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全生妇科十讲4: 不孕症(10/5/2011)

 育龄夫妇性生活正常、同居、未避孕,1年及1年以上未妊娠者,称为不孕症。从未怀孕者为原发性不孕症,曾有生育或流产后无避孕而两年以上不孕者为继发性不孕症。本症发生的原因较多,主要为生殖器病变,如排卵障碍、输卵管闭阻、子宫内膜异位等。若是先天性的生理缺陷如无子宫、无卵巢、无子宫内膜等,则非药物所能解决.
 
不孕症为妇科常见难治病之一, 其发病率呈明显上升趋势。世界卫生组织于20世纪80年代中末期在25个国家中的33个中心调查结果显示,发达国家约有5%~8%的夫妇受到不孕症的影响,发展中国家一些地区不孕症的患病率可高达30%,中国约为6%~15%。全世界的不孕患者人数约为8000万~1.1亿。不孕症发病率的递增趋势可能与晚婚晚育、人工流产、性传播疾病、生活压力大、作息不规律等相关。
 
中医认为,肾中精气亏虚是不孕症的基本病机,而痰凝、血瘀、气滞是其主要矛盾. 在其诸多证型中,月经紊乱、痛经、闭经、崩漏、带下异常为其共同特征。肾阳虚者尚有小腹冷感,性欲减退,带下清稀,畏寒肢冷等症;肾阴虚者尚有形体消瘦,潮热盗汗,五心烦热等症;痰湿者多见形体肥胖,白带黏稠量多,胸闷呕恶等症;肝郁者则有胸胁、乳房作胀,情志抑郁等症;瘀阻者多兼肌肤甲错,面色萎黄等症。
 
历代医家对不孕症的证治极为重视,根据“求子之道,首先调经”的指导思想,以补肾气、益精血、养冲任、调月经为总原则,并结合辨证,配以疏肝理气、化痰祛瘀等法,最后达到治疗不孕症的目的。
 
现代中医对不孕症的治疗,最早报道于50年代,按月经周期治疗不孕症。60年代以来,各地陆续有“中药人工周期”疗法的报道。80年代后,对不孕症治疗的文献报道逐年增多,尤其是近年来,随着现代医学诊断技术的发展,中医治疗本症在辨证与辨病结合及中药人工周期疗法等方面都有重要进展。女方不孕因素包括下丘脑-垂体-卵巢轴功能紊乱致无排卵,输卵管阻塞影响。实验研究证实“肾虚证”的出现与下丘脑性功能紊乱关系密切。补肾药调节性腺轴功能的作用水平在下丘脑,表明“肾主生殖”的功能与下丘脑对女性性腺轴功能调节作用密切相关。同时,在临床上也收到了较好疗效,据报道,对临床384例月经不调致不孕病例统计,应用中药人工周期治疗后,有效率达80%,妊娠率在60%以上。
 
最新研究报告显示,中医药能够调节促性腺激素的释放,促进排卵,改善子宫内膜血流。另一最新研究报告的结论是针灸能治疗多囊卵巢综合征、忧虑、抑郁和免疫功能障碍所致的不孕症。针灸或许是一种有效的无副作用的治疗不孕症的方法 (The British Medical Acupuncture Society).
 
导致不孕的原因很多, 应尽可能查明病因,有针对性地治疗。在目前已经明确的引起不育的原因中,因男方原因引起的约占1/3,因此首先检查男方,排除男性因素。若男女双方都有毛病, 应男女同治, 提高受孕机会。性生活不宜太频,积蓄精力在月经周期第14天前后(月经第1天算起)性交,性生活宜男上位。思子心切, 整天忧思不乐,是导致不孕的一个常见病因。因此,男女双方特别是女方要乐观一些,放松自己,不要因为暂时不孕而苦恼。平时按摩关元、中极、子宫穴或小腹,或按揉血海、地机、三阴交等穴位,对受孕有帮助。
 
下期敬请关注全生妇科十讲5: 卵巢囊肿. 更多全生讲中医, 敬请访问卢全生中西医结合博士的网站www.wholelifeherb.com,或直接拨打中文热线电话301-340-7682,301-919-9898约诊. 全生中医针灸医疗中心地址:  416 Hungerford Dr, Suite 215, Rockville, MD 20850. 或 9801 Georgia Ave, Suite 337, Silver Spring, MD 20902
 

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