Infertility is defined as having normal sexual intercourse without contraception for one year without pregnancy. In recent years, with the increase of chronic tubal infection, sexually transmitted diseases and endometriosis, the incidence of tubal infertility has been increasing year by year.
The clinical manifestations of this disease are mainly infertility, lower abdominal pain and excessive leucorrhea, etc. The symptoms are scattered in “childlessness”, “broken thread”, “obstruction” and “irregular menstruation”. The symptoms are scattered in the treatises of “childlessness”, “broken sutures”, “obstruction”, “irregular menstruation”, etc. At present, the diagnosis of tubal infertility is mostly determined by hysterosalpingography or tubal lavage or laparoscopy combined with tubal lavage, but its treatment is still a difficult problem in infertility. Professor Liu Ruifen, the mentor, has been engaged in clinical work in gynecology for more than 30 years and has accumulated rich experience in identifying and treating this disease in her long-term clinical practice. The author has had the honor to study with her teacher and has benefited greatly from her experience, which is presented below.
1. Blood stasis and kidney deficiency are the key factors in the pathogenesis of this disease
Professor Liu believes that blood stasis is an important pathological basis for tubal infertility, and that blood stasis obstructing the flushing, the uterus and the uterine ligament is the core pathogenesis of this disease. In the Ming Dynasty, Li{s “Introduction to Medicine – Gynecology” said: “The blood of a woman is the mechanism of birth and biochemistry, and when the fetus is not yet born, the blood flows continuously and arrives on time, and when the fetus is born, the blood glorifies and nourishes the fetus. The importance of the uninterrupted flow of blood and Qi is explained. If blood stasis blocks the uterus and veins, the Qi and blood do not run smoothly, the veins are blocked or not smooth, and the two sperms cannot fight each other and cause infertility, as Wu Qian of the Qing Dynasty said in the “Medical Jinguan – Gynecology Xinfa Essentials”: “The reason for a woman’s infertility is due to injury to her punching point, or because of the accumulation of blood in the cells, the new blood cannot become pregnant”.
Regardless of whether the cause of the disease is an external evil, an emotional disorder, or a failure to regulate life properly or a weak constitution, “blood stasis” is an indispensable pathological factor in the development of the disease. Blood stasis is not only a pathological product of various pathogenic factors, but also the most important pathogenic factor.
The kidneys are essential to a woman’s fertility. In Suwen Shanggu Tianzhen, it is pointed out that “when a woman is seven years old, her kidney qi is strong, her teeth are longer and her hair is longer; when she is two or seven years old, the heavenly sap arrives, the Ren vein is open, the Taichong vein is strong, and the menstruation is at the right time, so she has children”, indicating that the root of reproduction lies in the kidney, with kidney qi and heavenly sap as the material basis. When a woman is at a certain age, her kidney energy is abundant, her tien-kuei is mature, her tai-chong pulse is full, and the two sperms fight each other to form a fetus. Kidney deficiency, lack of essence and blood, affect the internal organs of the moistening, dysfunction of the internal organs, blood flow is slow and easy to become stasis; kidney qi deficiency, Yang Qi deficiency, warming dereliction of duty, blood flow is delayed, blood stasis blocking the uterus and rushing any and cause the disease. In turn, blood stasis blocks the ligaments, the kidney loses its nourishment and the source of essence is lacking. Blood stasis is the core pathogenesis of the disease and is present throughout the course of the disease. If the disease does not heal over time and the vital energy is damaged, the blood stasis and kidney deficiency evidence will eventually appear as a mixture of deficiency and reality.
In summary, Professor Liu believes that blood stasis and kidney deficiency are the key factors in the development of this disease.
2. The method of activating blood stasis, promoting qi circulation and tonifying the kidney and cultivating the yuan
In the Su Wen (The Great Treatise on the Supreme Being), it is written, “Diversify the blood and qi, so that it can be regulated and brought to peace.” In Su Wen – Yin Yang Ying Xiang Da Lun, it is pointed out that “it is advisable to resolve blood stasis”, which initially formed the idea of activating blood and resolving blood stasis. The “Danxi Xinfa” points out that “if the blood and qi are harmonious, all diseases will not arise, but if there is fries, all diseases will arise”, emphasizing the importance of clearing the stagnation of blood and qi. Blood stasis is an important pathological basis of tubal infertility, and blood stasis is the core pathogenesis of the disease, and it runs throughout the entire course of the disease, so activating blood and removing stasis must be the basic treatment for the disease.
The blood-stasis activating drugs can improve the thick, sticky, clotted and stagnant state of blood, promote pelvic microcirculation, strengthen blood supply to ovaries and uterus, promote the absorption of inflammation, release adhesions and accelerate tissue repair and regeneration; meanwhile, blood-stasis activating drugs have certain regulatory effects on humoral immunity and cellular immunity, and have two-way effects on immune function, both immune suppression and immune enhancement. Modern medicine believes that the blood flow in the pelvic cavity can be accelerated by blood-stasis activating herbs, which increases the blood perfusion to the local tissues and promotes the metabolism of the tissues, thus facilitating the absorption and dissipation of the inflamed tissues.
Qi and blood are interdependent and inseparable in the human body, as the saying goes, “the blood is the carrier of Qi, and the Qi is the transporter of blood.” Therefore, “qi is the blood, qi stops the blood, qi is slippery, blood is slippery, qi is cold, blood is condensed. If the qi does not move, the blood does not work. Therefore, the main clinical manifestation of tubal infertility is pain in the lower abdomen, in addition to infertility. After the formation of blood stasis, it will in turn affect the local and even systemic flow of qi and blood, exacerbating the development of the disease or producing other pathologies and becoming a new causative factor. The causes and results affect each other, as stated in the Treatise on Blood Evidence: “Qi knotting leads to blood clotting, Qi deficiency leads to blood loss, and Qi compression leads to blood walking, blood stasis and Qi stagnation”.
Zhang Jingyue also has unique insight on blood stasis, and believes that “blood must be made of qi, and qi is the blood line, so whenever you want to treat blood, either by attacking or supplementing, you should first regulate qi”, emphasizing the importance of moving qi and activating blood. Therefore, the clinical evidence must pay attention to activating blood circulation and removing blood stasis, moving qi and opening the ligaments, and the qi-opening products can improve the efficacy of blood-activating drugs and play a role in relieving pain. Modern research has confirmed that qi-regulating drugs have obvious analgesic effects, counteract exudative inflammation and proliferative inflammation, inhibit connective tissue proliferation, enhance the body’s non-specific immune function, and improve microcirculation.
Tubal infertility has been prolonged for a long time and is most likely to injure the qi in the qi and blood and the kidneys in the viscera. On the one hand, by supporting the positive qi to supplement the depletion of the positive qi of the body due to the prolonged and repeated attacks of the disease, it can improve a series of weaknesses; on the other hand, it can also make the positive qi strong and resistant to evil, which makes it difficult for the evil to invade and prevent the recurrence of the disease, and it can promote the normal operation of the blood, which also plays a certain role in promoting the revitalization of blood stasis.
Based on the above treatment, Prof. Liu has created the formula of Tongguan Seeds with more than 30 years of clinical experience, which consists of Danshen, Radix Paeoniae, Shengpuhuang, Fried Lingliao, Chuanjian, Cuscuta, Lianxiao, Xiangxiang, Gunpowder, Centipede, Lulutong and Wang Buliu. The combination of Salvia miltiorrhiza and Radix Paeoniae is the ruler to enhance the power of activating blood circulation and resolving blood stasis, and Radix Paeoniae can clear heat and cool the blood to prevent stasis from turning into heat for a long time. The combination of raw Pu Huang and fried Ling Fei is used to double the power of activating blood stasis, dispersing nodules and relieving pain, which is an experienced medicine pair for treating blood stasis and pain, and contains the meaning of loss of laughter; Lian Qiao is good at clearing heat and detoxification, dispersing nodules and subduing swelling, and can clear residual toxins in blood, preventing stasis from turning into heat for a long time, and can use the power of propagation to regulate qi and blood.
The above three medicines are used as ministers. The combination of Cuscuta and Chuan Cuscuta can nourish the liver and kidney, and together with the ruler and minister take the effect of helping to dispel evil, invigorate the blood and nourish the kidney; the aromatic herb, the gunner’s nail and the centipede can dredge the liver and regulate the qi and relieve pain, and the Wang Bu Li and Lu Lu Tong can invigorate the blood and regulate the qi. The above are adjuvant medicines. Glycyrrhiza glabra harmonizes all the medicines as the herbs. The combination of all the medicines can activate blood circulation and eliminate blood stasis, promote the circulation of Qi and improve the function of nourishing the kidney and cultivating the vital energy. It is especially suitable for the evidence of blood stasis and kidney deficiency due to the prolonged nature of the disease and the mixture of deficiency and reality. Chinese herbal medicine is generally used orally for 3 menstrual cycles and stopped during menstruation. Professor Liu often advises patients to use 3g of cannabis sativa and 1 centipede to take the powder or capsules for better results. v If cannabis sativa is used in soup, it usually takes more than 9g w and reduces the financial burden for patients.
3. Add and subtract with evidence
In the treatment of tubal infertility, Prof. Liu takes activating blood circulation and tonifying the kidneys as the basic treatment method, and pays attention to adding and subtracting flexibly according to the evidence. If heat symptoms are obvious, such as dry mouth, yellowish leucorrhea, yellow urine and dry stool, red tongue, yellow fur, and number of pulse, add heat-clearing herbs, such as Fructus sanguinis, Red Vine, and Phellodendron; if dampness symptoms are obvious, such as heavy drop in the abdomen, white and thin leucorrhea, greasy mouth, poor appetite, white fur on the tongue, and slippery pulse, and hydrocele in the fallopian tubes on imaging or pelvic fluid and cystic mass on ultrasound, then take into account the dispelling of dampness, add dampness dispelling herbs, such as raw Coix rice, Yun Ling, etc. If there is endometriosis in the endometrium, it is better to use the herb of blood circulation and water circulation, such as motherwort, zelenium, verbena, etc;
If accompanied by endometriosis or uterine fibroids or pelvic inflammatory masses, you can add drugs that soften and disperse the knots, such as zhebei, turtle shell, oyster, etc., which can resolve blood stasis without increasing the amount of blood away from the menstrual blood, such as trigonella, curcuma and other blood-breaking and eliminating Y, etc.; if accompanied by heavy menstruation or prolonged periods or premenstrual or intermenstrual bleeding, you can add drugs that resolve blood stasis and clear heat to stop bleeding, such as cyperus, squid bone, panax quinquefolius, sanguinaria, sanguinaria, etc. If it is accompanied by late menstruation or low menstrual flow, we can add blood nourishing and warming medicines to regulate the menstruation, such as henbane, zithromax, sanguinaria, etc.; if it is accompanied by five heart troubles, thirst and dry throat, we can add yin nourishing and moistening medicines, such as maitong, dendrobium, raw earth, etc. In short, according to the clinical manifestations, add and subtract according to the evidence.
4.Comprehensive treatment to improve the efficacy
Professor Liu pays attention to the use of comprehensive therapy to improve the efficacy of treatment of this disease:
(1) Use 100-150ml of concentrated decoction of Chinese herbal medicine composed of Danshen, Radix Paeoniae, Forsythia, Soapberry, Red Vine, Radix Rehmanniae, Lactobacillus, and Fructus septicae to activate blood circulation, clear heat, disperse nodules, and promote circulation;
②Preserve the dregs of oral or enema herbal medicine, wrapped in coarse cloth, and apply hot compresses to the middle and both sides of the small abdomen, or cooperate with the divine light physiotherapy for better effect;
③ decoct foot soak with the dregs of oral or enema Chinese medicine;
④Computerized medium frequency ion introduction;
⑤Anal medication such as Kang women anti-inflammatory suppository;
(6) Intravenous injection of Danshen or Xiyangping;
(7) Three to seven days after menstruation, use gentamicin, dexamethasone or Xiyangping to inject drugs into the uterine cavity;
(8) If necessary, cooperate with surgical treatment.
5.Regulate the emotions and grasp the dense time to improve the chance of conception
Patients with this disease mostly have heavy ideological and economic burdens due to the long duration of the disease and the difficulty in healing, so Professor Liu believes that patients with this disease should pay attention to the regulation of emotions and psychological guidance while taking medication. For example, during clinical treatment, patients should listen carefully to their demands and establish a good doctor-patient relationship; explain the treatment plan to patients in easy-to-understand language, or give examples of successful cases to enhance patients’ confidence; advise patients to use contraception during treatment to avoid ectopic pregnancy; if one side of the fallopian tube is patent after treatment and the other is not, monitor ovulation on the patent side according to ultrasound to guide patients to If one side of the fallopian tube is patent after treatment and the other side is incompetent, the ovarian ovulation on the patent side is monitored according to ultrasound to guide the patient to conceive.
The “Certificate of Treatment” cloud: “Where a woman has a menstrual cycle, there must be a day, the dense wait, in an hour of this wait also smooth and apply, then into a fetus.” Menstruation has a cycle, rhythmical, the 14th to 15 days of the cycle, also known as the dense time, or “the wait”, “true machine” period (that is, the Western medicine called “ovulation”), is the heavy It is the time when yin turns to yang, when yin flourishes and yang moves, and it is the time for seeds. Therefore, if the patient is instructed to have intercourse under the condition of ultrasound monitoring of ovulation on one side of the patent fallopian tube, the patient’s chance of conception can be greatly improved.