Infertility is a common and difficult disease in gynecology; it is not only a simple reproductive problem, but also receives high attention as a factor that affects the physical and mental health of both men and women and causes family and social instability. And hyperprolactinemia is a common cause of infertility. Hyperprolactinemia refers to abnormal elevation of serum prolactin (PRL) >1.14 nmol/L (25 μg/L) due to various causes. Among them, pituitary disorders are the most common cause of hyperprolactinemia, with pituitary prolactinomas being the most common. Clinical features are overflow of breast and menstrual disorders, infertility, and headache. Professor Liu Ruifen is a doctoral supervisor of Shandong University of Traditional Chinese Medicine, chief physician, academic leader of key disciplines and key specialties of the State Administration of Traditional Chinese Medicine, and instructor of the fifth batch of national old Chinese medicine experts’ academic experience succession, with rich teaching, clinical and scientific research experience, and rich experience in the treatment of hyperprolactinemia infertility. The patient, female, 28 years old, was first diagnosed on January 21, 2014. She had been taking Chinese herbal medicine, Daying-35 and bromocriptine to regulate her menstruation for the past four years, and now she is planning to get pregnant. LMP: 2013.12.30, 4 days net, low volume, color acceptable, menstrual cramps, lumbago, now on the 23rd day of menstrual cycle. LMP: 2014.1.28, PRL: 3667.66↑uIU/ml, diagnosis: 1, secondary amenorrhea. 2, hyperprolactinemia. 2, hyperprolactinemia. Liu gave self-prescribed formula for regulating menstruation No. 5 (Angelica sinensis 12g, Radix Paeonia lactiflora 12g, Radix Paeonia lactiflora 12g, Radix Bupleurum chaihu 12g, Radix Aromaticus vinegar 15g, Semen malt 18g, Peppermint 9g (later down), Poria cocos 12g, Atractylodes macrocephala 12g, Radix Achyranthes sinensis 18g, Rhizoma safflower 12g, Radix sequestra 18g, Semen cuscutae 15g, Dampi 12g, Roasted licorice 6g). 14 payments were taken with water decoction. Also gave bromocriptine 1.25mg, bid, po. Second consultation, April 25, 2014, LMP: 2014.4.6, cycle 38 days, 5 days net, low volume, bright red color, no clot, accompanied by lower abdomen, lumbar distension and pain, tolerable, now on the 20th day of menstrual cycle, nasal, sleep is poor, diaphoresis is regulated. 24 April PRL: 3116.00↑uIU/ml. FSH: 1.030mIU/ml. gave above plus 9g each of fried grain and rice sprouts, 14 decoctions in water, bromocriptine 2.5mg, tid, po. 3rd consultation: 24.6.2014, LMP: 2014.6.13, low volume, spotting out, 2 days net, bright red, clot, premenstrual distension in abdomen, postmenstrual pain in vulva with yellow urine and burning in urethra. June 23 PRL: 2245.00↑uIU/ml. June 24 MRI: suspicious abnormal signal in the left part of pituitary gland, possible microadenoma. Diagnosis: pituitary microadenoma, hypomenorrhea. Given above plus roasted turtle nail 12g, curcuma longa 12g, peach kernel 12g, plantain 12g, 14 payments decoction in water, bromocriptine 2.5mg, tid, po, together with artificial cycle (tonic jelly, progesterone) Fourth consultation: 11.11.2014, LMP: 2014.11.10. not clear, now on day 2 of menstrual cycle, hormone six: FSH: 8.67mIU/ The hormones are: FSH: 8.67mIU/ml, LH: 3.79mIU/ml, PRL: 1563.00↑uIU/ml, T: 0.238ng/ml, E2: 5.0Pg/ml,P: 1.76ng/ml. , Chuan Niu Knee 15g, Mudan Pi 9g, Safflower 12g, Chai Hu 12g, Poria 15g, Chen Pi 9g, roasted licorice 6g ), and also clomiphene 100mg, qd, po, and other treatments as above. Fifth consultation: 21.11.2014, LMP: 2014.11.10, stopped clomiphene for 3 days, now on day 12 of menstrual cycle, monitored follicles on 21.11.2014: r: 1.2×30.75px, 1.4×30px, L: 1.67×32.25px, Em: 16.25px. gave fenomycin (estradiol tablets) 1 tablet, bid, estradiol tablets 1 tablet, qn, for topical application. The soup was continued and she was instructed to monitor her follicles every other day. Sixth consultation: 26 November 2014, LMP:2014.11.10. day 17 of menstrual cycle, follicle monitoring on 23 November: R: 1.92 × 40.5px, 2.07 × 39px, L: 2.02 × 40.75px, Em: 16.5px,,, follicle monitoring on 26 November: R: 2.30 × 49.75px, 1.09 ×She was instructed to stop taking Fentanyl (estradiol tablets) tomorrow and take Fentanyl (estradiol digestrol tablets) 1 tablet, bid, po for 10 days. We also gave self-prepared formula for tonifying the kidney and calming the fetus (Cuscuta sinensis 15g, Chuanxiansuan 18g, w parasiticus 15g, Radix Codonopsis pilosulae 18g, Atractylodes macrocephala 12g, Scutellaria baicalensis 9g, Medicago sativa 9g) with lily of the valley 12g, cypress seeds 12g, Aconite 10g, placenta powder 3g, 10 decoctions in water. Seventh diagnosis: December 10, 2014, LMP:2014.11.10. day 31 of menstrual cycle, December 8 β-HCG: 87.23mIU/m↑, prolactin: 1521mIU/m↑. Diagnosis: early pregnancy? She was instructed to retest the three early pregnancy tests. The ultrasound showed that a gestational sac was detected in the uterus and a dotted fetal germ 12.5 px long, and a fetal heartbeat was detected. Prolactin tends to be stable. According to “Su Wen – Shang Gu Tian Zhen Lun”, “When a woman is seven years old, her kidney energy is strong and her teeth grow longer; when she is seven years old, her kidney energy is strong and her teeth grow longer; when she is two years old, her kidney energy is strong, her renal vein is open and her tai chong vein is strong, so she has children at the time of menstruation”. However, in modern society, many factors such as life and work pressure lead to depression of liver qi in women, loss of drainage, dysregulation of the stroke and overflow of blood, so the treatment is supplemented by draining the liver and regulating qi, and combining with western medicine in different stages of menstruation. The treatment is based on draining liver heat and clearing liver fire. In the No. 5 formula for regulating menstruation, peony bark clears liver heat, angelica and white peony nourish blood and soften liver, Chai Hu, aromatic herb and wheat sprout dredge liver and relieve depression, white atractylodes, poria and licorice strengthen spleen and help transport, red peony, safflower and Chuan Niu Kne invigorate blood and remove blood stasis, sequesters and cuscuta calmly tonify kidney yin and kidney yang. The combination of all the herbs together can help tonify the kidney and clear the liver, together with bromocriptine, the starting amount is 1.25mg, 2 times u-day, and the PRL is checked again, and then the dosage of bromocriptine is adjusted to 2.5mg, tid, according to the PRL result, so that the PRL can be effectively controlled. At the same time, she was given a Western medicine artificial cycle (21d of Tonic on the 5th day of menstruation and progesterone on the 16th day of Tonic) to mimic the cycle of normal human ovaries and uterus, so that menstruation could come on time. During the trial period, she was given Menstrual Regulation No. 1, in which Angelica sinensis, Radix Rehmanniae, Semen Fructus and Fructus Lycii tonify the kidney and nourish the blood; Epimedium and Zizyphus warm the kidney yang and warm the uterus to promote fertility; |Serum and Chuan Xuan Zizi tonify the kidney yin and kidney yang; Chuan Niu Knee, Chai Hu, Radix Aromaticus, Rhizoma Polygonatum and Mudanpi regulate the liver and regulate the qi, activate the blood circulation and induce the blood to move downward, and she was given Clomiphene on the 5th day of menstruation, and Fentanyl (estradiol tablets) orally before ovulation, while Vaginally administered for better endothelial growth. After ovulation, while tonifying the kidneys and strengthening the spleen, nourishing the heart and calming the mind, she also focuses on activating blood circulation and resolving blood stasis, soothing the liver and regulating qi, and regulating the flushing. We gave the self-prepared formula for tonifying the kidneys and calming the fetus with addition and subtraction. Among them, Cuscuta sinensis, Chuan Jian, Sambucus nigra and Fructus Lycii nourish the liver and kidney; Radix Codonopsis pilosulae, Radix Astragali, Rhizoma Atractylodis Macrocephalae and Radix Glycyrrhizae benefit the Qi, strengthen the spleen and calm the fetus; Scutellaria baicalensis and Madonnas nourish Yin and clear heat, cool the blood and calm the fetus. At the same time, the use of Fentanyl estradiol tablets was changed to estradiol dydrogesterone to supplement estrogen and progesterone to achieve the purpose of conception. Summary: Clinically, this type of patients are more common. Ms. Liu takes the principle of diagnosis and treatment to tonify the kidney and dredge the liver, combined with the level of prolactin, combined with bromocriptine, with artificial cycle treatment, if treated with bromocriptine alone, it is easy to relapse after stopping the drug, with great side effects and drug resistance; the combination of drugs can significantly improve the clinical efficacy.