【摘要】：背景：卵巢儲備功能下降(Diminished Ovarian Reserve,DOR)是育齡期婦女較為常見的生殖內(nèi)分泌疾病,在不孕癥人群中,發(fā)病率約為10%。近年來由于生活節(jié)奏不斷的加快,空氣質(zhì)量及生活環(huán)境的持續(xù)惡化,生活及工作的壓力的不斷增加,其發(fā)病率有逐年上升的趨勢。但是由于卵巢儲備功能下降起病隱匿,臨床表現(xiàn)多無特異性,患者常因為不孕就診時發(fā)現(xiàn)患有此病。若不及時有效的干預(yù),可發(fā)展為卵巢早衰。雖然不是危及人類生命的急病、重病,但是能夠引起女性生育能力的下降及圍絕經(jīng)期的一系列癥狀,給患者造成極大的生理和心理負(fù)擔(dān),甚至?xí)绊懠彝サ姆�(wěn)定,值得我們持續(xù)深入的關(guān)注和研究。由于目前卵巢儲備功能下降的發(fā)病機制尚不明確,現(xiàn)代醫(yī)學(xué)對其尚無特異性的有效治療手段,多為對癥治療：對無生育要求的病人采用激素替代療法以改善癥狀,減少并發(fā)癥的發(fā)生；對有生育要求的病人多采用輔助生殖技術(shù)治療,但其妊娠率由于受卵子、胚胎質(zhì)量以及子宮內(nèi)膜容受等因素的影響而比較低,約30%-40%。中醫(yī)從整體出發(fā),辨證施治,采用多角度、多靶點、全方位的整體調(diào)治,并注重個體化診療,臨床取得了滿意的療效。許多研究表明,中醫(yī)藥治療卵巢儲備功能下降療效優(yōu)勢明顯,已成為卵巢儲備功能下降的重要治療手段。目的：杜寶俊教授從醫(yī)近三十年,致力于中醫(yī)藥治療不孕不育癥及婦科生殖內(nèi)分泌疾病的臨床研究,在卵巢儲備功能下降的中醫(yī)治療上逐漸形成了自己獨具特色的診療思路,本文旨在通過整理和總結(jié)其對卵巢儲備功能下降的臨床治療經(jīng)驗,從而為中醫(yī)治療卵巢儲備功能下降提供新的思路和方法。方法：通過檢索現(xiàn)代醫(yī)學(xué)及中醫(yī)學(xué)文獻(xiàn)對卵巢儲備功能下降病因、病機、治則、治法的相關(guān)論述,總結(jié)了現(xiàn)代醫(yī)學(xué)對卵巢儲備功能下降的認(rèn)識和評估方法及卵巢儲備功能下降的診療現(xiàn)狀以及存在的問題；同時較系統(tǒng)回顧了古代文獻(xiàn)及現(xiàn)代中醫(yī)對本病癥的認(rèn)識及診療經(jīng)驗,總結(jié)了中醫(yī)藥對本病的病因、病機、治法的認(rèn)識,以期更好地總結(jié)和領(lǐng)會導(dǎo)師治療本病的經(jīng)驗。通過近三年跟隨導(dǎo)師臨診、授課,以及總結(jié)病歷和回顧相關(guān)文獻(xiàn)等方式,總結(jié)了導(dǎo)師對卵巢儲備功能下降病因病機的認(rèn)識及辨證論治特點、治法及用藥特點。結(jié)果：杜寶俊教授在治療卵巢儲備下降過程中,逐漸形成了一套較完整且獨具特色的辨證思路和診療方法,導(dǎo)師認(rèn)為該病病位在腎,病機主要是腎虛,可兼見肝郁、脾虛、血虛、血瘀,治法以補腎為主,注重腎肝脾同調(diào),養(yǎng)血活血并用。導(dǎo)師在中藥辨證施治的同時聯(lián)合針刺療法,并重視心理疏導(dǎo),臨床取得了滿意的療效,較西醫(yī)治療有明顯優(yōu)勢,其經(jīng)驗值得總結(jié)、推廣。結(jié)論：杜寶俊教授對于卵巢儲備功能下降的認(rèn)識和治療具有獨到的見解,臨床療效顯著。其經(jīng)驗具有較強的臨床指導(dǎo)價值,并可為認(rèn)識和診治卵巢儲備功能下降提供新的思路。
[Abstract]:BACKGROUND: The decline of ovarian reserve function (DOR) is a more common reproductive and endocrine disease of women in the age of childbearing age. In the infertility population, the incidence rate is about 10%. In recent years, due to the increasing pace of life, the continuous deterioration of air quality and living environment, and the increasing pressure of life and work, the incidence of life has increased year by year. However, due to the low function of ovarian reserve, the disease is hidden, the clinical manifestations are not specific, and the patient is often found to have the disease due to the infertility. If there is no timely and effective intervention, it can be developed into premature ovarian failure. Although not life-threatening, serious illness, but it can cause the decline of female fertility and a series of symptoms of perimenopausal period, which can cause a great physical and psychological burden to the patient, and even affect the stability of the family, which is worth our continued in-depth attention and research. Because the pathogenesis of the decline of the function of the ovarian reserve is not clear, the modern medicine has no specific effective means of treatment, which is for the symptomatic treatment: the hormone replacement therapy is adopted for patients with no reproductive requirements to improve the symptoms and reduce the occurrence of the complications; The rate of pregnancy is low, about 30% to 40%, due to the influence of the ovum, the quality of the embryo and the tolerance of the endometrium. The traditional Chinese medicine is based on the whole, the differentiation and treatment, the multi-angle, multi-target, all-round overall adjustment, and the individual diagnosis and treatment, the clinical results have achieved the satisfactory curative effect. Many studies have shown that the effect of traditional Chinese medicine in the treatment of the function of ovarian reserve is obvious, and has become an important therapeutic means for the decline of the function of the ovarian reserve. Objective: Professor Du Bao-jun has been devoted to the clinical study of the treatment of infertility due to infertility and the reproductive endocrinopathy in the past three decades, and has gradually formed its own unique diagnosis and treatment idea on the treatment of the decline of the function of ovarian reserve. The aim of this paper is to provide a new thought and method for the reduction of the function of the ovarian reserve by arranging and summarizing its clinical experience in the decline of the function of the ovarian reserve. Methods: The diagnosis and evaluation of the function of ovarian reserve function and the diagnosis and treatment of the decline of the function of the ovarian reserve and the existing problems were summarized by searching the related discussion of the etiology, the machine, the treatment and the treatment of the function of ovarian reserve in modern medicine and the literature of traditional Chinese medicine. At the same time, the understanding of the ancient literature and the modern Chinese medicine on the condition and the experience of the diagnosis and treatment of the disease were reviewed, and the cause, the disease and the treatment of the disease were summarized, with a view to better summarizing and understanding the experience of the tutor in the treatment of the disease. Through the follow-up of the tutor in the last three years, the teaching, the summary of the medical records and the review of the relevant literature, the paper summarized the understanding of the cause of the decline of the function of the ovarian reserve by the tutors and the characteristics of the treatment and treatment and the characteristics of the treatment. Results: In the course of the decline of the ovarian reserve, Professor Du Bao-jun gradually formed a complete and unique thought and method of diagnosis and treatment, and the teacher thought that the disease was in the kidney and the disease machine was mainly due to the deficiency of the kidney. It can also be used as the main part of the kidney, spleen deficiency, blood deficiency, blood stasis, and the treatment of the kidney. It is focused on the liver and spleen of the kidney, and is used for nourishing blood and promoting blood circulation. At the same time, the tutor combined with the acupuncture therapy in the treatment of the syndrome differentiation of the traditional Chinese medicine, and attached great importance to the psychological guidance. The clinical results achieved satisfactory curative effect, and the treatment with western medicine has obvious advantages, and the experience is worth summarizing and promoting. Conclusion: Professor Du Bao-jun has a unique insight into the cognition and treatment of the function of ovarian reserve, and the clinical effect is significant. The experience has a strong clinical guidance value and can provide a new way for understanding and diagnosing the decline of the function of the ovarian reserve.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249;R271.9

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