李坤寅教授以瘀为本分期辨治子宫内膜异位症性不孕

方庆霞 高山凤 徐耀 杨梦婷 席艳雪 朱馥丽 李坤寅

〔摘要〕 子宫内膜异位症性不孕归属于中医学“痛经”“不孕”“癥瘕”“月经不调”等范畴，是由于逆流经血难以被清除，影响肾及冲任的正常功能从而导致不孕。李坤寅教授认为瘀血是子宫内膜异位症性不孕的主要病机，故以活血化瘀为基本治法，少腹逐瘀汤为基础方，并依据女性生理周期气血消长的规律分期论治：行经期活血化瘀促进血肿、包块吸收，经后期及经间期温补阳气、破血利气促排卵，经前期温肾活血、疏肝理气以利于孕卵着床，并采用中药外敷、针灸等外治法辅助癥瘕的吸收，从而取得较好的临床疗效。

〔关键词〕 子宫内膜异位症;不孕;活血化瘀;分期论治;少腹逐瘀汤;中药外敷;针灸;李坤寅;名医经验

〔中图分类号〕R271.14       〔文献标志码〕B        〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.12.021

Professor Li Kunyin Treats Endometriotic Infertility by Stages Based on Blood Stasis

FANG Qingxia1， GAO Shanfeng1， XU Yao2， YANG Mengting1， XI Yanxue1， ZHU Fuli1*， LI Kunyin3

（1. Xiyuan Hospital， Chinese Academy of Traditional Chinese Medicine， Beijing 100091， China; 2. Tai’an Municipal Hospital of Shandong Province， Tai'an， Shandong 271000， China; 3. The Third Affiliated Hospital of Guangzhou University of Chinese Medicine， Guangzhou， Guangdong 510378， China）

〔Abstract〕 Endometriosis infertility belongs to the categories of “dysmenorrhea”， “infertility”， “irregular menstruation” and so on in traditional Chinese medicine. It is due to the difficulty of clearing the countercurrent menstrual blood and affecting the normal function of kidney and Chong Ren， lead to infertility. Professor Li Kunyin believes that blood stasis is the main pathogenesis of endometriosis infertility. Therefore， the basic treatment method is to promote blood circulation and remove blood stasis， Shaofu Zhuyu Decoction is the basic prescription. It is treated by stages according to the law of the growth and decline of Qi and blood in women’s physiological cycle： promoting blood circulation and removing blood stasis during menstruation to promot the absorption of hematoma and mass， warming Yang Qi， breaking blood and promoting Qi to promote ovulation in later menstrual period and between menstrual periods， warming kidney and activating blood， soothing liver and regulating Qi in early menstrual period， so as to facilitate the implantation of pregnant eggs， external treatment methods such as traditional Chinese medicine topical application and acupuncture and moxibustion were used to assist the absorption of symptoms， so as to achieve better clinical curative effect.

〔Keywords〕 endometriosis; infertility; promoting blood circulation and removing blood stasis; treatment by stages; Shaofu Zhuyu Decoction; traditional Chinese medicine topical application; acupuncture and moxibustion; Li Kunyin; famous doctor experience

子宮内膜异位症（endometriosis， EMT）是引起盆腔痛与不孕的主要原因之一[1]。本病在育龄期妇女中发病率可达10%～15%，并呈逐年上升趋势，其中40%～50% EMT患者合并不孕[2]，EMT不孕的发病率是非EMT人群的20倍[3]。不孕症对家庭感情、社会关系的和谐稳定产生不利影响，且给不孕症患者带来情绪及心理上的巨大压力[4]。2000年，Buyalos等[5]首次提出EMT不孕的概念，指出不孕症与EMT之间是互相影响的，EMT可能通过影响妊娠的各个环节而引起不孕或自然流产，不孕症也是EMT的危险因素之一。EMT归属于中医学“痛经”“不孕”“癥瘕”“月经不调”等范畴。现代医学有关EMT的发病机制尚不明确，其导致不孕的机制主要与EMT引起性交痛，导致性交频率较少[6]，以及卵巢功能低下[7]、排卵障碍[8]、子宫内膜容受性差[9]、输卵管拾卵功能和配子运输能力异常等因素[10]有关。……