中日醫院趙紅教授參加第四屆中醫科學大會並做主題發言

2017年12月6日至8日，第四屆中醫科學大會暨第十三屆海峽兩岸中醫藥學術交流論壇在福建平潭綜合實驗區隆重舉行。

我院中醫婦科趙紅教授參加大會並做《中醫藥治療生殖障礙性疾病的優勢與思路》主題發言。

此次大會，邀請了諾貝爾生理學或醫學獎得主布魯斯•博伊特勒（Bruce Beutler）、世界衛生組織前總幹事陳馮富珍女士、陳竺、張伯禮、吳以嶺、陳凱先、陳可冀等9位院士、周岱翰、張大寧、楊春波、劉嘉湘4位國醫大師以及部分長江學者、傑出青年和中醫藥領域的知名專家與在場700餘位醫學精英一起分享了科研成果和醫學心得。

中醫婦科趙紅主任作為中日醫院中醫學科的帶頭人之一，在臨床實踐與基礎研究方面做了主題精彩發言，她分別從中醫藥生殖醫學的源流與發展、「腎—天癸—沖任—胞宮軸」主宰女性的生殖生理、中醫特色療法在生殖障礙性疾病中的應用三個方面闡述了中醫藥在生殖障礙性疾病中的治療思路，高度概括總結了中醫藥在生殖醫學領域的優勢及貢獻。

中醫科學大會是中醫藥科學領域最高規格的學術論壇，至今已舉辦三屆。

本屆大會以「科學認識中醫藥，促進中醫藥傳承與創新」為宗旨，以中醫科學與「一帶一路」為主題，致力於共同推動中醫藥融入「一帶一路」建設，構建「健康絲綢之路」和中西醫溝通的橋樑，旨在傳承中醫智慧，弘揚科學精神，服務「一帶一路」，提升中醫藥健康服務國際影響力，共同促進人類健康。

趙紅：中醫藥治療生殖障礙性疾病的優勢與思路

中醫藥在兩性生殖健康領域的研究源遠流長，幾千年來為中華民族的繁衍做出了巨大的貢獻。

1.中醫生殖醫學的源流與發展

早在夏商時代，當時已有關於生殖不孕的記載；《黃帝內經》是我國現存的第一部醫學經典著作，其中《素問·上古天真論》提出的「……，二七而天癸至，任脈通，太沖脈盛，月事以時下，故有子，……」奠定了女性生殖生理的理論基礎；《神農本草經》「紫石英」條下記載「女子風寒在子宮，絕孕十年無子」;《金匱要略》：「溫經湯亦主婦人少腹寒，久不受胎」，被稱為調經祖方；《諸病源候論》專設「無子候」；《婦人大全良方》內設「求嗣篇」，突出了生殖醫學在醫學分科中的獨立地位；此後的金元四大家及明清的各大醫家都從不同角度完善和豐富了不孕症的治療。

特別是強調「夫婦雙方調治」、 」種子必先調經」等，為我們當今研治不孕提供了寶貴的經驗。

進入21世紀，生殖障礙已被WHO列為影響人類健康與生活的三大疾病之一，而不孕症成為生殖障礙的最主要的疾病。

特別是隨著「二孩」政策的全面開放，生殖醫學的研究就愈發顯得緊迫和重要。

然而，在臨床實踐中，輔助生殖技術也遇到了很多瓶頸問題。

中醫藥的適時應用，起到了很好的效果，其治療優勢與特色日益凸顯。

2. 「腎-天癸-沖任-胞宮軸」主宰著女性的生殖生理

女性的生理特點是月經、帶下、妊娠和產育。

而其功能的正常是腎氣、天癸、沖任共同作用於子宮的結果。

結合西醫學的「下丘腦－垂體－卵巢軸」對女性生理功能的調控，不難發現它與中醫的「腎-天癸-沖任-胞宮軸」是極為相近的。

正如國醫大師中醫婦科名家許潤三教授所指出的，中醫的腎氣相當於下丘腦，主宰著天癸、沖任行使女性生理功能；天癸相當於垂體，為影響人體生長、發育和生殖的一種陰精物質，在腎氣盛的前提下，天癸極盛，任通沖盛，而行使女性的生殖生理功能；沖脈相當於卵巢，沖為血海，為月經之本，血海的盈虛靠沖脈調攝，沖脈盛則血海充盈，月經以時下；任脈相當於子宮，任主胞胎，為妊養之本，主一身陰精；腎氣、天癸、沖任共同作用於子宮，使之產生月經、妊娠、分娩。

同樣，「腎-天癸-沖任-胞宮軸」的功能異常，則會產生婦科的病證。

3.中醫婦科的特色療法在生殖障礙性疾病中的應用

（1）中醫的周期治療

由於女性的月經生育是受「腎-天癸-沖任-胞宮軸」的調控，呈現出周期性的變化。

順應月經周期性的陰陽氣血的變化，分期論治，即中醫的周期療法。

①經後期（卵泡期）經血排出，血海空虛，陰長陽消，治法當滋補肝腎精血，促進卵泡發育；②經間期（排卵期）重陰必陽，陽氣內動之氤氳動情期，治法當補腎助陽，活血通絡，促進成熟卵子排出；③經前期（黃體期）重陰必陽，治療當溫補腎陽，調經安胎；④行經期（月經期）重陽必陰，治療當養血和血，促進子宮內膜脫落。

此療法適用於高齡求子者，卵巢貯備功能減退，卵巢早衰等。

（2）中醫藥的外治法

主要包括中藥灌腸、中藥熱敷、離子導入，熏洗、貼敷、足浴等。

由於婦科生殖器官解剖部位的特殊性，這種多途徑的給藥方式，可以直達病所，促進盆腔血液循環，改善組織營養，促使粘連松解和癥瘕消散。

目前主要是針對引起女性不孕的主要病因，也是難治之症，即輸卵管阻塞和盆腔粘連，臨床也獲得了很好的療效。

總之，在生殖領域，中醫、西醫相互交融，優勢互補，必將為提高中華民族的人口數量與質量再創輝煌。

The Strengths and treatment strategies of Traditional Chinese Medicine (TCM) for reproductive disorders

Hong Zhao

China-Japan Friendship Hospital 2017.12.6

Traditional Chinese medicine (TCM) has been applied for treatment with reproduction disease for a long time and has made great contributions to the reproduction of the Chinese people for thousands of years.

1. The origin and development of TCM reproductive medicine

As early as the Xia and Shang dynasties, infertility were documented. The Yellow Emperor’s Inner Classic (Huangdi Neijing) is the first medical classic in China, which indicated that "...when women are 14 years old, memstruation (reproduction-stimulating essence) comes. Subsequently, Ren meridian unblocks and Chong meridian is sufficient. women have regular menstruations and can produce children". That lays the theoretical foundation for physiology of reproduction in women. In Shen Nong’s Classic of the Materia Medica (Shennong Bencao Jing), it is shown in the chapter of Fluorite (Zishiying) that "if wind-cold in the uterus, women cannot be pregnant in ten years". 「Wen Jing Decoction」 which was regarded as origin of regulation of menses, was recorded in Essentials from the Golden Cabinet (Jin Gui Yao Lue). That showed 「if women suffer from abdomen cold and cannot conceive a child, Wen Jing decoction may solve this problem」. In Treatise on the Origins and Manifestations of Various Diseases (Zhu Bing Yuan Hou Lun), infertility was considered as a special disease for the first time. In The Complete Collection of Prescriptions for Women (Furen Daquan Liangfang), a chapter named "Reproduction", highlighted the status of reproductive medicine as an independent specialty in medicine. From then on, the four most famous doctors of Jin and Yuan Dynasties and doctors in the following Ming and Qing dynasties continually enriched and improved the treatment of infertility from different perspectives. The theories of "treatment of both the man and the wife" and "regulating menstruations before trying to conceive a baby" have provided valuable experience for treatment of infertility today.

In the 21st century, reproductive dysfunction has become one of the three major diseases threatening the health of human beings in their daily life, and infertility is the main cause of reproductive dysfunction. With the two-child policy widely adopted in China mainland, the research on reproductive medicine is urgently needed. However, assisted reproductive technology faced many challenges which have impeded its development in clinical practice. The timely application of TCM is proved effectively in treating infertility and its advantages have been discovered in many aspects.

2. The "kidney–memstruation–Chong and Ren meridian –uterus axis" dominates the reproductive physiology of women

Women have their unique physiological features, including menstruation, leucorrhea, pregnancy and childbirth. The joint effect of the kidney, memstruation, Chong and Ren meridian on the uterus ensures the normal physiological role in women. The effect of the "hypothalamic–pituitary–gonadal axis" on female physiological functions in western medicine, is similar with the "kidney, memstruation, Chong and Ren meridian–uterus axis" in TCM. As professor Xu Runsan—a famous TCM gynecologist and an accredited TCM master—suggested, kidney qi in TCM is equivalent to the hypothalamus, and memstruation, Chong and Ren meridian perform the physiological functions under its control; Equivalent to the pituitary gland, memstruation is a kind of yin essence that influences human growth, development and reproduction. On the assumption of sufficient kidney Qi, memstruation is sufficient, Ren meridian unblocks and Chong meridian is sufficient. Thus, the reproductive function can be performed; Chong meridian is equivalent to the ovary and regarded as the sea of blood and the foundation of menstruation. When Chong meridian is sufficient, menstruation will come at regular intervals; Equivalent to the uterus, Ren meridian is the foundation of pregnancy and embryo development which controls yin essence of the whole body.

Under the joint influence of kidney Qi, memstruation, Chong and ren meridian, the uterus produces menstruation, nurtures the embryo and enables childbirth. Likewise, the abnormal function of the "kidney–memstruation–chong and ren meridian–uterus axis" would cause gynecological diseases.

3.The applications of special treatment with TCM gynecology in reproductive disorders

(1)Periodic treatment with TCM

The menses and fertility changed periodically, which are controlled by kidney–memstruation–Chong and Ren meridian –uterus axis. The periodic treatment with TCM means different treatment was performed according to periodic change of Yin, Yang, Qi and blood. (1) postmenstrual (follicular phase), we should nourish essence and blood of kidney and liver to accelerate the development of follicular according to the insufficient of blood sea, decrease of Yinand growth of Yang in TCM. (2)intermenstrual period (ovulatory phase), extreme yin will change to Yang in TCM. We should nourish kidney Yang and promote blood circulation to boost the follicular discharge. (3) premenstruum period (luteal phase), we should nourish kidney Yang, regulate menses and prevent miscarriage. (4) menstrual period, extreme yang will change to Ying in TCM. We should nourish blood to promote shedding of the endometrium. This treatment strategy applies for the patients who suffer from advanced age, reduced ovarian reserve function and premature ovarian failure.

(2)External treatments in TCM

External treatments in TCM include that traditional medicine clyster, iontophoresis, fumigation, sticking and foot bath etc. On account of the special anatomical position of reproductive organs, the above treatment strategies can promote blood circulation in pelvic cavity, improve the nutrition of tissues and eliminate adhesion and abdominal mass. Salpingemphraxis and pelvic adhesion, the main causes for infertility, can be also cured by the above treatments in clinical practices.

In summary, the complementary advantages of Western medicine (WM) and TCM in reproduction, will make progress in quantity and quality of the Chinese people.

（中醫婦科劉寶琴供稿）

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