Infertility is a relatively common clinical syndrome caused by various diseases or factors, mainly reproductive disorders, of which 32.8% are caused by obstruction of fallopian tubes. In recent years, the incidence of tubal obstructive infertility has increased significantly due to environmental pollution, changes in dietary habits, the sharp rise of sexually transmitted diseases and endometriosis, as well as the rapid increase in the number of pelvic inflammatory diseases and premarital abortions, so it is especially urgent to actively explore effective treatment methods. In the past two years, most doctors have explored the advantages of Chinese and Western medicine from multiple perspectives, and the results are very good, which are reviewed as follows: 1. It is pointed out that Zhu Danxi’s so-called “the two gyri” refers to the fallopian tubes, and the factors that block the two gyri are mostly due to the dysfunction of the internal organs, poor flow of qi and blood, or inappropriate rest during menstruation, postpartum, or after surgery, resulting in the attack of wind, cold, damp, and heat evils, stagnation of qi and blood, stasis of the uterus, and blockage of the uterine vessels, which prevents the ingestion of sperm for pregnancy. It is also classified as Qi stagnation and blood stasis, cold stagnation and blood stasis, kidney deficiency and blood stasis, phlegm and dampness stagnation, Qi deficiency and blood stasis, and heat stagnation and obstruction. Modern medical research shows that tubal obstruction is mostly caused by abnormal development of the fallopian tubes, placement of intrauterine devices, various nonspecific inflammatory diseases, tuberculosis, pelvic infection, surgery, etc., resulting in tubal congestion, edema, inflammatory infiltration, pus and fluid accumulation, and granulation tissue proliferation, which eventually cause tubal incompetence or poor patency, but pseudo-obstruction caused by mucus plugs, endometrial debris and uterine horn spasm also accounts for a significant proportion of them. He et al [2] pointed out that inflammation not only causes tubal obstruction, but also causes stiffness of the tubal wall and peritubal adhesions due to scar formation, which affects tubal peristalsis, while the endometrium of the fallopian tube is damaged by inflammation and affects cilia movement, which prevents the passage of fertilized eggs and causes infertility. 2.Simple herbal treatment: Chen et al [3] took self-prepared ligamentous soup (peach kernel, safflower, angelica, dilong, pierced sorrel, saponaria, lutong, aromatic herb, er peony, luo shi teng, qingpi, lianxiao, licorice) orally after menstruation for 20 d as a course of treatment, compared with the simple ligamentous group. The treatment group was 95 cases, with a cure rate of 61% and an efficiency of 85%; the control group was 100 cases, with a cure rate of 18% and an efficiency of 39%, and the treatment group had the most significant efficacy in 3-6 months and >6-12 months. Shen et al [4] formulated their own cicatrization cream (raw leech, calamus, angelica, zhebei, lutong, dilong, raw semen, raw fenugreek, hossein, cinnamon stick, raw strychnine. Soak 3000ml of pure aromatic oil for a week, fry through and remove the slag, boil until the water drips into a pearl, put down the right amount of Huang Dan into a paste, pour into the water 3d pull fire poison, spread on a cloth and set aside,
(20g/post) apply to the uterus point, 1 post/week/point,
Among 182 patients, 23 cases were cured in 1 course; 57 cases in 2 courses; 81 cases in 3 courses; 13 cases with significant effect and 8 cases with no effect. Cheng et al [5] used a decoction of Junjun (Sanleng, Curcuma longa, Dioscorea, Aromatic herb, Peony skin, Dan Shen, Xia Gu Cao, Lutong, Andrographis paniculata, Red vine, Severus, Astragalus, Xian Ling Spleen, Cistanches) + enema (Sanleng, Curcuma longa, Soapberry, Beehive, Red peony, Sumac, Dandelion) after menstruation.
Three menstrual cycles were used as a course of treatment, compared with the simple lavage group. The total effective rate was 84.31% for 102 cases in the treatment group and 64.71% for 34 cases in the control group. 3.Simple Western medical therapy treatment: Xu et al [6] applied modified micro-catheter interventional recanalization treatment in 108 cases, and the recanalization rate was 84.26%. The observation showed that proximal tubal obstruction was predominant in primary infertility (70.5%), while distal obstruction was more common in secondary infertility (66.7%). This method reduces tubal spasm, eliminates painful dilatation of the uterine cavity, and reduces the false-positive rate. Yan et al [7] performed tubal horn implantation to treat proximal tubal obstruction in 22 cases with a patency rate of 100% and a pregnancy rate of 77.3% at 2 years. The key to the success of the procedure is to control infection before and after surgery, to control bleeding at the uterine horn during surgery, to have a normal tubal umbrella, to have a patent segment no shorter than 3 cm, to implant a tubal segment that opens into the uterine cavity, and to minimize tissue damage, especially to the plasma layer and umbrella of the patent segment of the fallopian tube. Avoid clamping. 4. Tubal lavage or interventional therapy combined with Chinese herbal medicine: Dai et al [8] observed that the total effective rate of the treatment group was 83.3% compared with that of the control group (47.6%) in 24 patients treated by combining lavage with chemotherapy (peach kernel, safflower, danshen, saponaria, perforated nail, trigonella, made aromatic herb, mucuna pruriens, curcuma, citrus aurantium, astragalus, atractylodes, yam). Zhao et al [9] started oral administration of herbal medicines (Chai Hu, Danshen, Xia Gu Cao, Dang Shen, Angelicae, Yan Hu Suo, Curcuma longa, Jin Yin Hua, Coix Seed) to invigorate blood circulation and remove blood stasis and promote circulation 1 month before performing hysteroscopic lysis, and the total effective rate was 90.62% after 4 months. Chen’s [10] treated 25 cases with the oral treatment of Tongzhijiaozhi (Wei Lingxian, Pao Shanjia, Saponaria, Angelicae, Lutong, Scorpion, Serpent’s bed) together with Tongliang, and the cure rate was 80% after 3 to 6 courses. In Han et al [11], 48 cases were treated with tubal recanalization No.1 (Coix lacrymae, sophora, red vine, cinnamon stick, poria, dandruff, red peony, peach kernel, lutong, and penetrating sorrel) with lavage, with a total effective rate of 87.5%. Cao et al [12] used Chinese herbal medicines (Angelica sinensis, Radix Paeoniae, Salviae Miltiorrhiza, Andrographis paniculata, Lupinus tridentata, Curcuma longa, Saponariae rhizoma, Chuanxiong rhizoma, Peach kernel, Radix et Rhizoma aromaticae, Turtle worms, Red vine) to invigorate blood circulation and break down blood stasis and soften hard knots.
The paste is applied to the Shen Que point on a cotton resin cloth and the interventional tubal recanalization is performed at the same time. Compared with the interventional tubal recanalization, 26 cases were cured, 11 cases were improved and 8 cases were invalid in the treatment group, with a total effective rate of 82.21%; 14 cases were cured, 7 cases were improved and 9 cases were invalid in the control group, with a total effective rate of 69.99%. The study showed that the herbal medicine could significantly improve the blood supply to the uterus and promote endometrial hyperplasia and follicular growth. In Liu et al [13], the herbal medicine was used to improve the blood supply to the uterus and promote endometrial hyperplasia and follicular growth. 49 of 68 patients (72.05%) conceived within two years, 15 improved (22.05%) and 4 invalid (5.9%), with an overall effective rate of 94.1%. 94.1%. Wang et al [1] used oral blood circulation and draining soup (Lulutong, Andrographis paniculata, Myrrh, Wang Bu Liuxing, Fructus sanguinis, Peach kernel, Safflower, Red peony, Angelica sinensis, Astragali, Radix Codonopsis pilosulae, Glycyrrhiza glabra) + Chinese herbal enema (Red vine, Fructus sanguinis, Dandelion, Duck Plantago, Zingiber officinale, Trigonella, Curcuma longa, Peach kernel) + Chinese herbal topical application (Qian Qian Jian, Chou Di Feng, Qiang Wu, Dou Wu, Boswellia serrata, Myrrh, Blood exhaustion, Pepper, Seoran, Wu Jia Pi, The pregnancy rate was 47.3% in 55 cases treated with the combination of dahurica dahurica, mulberry, red peony, danggui tail, safflower, fangfeng, mugwort, and turbinarium, compared with only 5.5% in the group treated with fluids alone. Nian et al [14] treated 38 patients with tubal obstruction recanalization, before and after the operation, with the supplemental treatment of lateral vault closure and enema with Chinese herbal medicine, and the effective rate was 93.4%; the postoperative conception rate was 67.3%. Zhong et al [15] treated 38 cases with selective tubal recanalization based on the addition of tonifying and toning soup (fried neem, yanhuosuo, deer antler cream, zihejiang, angelica, erxiao, loofah, loofah, lutong, henbane, salvia, soapberry), with a total effective rate of 92.1%; 79.4% for the interventional group alone. 5.Integrated therapy: Liu et al [16] used ultrashort wave and audio electricity combined with intrauterine injection to treat 120 cases, and after 3 courses, the tubal patency rate was 85.4%, and the pregnancy rate after 2 years was 87.5%; the simple intrauterine injection was 62.9% and 55%, respectively. Shi [17] performed microwave thermotherapy on the 3rd day of clean menstruation with oral danshenone (1g/tid) for 7 days and lavage after 3 menstrual cycles. The pregnancy rate was 50.25% and 33.33% in the two groups compared with the oral metronidazole with fluid passage group. Wang et al [18] took oral Yin Qiao Hong Jiao Detoxification Tang plus reduction (Dan Pi, Angelica sinensis, Red Peony, Forsythia sinensis, roasted licorice, Soapberry, Trigonella, Curcuma longa, Honeysuckle, Red Vine, Sulforaphane, Coix seeds, Peach kernel, Yan Hu Suo, Lulutong, Pao Shanjia) +
The total effective rate was 95.1% in 62 cases treated with Chinese medicine enema (Danshen, Radix Paeoniae, Curcuma, Trigonella, Saponariae, Sulforaphane) + uterine injection (saline 20ml, Danshen injection 4-6ml, Dexamethasone 5mg, α-chymotrypsin 1000u, Gentamicin 160,000u) + bilateral foot Sanli injection (α-chymotrypsin 1000u, saline 2ml). The total effective rate was 95.1%. 6. Conclusion: In conclusion, although the efficacy of various treatment methods has been quite positive in the past two years, there are problems such as imperfect trial design and long treatment time, which will be subject to more in-depth study by medical doctors. In the author’s opinion, the key to the treatment of tubal obstruction infertility is the accurate localization of the tubal obstruction and detailed understanding of the function of the fallopian tubes, so that the appropriate treatment can be selected in a more targeted and flexible way. In view of this, the combination of continuously improved radio-interventional therapy with traditional Chinese medicine may become the leading research in the future.