基于“寒气生浊”理论的子宫内膜异位症相关纤维化辨治思路探析

强若男; 刘雁峰

doi:10.3969/j.issn.1006-2157.2024.09.001

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基于“寒气生浊”理论的子宫内膜异位症相关纤维化辨治思路探析

“中医药防治妇科疾病”专题 | 更新时间：2024-10-09

- 基于“寒气生浊”理论的子宫内膜异位症相关纤维化辨治思路探析
- Diagnosing and treating endometriosis-related fibrosis based on the perspective of the traditional Chinese medicine theory of " coldness produces turbid yin"
- 北京中医药大学学报 2024年47卷第9期页码：1185-1190
- 作者机构：
  
  北京中医药大学东直门医院　北京　100700
- 作者简介：
  
  强若男，女，在读硕士生
  #刘雁峰，女，博士，教授，主任医师，博士生导师，主要研究方向：中医药防治女性生殖内分泌疾病，E-mail：liuyaf8888@sina.com
- 基金信息：
  
  国家自然科学基金项目(82274567;82074480)
- DOI：10.3969/j.issn.1006-2157.2024.09.001
  中图分类号： R271.171
- 纸质出版日期：2024-09-30，
  
  网络出版日期：2024-08-14，
  
  收稿日期：2024-03-12，
- 稿件说明：
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强若男, 刘雁峰. 基于“寒气生浊”理论的子宫内膜异位症相关纤维化辨治思路探析[J]. 北京中医药大学学报, 2024,47(9):1185-1190.

QIANG Ruonan, LIU Yanfeng. Diagnosing and treating endometriosis-related fibrosis based on the perspective of the traditional Chinese medicine theory of " coldness produces turbid yin"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2024,47(9):1185-1190.
强若男, 刘雁峰. 基于“寒气生浊”理论的子宫内膜异位症相关纤维化辨治思路探析[J]. 北京中医药大学学报, 2024,47(9):1185-1190. DOI： 10.3969/j.issn.1006-2157.2024.09.001.

QIANG Ruonan, LIU Yanfeng. Diagnosing and treating endometriosis-related fibrosis based on the perspective of the traditional Chinese medicine theory of " coldness produces turbid yin"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2024,47(9):1185-1190. DOI： 10.3969/j.issn.1006-2157.2024.09.001.

摘要

子宫内膜异位症具有易长难消、广泛受累、病情缠绵等特点，是导致患者生活质量降低的常见妇科疾病。异位内膜组织的纤维化既是本病的主要病理特征，也是导致患者痛经、不孕及慢性盆腔痛的主要原因之一。中医学认为，血瘀为子宫内膜异位症的病理基础及病机核心所在，且以活血化瘀之法贯穿疾病治疗始终。“寒气生浊”源自《素问·阴阳应象大论篇》，寒为阴邪，其性凝滞且易伤阳气，痰湿瘀血等浊邪则内生而为患。基于此，本文分阶段探析子宫内膜异位症的病因病机，初始期以“寒气盛、凝血为瘀，浊邪生、癥之所结”为主，进展期则为“阳气虚、寒瘀难解，纤维化、癥久而成”；针对不同阶段的病机特点，提出散寒化浊、温阳消癥、分阶段施治的理念。未病及初病之时以散寒活血、化浊通络为主；久病难解则重在温阳化浊、软坚消癥，扶正与祛邪并举以消久癥。寒气消散，瘀血浊邪得清，则病势可缓；阳气充盛，纤维化得解，则久癥渐除。

Abstract

Endometriosis is a prevalent disease in gynecology. The symptoms of endometriosis are challenging to treat

affect various organs

and persist in the body

adversely impacting patients′ quality of life. Endometriosis-related fibrosis is a primary cause of dysmenorrhea

infertility

and chronic pelvic pain

which represents the main pathological feature of endometriosis. Traditional Chinese medicine identifies blood stasis as the primary pathological basis of endometriosis

emphasizing the use of treatments to promote blood circulation and resolve stasis. The traditional Chinese medicine theory

" coldness produces turbid yin"

suggests that coldness plays a crucial role in the formation of blood stasis and damp phlegm. Coldness is harmful to yang qi

leading to the accumulation of blood stasis and damp phlegm in the body

which can cause endometriosis. Based on this theory

the etiology and pathogenesis of endometriosis were discussed in stages. " Strong coldness coagulation is blood stasis

turbidity generating abdominal masses" is the first etiological factor. The progress stage is " yang qi deficiency is difficult to resolve cold blood stasis

and fibrosis is formed over a long period". According to the pathogenesis characteristics at different stages

the treatment concept for endometriosis is warming yang to resolve turbidity and blood stasis. During the initial stage of disease treatment

the treatment principle is primarily based on dispersing cold

activating blood circulation

and removing damp phlegm and blood stasis. The primary treatment is to improve yang qi to dissipate turbidity and circulate blood

and eliminate stasis to reduce abdominal masses if endometriosis is challenging to treat over a long period. In conclusion

endometriosis can be treated when blood stasis and damp phlegm are dissipated

and endometriosis-related fibrosis can be treated to clear abdominal masses when yang qi is filling the body.

关键词

子宫内膜异位症纤维化寒气生浊阳虚寒凝

Keywords

endometriosisfibrosiscoldness produces turbid yinyang deficiencycold coagulation

references

中国医师协会妇产科医师分会，中华医学会妇产科学分会子宫内膜异位症协作组．子宫内膜异位症诊治指南(第三版)[J].中华妇产科杂志，2021，56(12)：812－824.

JOHNSON NP, HUMMELSHOJ L, ADAMSON GD, et al. World Endometriosis Society consensus on the classification of endometriosis[J]. Hum Reprod, 2017, 32(2): 315－324.

HENDERSON NC, RIEDER F, WYNN TA. Fibrosis: from mechanisms to medicines[J]. Nature, 2020, 587(7835): 555－566.

谢幸，孔北华，段涛. 妇产科学[M]. 9版. 北京：人民卫生出版社，2018: 261－267.

VIGANO P, CANDIANI M, MONNO A, et al. Time to redefine endometriosis including its pro-fibrotic nature[J]. Hum Reprod, 2018, 33(3): 347－352.

GARCIA JM, VANNUZZI V, DONATI C, et al. Endo-metriosis: cellular and molecular mechanisms leading to fibrosis[J]. Reprod Sci, 2023, 30(5): 1453－1461.

ZONDERVAN KT, BECKER CM, MISSMER SA. Endometriosis[J]. N Engl J Med, 2020, 382(13): 1244－1256.

刘雁峰，梁雪芳，徐莲薇. 中医妇科学[M]. 4版. 北京：人民卫生出版社，2021.

耿运玲，吴圣贤，马媛媛，等. 试述寒气生浊[J]. 中医杂志，2019, 60(14): 1181－1184.

张景岳. 类经[M]. 范志霞，校注. 北京：中国医药科技出版社，2011: 9.

张晋锐，吴圣贤，杜雅薇. 基于“寒中于暮”探析动脉粥样硬化的病因病机[J]. 北京中医药大学学报，2024, 47(1): 92－96.

张明健，刘君，林杪，等. 对原发性痛经寒凝血瘀证患者任、督、冲三脉经穴热学特性的研究[J]. 北京中医药大学学报，2022, 45(12): 1266－1276.

张禹成，闫理想，陈猛，等. 从“浊邪害清”论骨髓微环境与白血病的关系及中医辨治[J]. 北京中医药大学学报，2023, 46(10): 1467－1472.

孙飞，杜武勋，张少强. 《黄帝内经》“浊”及其相关概念的理论研究[J]. 中医杂志，2015, 56(20): 1711－1715.

张景岳. 景岳全书[M]. 李继明，整理. 北京：人民卫生出版社，2011.

闫菲，刘雁峰，赵琦，等. 浅析丹溪学说在绝经前后诸证中的临床运用[J]. 北京中医药大学学报，2022, 45(7): 728－732.

孙广仁. 中医学的阴气、阳气概念辨析[J]. 中华中医药杂志，2005, 20(11)：6－8.

邢玉瑞. 中医浊毒概念问题探讨[J]. 中医杂志，2017, 58(14): 1171－1174.

GUO SW. Cancer-associated mutations in endometriosis: shedding light on the pathogenesis and pathophysiology[J]. Hum Reprod Update, 2020, 26(3): 423－449.

李冰冰，刘雁峰，王铁枫，等. 从“肾阳虚，肝脉寒伏”辨治卵巢巧克力囊肿纤维化[J]. 中华中医药杂志，2019, 34(5): 2208－2211.

韩倩，王子衿，石举梅，等. 子宫内膜异位症患者中医体质分布情况及影响因素分析[J]. 现代中西医结合杂志，2023, 32(7): 920－925.

王姝，郎景和. 子宫内膜异位症——一种干细胞疾病？[J]. 现代妇产科进展，2008, 17(10): 721－724.

单婧，王晓秋，李大金. NK细胞参与子宫内膜异位症及其不孕的分子机制[J]. 山东大学学报(医学版), 2021, 59(8): 8－13.

VICINO M, SCIOSCIA M, RESTA L, et al. Fibrotic tissue in the endometrioma capsule: surgical and physiopathologic considerations from histologic findings[J]. Fertil Steril, 2009, 91(4 Suppl): 1326－1328.

VALLVÉ－JUANICO J, HOUSHDARAN S, GIUDICE LC. The endometrial immune environment of women with endometriosis[J]. Hum Reprod Update, 2019, 25(5): 564－591.

HASSA H, TANIR HM, TEKIN B, et al. Cytokine and immune cell levels in peritoneal fluid and peripheral blood of women with early- and late-staged endometriosis[J]. Arch Gynecol Obstet, 2009, 279(6): 891－895.

DELVOUX B, GROOTHUIS P, D′HOOGHE T, et al. Increased production of 17beta-estradiol in endometriosis lesions is the result of impaired metabolism[J]. J Clin Endocrinol Metab, 2009, 94(3): 876－883.

KIM JJ, KURITA T, BULUN SE. Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer[J]. Endocr Rev, 2013, 34(1): 130－162.

RIZNER TL. Estrogen metabolism and action in endometriosis[J]. Mol Cell Endocrinol, 2009, 307(1/2): 8－18.

KAPOOR R, STRATOPOULOU CA, DOLMANS MM. Pathogenesis of endometriosis: new insights into prospective therapies[J]. Int J Mol Sci, 2021, 22(21): 11700.

DONNEZ J, SMOES P, GILLEROT S, et al. Vascular endothelial growth factor (VEGF) in endometriosis[J]. Hum Reprod, 1998, 13(6): 1686－1690.

MATSUZAKI S, POULY JL, CANIS M. Persistent activation of signal transducer and activator of transcription 3 via interleukin－6 trans-signaling is involved in fibrosis of endometriosis[J]. Hum Reprod, 2022, 37(7): 1489－1504.

MOEN MH, MAGNUS P. The familial risk of endo-metriosis[J]. Acta Obstet Gynecol Scand, 1993, 72(7): 560－564.

段梅，杜煜晗，杜惠兰. 杜惠兰辨治子宫内膜异位症不孕经验研究[J]. 河北中医药学报，2022, 37(3): 53－56.

吴静，刘甜甜，张志华，等. 梁瑞宁治疗腹壁子宫内膜异位症的临床经验[J]. 江西中医药大学学报，2019, 31(1): 29－30.

吉秀家，张小花，黄灿灿，等. 少腹逐瘀汤调控PTEN/Akt/mTOR信号通路减轻子宫内膜异位症纤维化[J]. 中国中药杂志，2023, 48(12): 3207－3214.

毛海燕，陈元欢，武权生，等. 加味少腹逐瘀汤对子宫内膜异位症寒凝血瘀证盆腔疼痛神经血管生成的影响[J]. 中国实验方剂学杂志，2022, 28(12): 141－147.

刘雁峰，史梅莹，王铁枫，等. 肖承悰教授治疗子宫内膜异位症(腺肌病)痛经临床经验浅析[J]. 中国医药导刊，2010, 12(3): 359－361.

何甜甜，闫军堂，郭亚楠，等. 国医大师王庆国基于“通平致和”理论论治子宫内膜异位症经验总结[J]. 现代中医临床，2023, 30(1): 5－8.

张胜君，苏鑫. 《傅青主女科》中引经药应用探析[J]. 中华中医药杂志，2022, 37(4): 2345－2347.

王伟，李瑾，谈勇，等. 夏桂成辨治子宫内膜异位症特色探析[J]. 安徽中医药大学学报，2018, 37(6): 44－45.

陆黎娟，刘迎，宋清霞，等. 试用肠－脑轴探析国医大师夏桂成治疗子宫内膜异位症经验[J]. 四川中医，2021, 39(2): 8－11.

贾丽平，赵可宁. 夏桂成论治子宫内膜异位症痛经[J]. 吉林中医药，2016, 36(12): 1208－1210.

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