. Seven days after the hCG treatment, the ovaries were resected and incubated or perifused with an extract of Hachimijiogan (TJ-7), Tokishakuyakusan (TJ-23) or Keishibukuryogan (TJ-25). Progesterone in media was assayed by radioimmunoassay. In the incubation study, TJ-23 significantly (p less than 0.001, p less than 0.05) increased progesterone concentrations, while TJ-7 or TJ-25 showed no remarkable effect. In the perifusion study, TJ-23 or TJ-25 augmented progesterone levels, whereas TJ-7 revealed no effect. These results suggest that TJ-23 or TJ-25 stimulates the corpus luteum to secrete progesterone.     

补肾化“痰”治疗下丘脑—垂体功能失调性闭经

我院在补肾治疗无排卵型功能性子宫出血病和多囊性卵巢综合症的基础上,自1979年12月至1982年6月对26例下丘脑—垂体功能失调性闭经患者进行补肾化"痰"治疗,并作了有关的实验室工作,现小结讨论如下。     

Effects of a Chinese herbal medicine, keishi-bukuryo-gan, on the gonadal system of rats

Keishi-bukuryo-gan (TJ-25) is a traditional Chinese herbal remedy containing five components: bark of Cinnamomum cassia, root of Paeonia lactiflora, seed of Prunus persica or P. persiba var. davidiana, carpophores of Poria cocos and root bark of Paeonia suffruticosa. This preparation has been used in the treatment of gynecological disorders such as hypermenorrhea, dysmenorrhea and infertility. In the present study, the effects of TJ-25 on plasma levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol (E2), and on uterine wet weight and thymidine kinase (TK) activity were documented in immature rats. Long-term daily oral administration of TJ-25 (300 mg/kg) for 14 days decreased plasma levels of LH, FSH and E2 by 94%, 67% and 50%, respectively, compared to controls. Uterine wet weight and TK activity were reduced to 65% and 64% that of controls, respectively. Short-term effects of TJ-25 on E2 were also examined. Thirty hours after administration of E2 (1.0 micrograms/kg) alone, uterine wet weight and TK activity were elevated 2.4- and 21-fold, respectively, over controls. However, simultaneous administration of TJ-25 (three consecutive doses, every 12 h) with E2 reduced E2-induced increases in uterine wet weight and TK activity by 29% and 39%, respectively. Treatment with TJ-25 also enhanced LH-RH-induced increases in plasma LH and FSH levels 1.2- and 2.5-fold, respectively, as compared with controls. The results obtained in the present study indicate that TJ-25 may act as a LH-RH antagonist and/or as a weak anti-estrogen.     

Effect of Choto-san,a Kampo medicine,on impairment of passive avoidance performance in senescence accelerated mouse (SAM)

Effect of Choto-san (TJ-47), a Kampo medicine, on impairment of learning performance was evaluated by means of a step-through passive avoidance task in SAMP8 mice, a senescence-prone substrain. Tokishakuyaku-san (TJ-23), another Kampo medicine, was also employed for comparison. SAMP8 mice at the age of 10-12 months showed a poorer passive avoidance response than SAMR1 mice, a senescence-resistant substrain, in the memory-retention test, but not in the memory-acquisition test. Improved response in the memory-retention test was observed in SAMP8 mice treated with TJ-47, and almost equal degree of improvement was also observed after treatment with TJ-23. These results suggest that a long-term administration of Choto-san could improve to some extent the impairment of memory caused by aging.     

Effects of hachimijiogan, tokishakuyakusan and keishibukuryogan on estrogen and progesterone secretions by rat preovulatory follicles

Ovaries of rats 48 hours after injection of 10 IU PMS when 27 days old were incubated or perifused with NIH-LH, Hachimijiogan (TJ-7), Tokishakuyakusan (TJ-23) and Keishibukuryogan (TJ-25). TJ-7, TJ-23 and TJ-25 decreased estradiol-17 beta (E2) levels in media and LH effects on progesterone secretions, while they increased progesterone in media and LH effects on E2 secretions. These results suggest that TJ-7, TJ-23 or TJ-25 stimulates preovulatory follicles to secrete progesterone but to suppress E2 secretions. Furthermore, it is indicated that their combination treatment with LH multiplies the sole effect of LH on E2 secretions but suppresses LH effects on progesterone.     

Effects of hachimijiogan, tokishakuyakusan and keishibukuryogan on the corpus luteum function and weights of various organs in vivo

27-day-old female rats received 20 IU PMS and 56 hours later, 40 IU hCG and were orally given with 20 or 200 micrograms of Hachimijiogan (TJ-7), Tokishakuyakusan (TJ-23) or Keishibukuryogan (TJ-25) daily for 3 or 5 days before sacrifice. Seven days after hCG treatment, the serum and ovarian tissue were assayed for progestins. 200 micrograms/day of TJ-23 significantly (p less than 0.05) decreased the progesterone and 17 alpha-hydroxyprogesterone levels, whereas it significantly (p less than 0.01) increased 20 alpha-hydroxyprogesterone. TJ-7 and TJ-25 showed a tendency to decrease these progestins. These results suggest that TJ-23 has a luteolytic effect on the corpus luteum in vivo.     

Effects of Tokishakuyakusan and its components on rat corpus luteum function in vitro

27-day-old female rats received 20 IU PMS and 56 hours later, 40 IU hCG. Seven days after hCG treatment, the resected ovaries were perifused with NIH-LH, Tokishakuyakusan (TJ-23) or its components. LH and TJ-23 increased progesterone in media and LH was more effective than TJ-23. Hoelen, Peony root, Alisma rhizome and Japanese angelica root also augmented progesterone. 17 alpha-hydroxyprogesterone and 20 alpha-hydroxyprogesterone were not stimulated by TJ-23. These results suggest that TJ-23 stimulates corpora lutea to secrete progesterone without direct luteotropic or luteolytic effect and that the effect may be attributable to Hoelen, Peony root, Alisma rhizome or Japanese angelica root.     

曾介绥经方治疗闭经验案举隅

曾介绥,湖南省新化县著名老中医,擅长妇科疑难杂症,尤在经方汤剂运用颇具心得,治疗妇女闭经、血瘀证与不孕症,立竿见影。温经汤-冲任失调,养血祛瘀、温经散寒,在寒温结合的基础上补泻兼施。黑丹栀逍遥散-肝郁血热,闭经长达5月,心躁烦热,平素月经正常,经前乳房发胀,究其原因,为瘀血阻滞,气血不畅,肝郁化热,丹栀逍遥散结合养血调经及疏肝清热作用。少腹逐瘀汤-宫寒夹瘀,月事不下、宫寒不孕,理应逐瘀活血,温阳理气为法,兼顾脾胃,少腹逐瘀汤乃清王清任所创,集温经逐瘀、种子安胎为一方,世人只知其为祛瘀之剂。八味肾气丸-肝肾不足,月经初潮伊始就闭经、子宫偏小,月经衍期,诸如此类病症均"先予后夺",即先补后泻,肾气丸加补益肝肾淫羊藿、何首乌、巴戟天、菟丝子,药后即矢气频多,乃肾气渐复之征。