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中医治疗女性不育

2011-04-20 22页 pdf 212KB 34阅读

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中医治疗女性不育 1 Treatment of Female Infertility A New Approach in Chinese Medicine Samuel Wang, Ph.D., L.Ac. 1. Overview The following synopsis presents a new approach in treating female infertility developed by Dr. Samuel Wang at Acupuncture Herbal Center, San Rafael, Califo...
中医治疗女性不育
1 Treatment of Female Infertility A New Approach in Chinese Medicine Samuel Wang, Ph.D., L.Ac. 1. Overview The following synopsis presents a new approach in treating female infertility developed by Dr. Samuel Wang at Acupuncture Herbal Center, San Rafael, California. The paper in its entirety was awarded Outstanding Achievement at the Fifth World Conference of Traditional Medicine in 2000. Dr. Wang is the founder of the latest microcosmic theory of Chinese medicine. In light of applying the philosophy of Chinese medicine to both microcosmic and macrocosmic views, he has integrated ancient Chinese medicine and the most advanced Western medical technologies in the field of female infertility. This new approach has succeeded in many difficult cases that had failed to respond to either conventional Western medicine or classical Chinese medicine. According to this new approach, the diagnostic procedure for female infertility first follows Western medical diagnosis of disease, and then each Western disease is subdivided into both microcosmic and macrocosmic patterns of Chinese medicine. For the different microcosmic and macrocosmic patterns, Dr. Wang has established a series of therapeutic protocols, including his unique herbal formulas and triple needle technique. His clinical studies show that this innovative method most effectively treats unexplained infertility in Western medicine, simple ovulatory dysfunction, luteal deficiency, cervical factors and immuno factors respectively. It can also effectively treat female infertility caused by endometriosis, polycystic ovaries, intrauterine factors, premature ovarian failure and obstruction of Fallopian tubes. Dr. Wang has opened a new avenue to the successful treatment of female infertility. 2. Introduction American Couples who experience difficulty in conception are estimated to be as high as 1 in 6, and among these infertile couples, female factors account for more than 60 to 70 percent. Female infertility is usually defined as failure to achieve pregnancy after one to two years of regular unprotected intercourse, in a woman during her reproductive age, with her male partner’s normal reproductive function. In fact, the concept of female infertility may be confusing. Of child-bearing women who conceived naturally, after the initiation of unprotected regular intercourse, 68 percent achieved pregnancy within six months, 86 2 percent within one year, 96 percent within two years, 98 percent within three years, 99.8 percent within 5 years and an additional 0.2 percent between the fifth and seventh years according to some reports (Fig.1). Therefore, the optimal length of time for the definition of infertility is still controversial. Dr. Wang’s opinion is that this time period should be set at two years for younger women prior to age 30 and at one year for women older than 30, so that patients can receive treatment without delay in case they are unable to conceive naturally. If an asymptomatic woman aged 30 or older does not conceive one year after trying to get pregnant, she should be considered clinically infertile and should consult a fertility specialist. However, if she is under 30, she may wait for two years before receiving her fertility evaluations. Women with gynecological symptoms such as dysmenorrhea, serious menstrual cramps and obscure pelvic pain, should consult their gynecologists as soon as possible Fig.1 Cumulative pregnancy rates of child-bearing women who conceived naturally after initiation of unprotected intercourse 68 86 96 98 99.8 100 50 60 70 80 90 100 110 0.5 year 1 year 2 years 3 years 5 years 7 years % o f c um ul at iv e pr eg na nc y ra te 3 3. Female Reproduction in Classical Chinese Medicine The Yellow Emperor's Classic of Internal Medicine has been the leading literature of Chinese medicine since it was first completed approximately 2,500 years ago. This classic believes that female fertility is associated with the Kidney, the Conception meridian and the Chong meridian, which are necessary for female reproduction. It also describes that a woman's physiological changes take place every seven years. At age 7, a girl has sufficient Qi in her Kidney. Her teeth begin to change and her hair grows longer. At 14, her Conception meridian begins to circulate and her Chong meridian becomes strong. As Tiankui arrives and menstruation starts, conception is possible. At 21, when her Kidney Qi has reached the highest peak, her wisdom teeth and body have fully developed. At 28, her tendons and bones are strong, hair has reached full length, the body continues to flourish, and she remains in the most fertile period in her life. At 35, her face begins to wrinkle and the hair thins when the energy in the Yang Ming meridian declines. At 42, as the Qi and Blood decrease substantially in the three Yang meridians that branch to her face, her face looks more wrinkled and her hair begins to turn gray. At 49, when her Conception and Chong meridians become deficient, her Tiankui exhausts, menstruation ceases, and fertility terminates. In fact, due to the cultural differences and the improvement in both nutrition and living conditions, women today, on the average, start puberty one to three years earlier, and menopause two to three years later than those in ancient times. Generally, today’s female fertility initiates its downturn between the ages of 35 and 38, and undergoes a rapid decline between 43 and 46. Although there are minor differences between modern and ancient women, the basic ideas about the physiology of female reproduction in The Yellow Emperor's Classic of Internal Medicine are still the important guidelines in today's diagnosis and treatment of female infertility in Chinese medicine. Any disturbances of the above physiological process may result in infertility. 4. Diagnosis of Female Infertility According to Microcosmic Method of Chinese Medicine Classical Chinese medicine perceives the human body only in the macrocosmic view, so it assumes that the microcosmic conditions in the human body are always compatible 4 with the macrocosmic ones. However, it cannot explain the fact that under certain circumstances, the differences do exist between microcosmic and macrocosmic conditions. Since modern Western medicine usually emphasizes the pathological changes in microcosmic view, classical Chinese medicine is dissociated with the achievements in modern Western medical sciences. The issue is still related to the research methodology of Chinese medicine. Dr. Wang has developed a new research methodology of Chinese medicine: applying the unique dialectical philosophy of Chinese medicine in microcosmic view to the achievements in modern Western medicine. He has discussed this new research methodology in detail in his article, The Research Methodology of Chinese Medicine. In light of this new research methodology, Dr. Wang has successfully established his innovative microcosmic theory of Chinese medicine, which enables Chinese medicine to be naturally integrated with modern Western medical sciences. Chinese medicine is essentially characterized by its dialectical concept, without which it is not Chinese medicine. However, microcosmic theory or microcosmic method of Chinese medicine is different from the classical Chinese medicine in some aspects. Microcosmic method of Chinese medicine not only inherits the essence of the methodology of classical Chinese medicine, but also absorbs the great achievements in modern Western medicine. Since its essence is not changed, microcosmic method of Chinese medicine is still in the category of Chinese medicine, except for its acceptance of modern medical sciences as well as its application of dialectical philosophy of Chinese medicine to both macrocosmic and microcosmic views. In microcosmic method of Chinese medicine, the pattern diagnosis for female infertility is still based on Eight Entities and Internal Organs, but there are patterns in both macrocosmic and microcosmic aspects. The Eight Entities for female infertility are the analysis and classification of Yin and Yang, Exterior and Interior, Cold and Heat, Deficiency and Excess, to determine the overall nature of the disease. However, in microcosmic method of Chinese medicine, the Eight Entities are subdivided into both macrocosmic and microcosmic ones. Yin and Yang are the general opposite sides in nature: Exterior, Heat and Excess belong to Yang, while Interior, Cold and Deficiency toYin. Hyper-functions are Yang and hypo-functions Yin. Yin and Yang are the most essential dialectics in Chinese medicine, opposing and unifying each other. When Yin and Yang are harmonized both microcosmically and macrocosmically in a woman’s body during her reproductive years, her Chong and Conception meridians will function properly and she will not have difficulty conceiving. However, when Yin and Yang are out of balance, Yin or Yang syndrome will occur. Yin syndrome refers to the decline of Yang Qi in the body or the excessive Yin Qi, demonstrating Cold in nature or feebleness in the body' s response. Yang syndrome means Yang and Qi Excess, suggesting Heat, Excess in nature or exorbitant body response to the pathogenic factors. In Yang syndrome, the vital Qi is usually intact. Female infertility is generally divided into these two main categories: Yin syndrome versus Yang syndrome. According to microcosmic method, sometimes, both Yang syndrome and Yin syndrome may occur in the same woman’s body at the same time, for 5 example, microcosmic view shows Yang syndrome while macrocosmic view demonstrates Yin condition, or vise versa. The Exterior and Interior indicate the location of pathological changes and the severity of disease. Conditions located superficially are considered to be Exterior pattern, which is usually less severe. However, conditions originating from the viscera and the pathological changes deeply located in the body belong to Interior pattern, which is usually more severe. Unfortunately, female infertility is almost always classified as Interior either in macrocosmic or microcosmic views. The Cold and Heat are two aspects to differentiate the nature of a disease. The Yellow Emperor's Classic of Internal Medicine points out that "Excessive Yin leads to Cold, and excessive Yang to Heat." and "Yin Deficiency generates Heat, and Yang Deficiency Cold." The Deficiency and Excess are two opposites to measure the strength of the defense mechanisms of the body, as well as the vital Qi. The Yellow Emperor's Classic of Internal Medicine also states "Exuberant pathogenic factors result in Excess pattern, while excessive consumption leads to Deficiency pattern." Deficiency pattern is mostly seen in those patients with insufficient Vital Qi. However, the stagnation of pathogenic factors of Chinese medicine in meridians and collaterals or in internal organs is in the category of Excess. So is Qi and Blood stagnation. All the above stagnations are almost always associated with Excess in microcosmic view, irrespective of the macrocosmic projection that may show either Excess or Deficiency. Because female infertility is almost always Internal conditions, Eight Entity pattern differentiations for female infertility only leave Cold versus Heat and Deficiency versus Excess. Classical Chinese medicine identifies four different combinations for female infertility: Excess Cold, Deficiency Cold, Excess Heat and Deficiency Heat respectively, as it views the Eight Entities macrocosmically only. However, Microcosmic method of Chinese medicine perceives the Eight Entities in both macrocosmic and microcosmic views, so it is much more complicated than the way that classical Chinese medicine perceives the Eight Entities. Theoretically, microcosmic method may recognize up to 16 combinations of Eight Entity patterns for female infertility, i.e., 4 (microcosmic Eight Entity patterns) x 4 (macrocosmic Eight Entity patterns) = 16 (combinations). Clinically, for female infertility, the most common forms of Eight Entities in microcosmic method of Chinese medicine are both microcosmic and macrocosmic Deficiency Heat as well as both microcosmic and macrocosmic Deficiency Cold, then microcosmic Excess Cold. Microcosmic Excess Heat may be seen in acute or chronic pelvic inflammation in women. Furthermore, it is not uncommon that an infertile woman may demonstrate Excess and/or Heat in microcosmic view, but Deficiency and/or Cold in macrocosmic projection simultaneously. 6 Pattern diagnosis of internal organs is also important in evaluating female infertility. However, only three organs, the Kidney, the Liver and the Spleen, are most directly involved in female infertility. The Kidney is essential to female reproduction. The Kidney is the source of congenital Essence and the root of life. It has two sides: Kidney Yin and Kidney Yang, which are the most important material and function of the female reproductive system. The Yin and Yang of the Kidney should not only be prosperous, but also harmonized. For Kidney syndrome, there are several pathological patterns: Kidney Yang deficiency, Kidney Yin deficiency with excess Yang, combination of both Kidney Yin and Yang deficiency, Kidney Qi deficiency, or Kidney Qi and Yin deficiency. Any of the above patterns in either macrocosmic or microcosmic views, or in both, may result in malnutrition of Chong and Conception meridians as well as in Qi and Blood stagnation, subsequently causing female infertility. The Liver stores Blood, regulates the normal flow of Qi and Blood, and coordinates the functions of the viscera. Emotional distress such as anger and depression impairs the Liver by stagnating the Live Qi. Persistent Liver Qi stagnation will eventually result in Blood stagnation. Blood stagnation due to stagnation of Liver Qi may be one of the etiologies of female infertility in Chinese medicine. Clinically, Liver Qi stagnation is so common that almost every infertile woman suffers from it in different degrees either microcosmically or macrocosmically. The Spleen is the source of acquired Essence as well as the source of Qi and Blood, supplying nutrients to the Five Viscera, the Six Hollow Organs and the female reproductive system. The Chong meridian also obtains Yuan Qi and Blood from Yangming Stomach meridian because they are connected to each other. When the Spleen and the Stomach are functioning properly, the Essence is sufficient, then Qi and Blood will be abundant. Therefore, a healthy Spleen will sufficiently nourish the Chong and Conception meridians, ensuring the basic requirements for both conception and gestation. If the Spleen is deficient, it cannot properly transport wastewater, resulting in Damp accumulation. Sooner or later, Excessive Damp will become Phlegm, which will subsequently obstruct the Chong and Conception meridians as well as the female pelvic organs — uterus, Fallopian tubes and ovaries. In microcosmic view of Chinese medicine, this process is the pathogenesis of uterine fibroids, endometriosis, polycystic ovaries, ovarian cysts and certain types of dysmenorrhea. Furthermore, because of the above process, the lack of acquired Essence may be the direct cause of female infertility. The Deficiency in the Spleen is usually a macrocosmic condition in female infertility, but the consequences of Spleen Deficiency, such as the accumulation of Damp and Phlegm, can be a microcosmic condition. Evidently, macrocosmic and microcosmic conditions can influence each other. In addition to complete physical examinations, modern Western medicine employs various special diagnostic techniques (sonogram, hysterosalpingogram, endoscopy and laboratory tests) to make a Western diagnosis for female infertility. The common causes of female infertility in modern Western medicine include simple ovulatory dysfunction, 7 luteal deficiency, Fallopian tube obstruction, cervical factors, immunological factors, uterine fibroids, other intrauterine factors, endometriosis, and premature ovarian failure. Clinically, about 10-18% of infertile women may fail to have a positive Western medical diagnosis even though they have gone through all the sophisticated Western medical examinations available. In Western medicine, these patients belong to the category of unexplained infertility. In order to obtain the best treatment results from Chinese herbs and acupuncture, the integration of both Chinese medical pattern diagnosis and Western medical diagnosis of disease is extremely important. According to microcosmic method of Chinese medicine, the diagnostic procedure is first based on the modern Western medical diagnosis of disease, and then each Western disease is subdivided into both microcosmic and macrocosmic patterns of Chinese medicine. When Western medicine is unable to reach a definite diagnosis, such as unexplained infertility, microcosmic method of Chinese medicine can still make a pattern diagnosis in either macrocosmic or microscopic view. Generally, in the macrocosmic aspect, the microcosmic method of Chinese medicine is quite similar to classical Chinese medicine, emphasizing the coordination of the whole body. However, in the microcosmic aspect, this method is focused on the local pathological changes or on the functional disturbances of a specific system of the body. Clinically, tongue, pulse and facial complexions of a patient usually reflect the macrocosmic patterns of Chinese medicine, but the individual Western medical diseases mostly correlate with the microcosmic patterns of Chinese medicine. Accordingly, in the same patient, the microcosmic patterns of Chinese medicine may not always be compatible with the macrocosmic ones. For example, endometriosis or polycystic ovary fits in Blood stagnation and Phlegm, definitely indicating Excess pattern in microcosmic view, but the pulse, tongue and facial complexion of the patient with endometriosis or polycystic ovary may show Deficiency pattern as long as the patient’s macrocosmic conditions are deficient. 5. Treatment of Female Infertility Using Microcosm Method of Chinese Medicine Since the microcosmic patterns of Chinese medicine are connected to certain Western pathological changes or Western functional disturbances as mentioned previously, the treatment principles of Chinese medicine for female infertility are discussed below in accordance with the Western terminology of diseases. Simple Ovulatory Dysfunction Simple ovulatory dysfunction is one of the most common causes of female infertility. In microcosmic method of Chinese medicine, the Kidney regulates the reproductive 8 functions through its axial system: Kidney — Chong and Conception meridians. This is similar to the concept of modern Western medicine that physiological functions of reproduction are regulated by the central axis: hypothalamus-hypophysis-ovary-uterus. In modern Western reproductive pathophysiology, the dysfunctions of the axial system of hypothalamus-hypophysis-ovary-uterus often disturb the ovulation. The periodical change of serum estrogen level, mainly Estradiol (E2) is the key in regulating ovulatory cycle. If E2 level is not high enough to trigger the surge of LH secretion before ovulation, ovulatory dysfunction occurs. Anovulatory patients are categorized into two main groups: low estrogen level group and relatively high estrogen level group. In microcosmic view of Chinese medicine, the former group is usually associated with Kidney Yang Deficiency, while the latter with Kidney Yin Deficiency. In addition to Kidney Yin Deficiency, many anovulatory patients with relatively high estrogen levels manifest microcosmic Liver Qi congestion. In general, anovulatory patients with high estrogen levels should be treated primarily by both nourishing the Kidney Yin and soothing the Liver, whereas those with low estrogen levels by warming the Kidney Yang. For kidney Yin def
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