The diagnosis of this disease can be based on basal body temperature, serum progesterone determination and endometrial biopsy. The most commonly used method of western medicine is to supplement the deficiency of progesterone in the body.
Traditional Chinese medicine often combines etiology and pathogenesis, and adopts methods such as tonifying kidney, soothing liver and clearing heat. At present, there are four empirical prescriptions for treating infertility due to luteal insufficiency, such as Jiawei Siwu Decoction.
1. Jiawei Siwu Decoction consists of Angelica sinensis 12g, Ligusticum chuanxiong 9g, Paeonia lactiflora, Paeonia lactiflora, Radix Rehmanniae and Radix Rehmanniae Preparata 15g each.
Change of addition and subtraction: for patients with kidney-yang deficiency, add Ziyingshi 10g, Rhizoma Curculiginis, Herba Epimedii, Semen Cuscutae and Ruby 15 ~ 20g, and add12 each time; Fructus Ligustri Lucidi, Ecliptae Herba, Fructus Lycii, Fructus Schisandrae Chinensis, Radix Scrophulariae and Radix Ophiopogonis each add 15 ~ 20g, and take 12 each time.
The treatment method is decoction, and the juice is about 100ml. Daily 1 dose, taken in the morning and evening, each menstrual cycle (20 2 days) is 1 course of treatment. Stop using it during menstruation and after pregnancy.
Indications: This prescription can nourish blood and promote blood circulation, regulate menstruation and tonify kidney. It is suitable for infertility caused by luteal insufficiency. Diagnostic criteria: ① The basal body temperature (BBT) was continuously measured for 2 ~ 3 months, and BBT was divided into type I (normal biphasic) and type II (high temperature phase)
Clinical observation of 40 cases of luteal insufficiency. Among them, 27 cases were treated with pure Chinese medicine, with an average of 45 doses. After that, there were 9 cases of pregnancy/kloc-0 (20 times) and 2 cases of abortion (re-treatment after abortion 1 case). Another 13 cases were not pregnant after two courses of medication, and clomiphene citrate was added (7 cases). 50m g// day, 5 days, starting from the fifth day of menstruation), or chorionic gonadotropin (HCG. 5 cases. Intramuscular injection of 5000u) or bromocriptine (CB- 154) on the 2nd, 4th and 6th days of hyperthermia. 1 example. 2.5mg daily, taken continuously). Seven cases were pregnant. The results of various tests showed that BBT and endometrial secretion were significantly improved after treatment.
This experience is based on Mei Jia Siwu Decoction. Adding kidney-tonifying products has proved to be effective in treating luteal insufficiency, and the pregnancy rate is 70.4% (19/27). Clomiphene citrate and other western medicines were added to the patients with unsatisfactory traditional Chinese medicine, and good results were achieved. Most of the cases in this group became pregnant within half a year after taking the medicine, so it is considered appropriate to take the medicine for three menstrual cycles, and then stop taking the medicine for at least three cycles. Its mechanism of action needs to be further clarified by the determination of pituitary and ovarian hormones.
Yang, et al. Siwu decoction in treating 40 cases of luteal insufficiency. Journal of traditional chinese medicine, 1986, (10): 34.2. Huang Zeng Pill consists of Bupleurum10g, Angelica 30g, vinegar Cyperus rotundus, Radix Paeoniae Alba, Radix Paeoniae Alba and Rhizoma Chuanxiong each15g; ; 5 grams of mint and 20 grams of Spatholobus suberectus.
Change of addition and subtraction: Add 5g of Cinnamomum cassia, Morinda officinalis 15 g, and Rhizoma Curculiginis15 g to the patients with liver depression and yang deficiency; Fructus Lycii, Fructus Ligustri Lucidi and Fructus Corni are added for patients with liver depression and yin deficiency and deficiency of essence and blood, each 15g. Enlarge the upper part by 10 times. According to the routine operation procedure, water is used to make pills, dried and bottled for later use.
Treatment: Take it on the third day after menstruation is clean. Every morning and evening 1 time, each time 10g, take it with warm boiled water. Stop taking drugs during menstruation for three menstrual cycles 1 course of treatment, and then take 1 course of treatment after failure. If amenorrhea occurs during taking the medicine, continue to take the medicine for observation until the pregnancy is diagnosed by BBT, urine pregnancy test or B-ultrasound. The dosage is halved and the medicine is stopped after taking the medicine for 4-6 weeks.
The main functions are soothing the liver, nourishing blood and activating blood, nourishing yin and supporting yang. It is suitable for infertility caused by luteal insufficiency.
69 cases of luteal insufficiency were treated with Huang Zeng Pill, and 48 cases were cured, with a cure rate of 69.6%. 8 cases were effective, accounting for11.6%; The total effective rate was 8 1.2%. For example, a 32-year-old patient developed premenstrual breast pain and secondary infertility for 4 years. Spontaneous abortion 2 times, generally less menstrual flow, dark color, sometimes red juice, less blood clots. Menstrual chills, faint cold pain in the lower abdomen, preference for warm pressure, indifference to sexual desire, depression, pale tongue with thin white fur and thready pulse. The syndrome is liver depression and yang deficiency, and chong ren deficiency and cold. After three menstrual cycles, the average temperature of BBT rose to 0.23℃. Diagnosed as luteal insufficiency, Huang Zeng Pill was added with 5g of Cinnamomum cassia, 5 g of Morinda officinalis/kloc-0, and 5 g of Rhizoma Curculiginis/kloc-0. After treatment, the average high-temperature phase of BBT in 1 menstrual cycle was 0.26℃, and the average high-temperature phase of BBT in the second menstrual cycle was 0.36. She stopped menstruating in the third menstrual cycle and became pregnant. The dose was halved, followed by 6 weeks, and full-term delivery 1 baby boy was achieved in May of the following year.
Experience shows that pregnant women who are pregnant after the treatment of this prescription have significantly less pregnancy reaction than ordinary pregnant women, and no pregnancy complications have been found. Because the pregnant reaction of pregnant women is light, it does not affect the normal intake of nutrients, so it is beneficial to the normal development of the fetus. 39/48 newborns have given birth and developed healthily. The above shows that this prescription is safe, effective and non-toxic in treating infertility caused by luteal insufficiency. Whether the invalid cases in this group are related to pituitary lesions needs further discussion.
The prescription comes from Xu Guisheng. Shugan Damu is mainly used to treat 69 cases of luteal insufficiency. New Chinese medicine, 1990, (10): 35.3. The prescription for promoting pregnancy consists of 30g of Semen Cuscutae, 30g of Radix Rehmanniae Preparata, 30g of Fructus Lycii, 20g of Herba Taxilli, 5g of Rhizoma Dioscoreae10g, and 0g of Radix Glycyrrhizae10g.
Addition and subtraction: velvet antler paste and cistanche deserticola are added in the later stage; Adding Radix Salviae Miltiorrhizae, Rhizoma Acori Graminei and Radix Astragali during intermission; Adding Fructus Ligustri Lucidi and Ecliptae Herba in the early stage.
The treatment method is simple oral pregnancy-promoting prescription, with a dosage of 1 dose per month and a dosage of 12 ~ 15 per cycle after menstruation. Combination of traditional Chinese and western medicine group: those who only took the prescription for promoting pregnancy for three cycles had no good effect, and were given clomiphene citrate 50 ~ 100 mg every day for five days from the fifth day of menstrual cycle.
Efficacy: This prescription can tonify liver and kidney, regulate chong and ren, and invigorate spleen and qi. Combined with clomiphene citrate, it is suitable for luteal insufficiency.
Evaluation method of clinical efficacy: BBT evaluation is based on Matsumoto method and HPS method. The evaluation of PNI is based on the method of fifty orchids. The significance of the judgment is as follows: ①BBT can be divided into seven types, type ⅰ is typical biphasic body temperature, and types ⅲ ~ ⅵ are suspected luteal insufficiency. ②HPS= 10 is normal, HPS.
After empirical treatment, statistics show that the prescription for promoting pregnancy can improve the corpus luteum, and the clinical effect is better after using clomiphene citrate. Animal experiments have proved that this recipe may promote the development and maturation of follicles through the gonadal axis and improve the corpus luteum. Some scholars believe that PNI is the main index to judge luteal function and whether fertilized eggs can be implanted in this cycle, and PNI is obviously improved after clomiphene citrate treatment. The pregnancy rate of Guangzhou Hospital of Traditional Chinese Medicine plus clomiphene citrate in the treatment of luteal insufficiency was 68%, which was higher than that of clomiphene citrate (465,438+0%). It is suggested that luteal function, endometrial secretion period and gland secretion are improved after treatment, which is suitable for fertilized eggs implantation and improves pregnancy rate. The qi and blood of the human body change with the cycle, so the menstrual cycle is also the result of the month. Based on this point, on the basis of the prescription for promoting pregnancy, antler cream and cistanche deserticola are added in the late menstrual period (follicular phase) with blood-sea deficiency and kidney-qi deficiency, in order to replenish yin and yang and restore the qi and blood of the uterus; When the menstrual period (ovulation period) turns from heavy yin to yang, Salvia Miltiorrhiza, Acorus gramineus and Astragalus membranaceus are added to promote blood circulation, enlighten resuscitation, replenish qi and nourish yin, so as to make kidney qi full and activate Yang Qi to ovulate; The premenstrual period (luteal phase) is the functional activity period of yang qi. Adding Ligustrum lucidum and Eclipta prostrata can help yang qi to get yin and biochemistry. Proper syndrome differentiation and flavored treatment should be carried out in time, which can make the monthly events smooth and give birth to a certain period.
Fang Yuan: Shen, et al. Clinical analysis of 60 cases of luteal insufficiency treated by combination of traditional Chinese and western medicine. New Chinese Medicine, 1992, (6): 37.4. Huang Fu soup consists of Cuscuta chinensis, Epimedium, Morinda officinalis each15g, cornu Cervi powder 6-9g, Cornus officinalis12g, Chinese yam and roasted turtle.
The treatment method is decoction, daily 1 dose. According to the classification of patients' illness, add and subtract drugs: kidney deficiency and liver depression, and add Toosendan Fructus, Rhizoma Cyperi preparata, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Semen Citri Reticulatae, Radix Bupleuri, Fructus Foeniculi, Shixiaosan, etc. Kidney-deficiency metrorrhagia and metrorrhagia are added with Yingshi, Heather Leaf, Radix Aconiti Lateralis Preparata, Radix Paeoniae Alba and Folium Artemisiae Argyi. Carthamus tinctorius, Semen Persicae, and Herba Leonuri are added for those with less menstrual flow. Radix Codonopsis, Radix Astragali, Fructus Lycii, Rhizoma Polygonati and Radix Rehmanniae Preparata are added for patients with kidney deficiency and spleen deficiency. Herba et Gemma Agrimoniae, cuttlefish bone, Radix Sanguisorbae preparata, Herba Cirsii Cirsii, and Herba Cirsii Cirsii are added for menorrhagia; Insomnia and dreaminess, add Poria, wick and Polygonum Multiflori; Add stir-fried lentils and radix aucklandiae to the loose stool.
Indications: this prescription is complementary to yin and yang, and liver and kidney are treated together. Indications: Infertility due to luteal insufficiency.
72 cases were treated with this recipe in clinic. Except for 4 cases (fallopian tube disease 3 cases, polycystic ovary 1 case), the other 68 cases were all effective, with an effective rate of 94.44%, of which 6 1 case was pregnant, with a pregnancy rate of 84.7%, and the clinical symptoms of 7 cases disappeared and BBT returned to normal. 2 1 case was cured within 3 months, and 25 cases were cured within 4 ~ 6 months. More than 6 months 12 cases.
Empirical Chinese medicine believes that "kidney governs reproduction" and kidney qi is the premise of menstruation; Western medicine believes that the pathogenesis of luteal insufficiency is related to insufficient gonadotropin secretion. Morinda officinalis and Semen Cuscutae, the aphrodisiac and kidney tonic drugs in Huang Fu Decoction, can improve the response of ovary to LH by increasing the function of HCH/LH receptor, at the same time, enhance the response of pituitary to LRH, improve the luteinizing function of hypothalamus-pituitary-ovary axis, and make its regulation more perfect. In the prescription, Chinese yam, dogwood and other liver and kidney are treated together, retaining the meaning of homology between B and Gui. The function of dispersing and regulating blood volume of liver depends on the nourishment of kidney water, and the function of kidney essence can only be realized by dispersing and regulating liver. Patients with luteal insufficiency are mostly kidney deficiency and liver depression, so this recipe should be used to complement yin and yang and treat liver and kidney together. The author believes that, firstly, the treatment of infertility caused by luteal dysfunction can be understood from the reproductive axis of kidney-Tiangui-Chongren in traditional Chinese medicine. The mechanism in this respect needs further study and discussion.
The origin of the prescription is Li Xiangyun. 72 cases of infertility due to luteal insufficiency treated by Huang Fu decoction. China Journal of Medicine, 199 1, (2): 34. (Note: The dosage of this prescription is added by the author)