Professor LUO Zhijuan's experience in the treatment of infertility in elderly women

Yong-Qin Pan Zhi-Juan Luo Yuan-Yuan Wu Kai-Ling Lan Pin-Hao He

1.Guangxi university of traditional Chinese medicine, nanning 530000, China

2.Ruikang hospital affiliated to guangxi university of traditional Chinese medicine, Nanning 530000, China

Keywords:

ABSTRACT

At present, the age of giving birth at old age is defined as female over 35 years old [1]. In older women, the incidence of infertility is positively correlated with age, that is, with the increase of age, the incidence of infertility gradually increases, mainly because the function of ovarian reserve gradually decreases with the increase of age. The incidence of infertility in women aged 35-40 years is about 30%, while the incidence of infertility in women aged 40-45 years can reach 64%[2].

Professor luo zhijuan, a famous doctor of traditional Chinese medicine in guangxi province, has 36 years of experience in gynecology clinical and scientific research. With solid theories and rich experience, she has high attains in the treatment of gynecologyrelated diseases. In the treatment of old age infertility, advocate the "three division method", namely "stage", "syndrome type", "period", the author was lucky to be with the teacher in the clinic, benefit from the experience of the tutor treatment of old age infertility is as follows.

1. Infertility at an advanced age

Infertility refers to the woman who has a normal sexual life and has not had a pregnancy without contraception for one year [3]. "Element asked, ancient naive theory article" recorded women increase the body function begin to decline with age is normal phenomenon, namely, "jiao tone, Yang Ming pulse failure" theory, also points out that to further increase with age to age perimenopausal women lose their reproductive functions, namely "the July 7th ren meridian, form bad without a child", thus, female body 35 by extremely fading from Yang Ming pulse tide began. The theory of traditional Chinese medicine tells us that the yangming pulse is multi-qi and multi-blood, the essence of blood is homologous, the chong pulse belongs to the yangming, the female five seven years yangming pulse function attenuation, the qi and blood chemical generation lack of source, the chong ren lost in the filling, the cell palace qi and blood can not fill up on time, the reproductive function is abnormal, then there is fertility decline. Modern studies have further demonstrated that the number of follicles in women's ovaries is negatively correlated with age, and the number of follicles gradually decreases with age, especially for women over or equal to 30 years old, the number of follicles in their ovaries decreases by half, and for women over or equal to 35 years old, the number of follicles decreases by 1/6 of the age of 30 years old [2]. Poor follicular quality and fewer follicles predicted decreased ovarian reserve function and decreased fertility in women [4]. Lu yuan et al confirmed that ovarian function decreased from reserve function to complete function failure, which only took 1-6 years [5-6].

2. Causes and pathogenesis of infertility in advanced age

Professor luo believes that the occurrence of this disease is mainly based on kidney deficiency, and is related to dysfunction of the heart, liver, spleen and viscera. The main pathological products are phlegm, dampness and blood stasis, which together lead to the dysfunction of kidney-tiangui-chongren-cell palace reproductive axis.

2.1 Kidney deficiency

Kidney collects essence, advocate procreation, be the origin of classics blood; Such as "fu qing advocate female branch" [7] : "husband and wife person suffer pregnancy, originally in kidney qi flourishing also...... ." Advanced age, deficiency of vital energy in kidney, blunt any deficiency, then can not be pregnant into sperm; "Fu qing advocate female branch" not only put forward "classics this at kidney", have pointed out "classics water out kidney" of say, kidney essence is insufficient, day decui exhaustion, then the blood sea cannot be on time full overflow, so see menstrual cycle gradually prolonging, menstruation thin hair, the amount of menstrual gradually reduce even classics have no son;

2.2 Dysfunction of heart, liver, spleen and viscera

Heart and kidney water and fire two zang, water and fire both to regulate the Yin and Yang changes and the function of the cell palace. "Ask · linglan secret classic theory" cloud: "the heart, the prince's official......" In the year of 77years, the woman's kidney Yin deficiency, kidney water deficit in the next not on the heart, then the heart fire alone on the overactive and not down, resulting in heat disturbance gods, so there is upset insomnia, hot flashes, night sweats, red face and other perimenopausal symptoms. On the subject of fever: "the moon does not come, the cytosine is closed......" ", "the cytology belongs to the heart and the collaterals are in the cell", the cytology is the channel through which the heart gas flows down to the cell, the cytology is unobstructed, and when the heart gas and blood flow flow smoothly down to the cell, the pregnancy is normal; otherwise, the cytology occlusion occurs, and infertility may occur.

National physician master Xia Guicheng professor has proposed "heart (brain) - kidney - uterine axis" theory, that women's menstrual and reproductive rhythms are done under the axial adjustment, proved that the heart of the zang-fu organs is very important to the female reproductive function, and in the clinical treatment according to heart kidney related theories to the kidney for treatment, has opened up a new train of thought for the treatment of ovarian premature aging [8-9].

The spleen is the main transport and transformation, the source of qi and blood, is the source of the day after tomorrow, the spleen and stomach are inside and outside each other, the woman blood for this, with qi for use; Five seven years of yangming pulse failure, spleen deficiency is insufficient qi and blood biochemistry, chong deficiency, blood sea not surplus, later menstruation, less, even amenorrhea; Spleen deficiency is the movement of the loss of division, it is easy to produce phlegm and dampness, phlegm and dampness lead to body obesity, blocking the cell palace; Or phlegm wet viscosity is easy to inhibit qi, qi stagnation is easy to blood stasis, block the cytoskeleton, resulting in the start of dense funyu qi limited to infertility, as the "doctor" jinjian said: "because the body sheng phlegm. Sterility in lipid membrane choked cell "; Because kidney is yuan Yin yuan Yang, Yin and Yang of the five zang organs, spleen Yang root in the kidney Yang, five seven years, spleen and kidney deficiency, kidney deficiency is weak, spleen deficiency is lack of source, lack of qi and blood, chongren lost nourishment, is bound to lead to the classics, belt, fetus, birth diseases;

Liver to hide blood, drainage, division of blood sea, likes to tune up, evil depression; "Fu qing zhu female section" [7] says: "women have the embrace of the evil can not bear children...... Who knows is the liver qi yu knot ", the elderly woman is bearing the social, work, family, birth and other aspects of pressure, easy to cause liver disorders, resulting in liver depression; Zhang jingyue pointed out in the woman's rule: "the woman's heavy in blood, blood can construct essence, pregnancy is into", women with blood for this, liver depression is not free qi, so see menstrual cycle delayed, menstrual less, no regular period before and after menstruation, infertility;

The relationship between son and mother of liver and kidney: the blood surplus of liver is partly injected into the meridians and concentrated in the cell palace, which is menstruation. The liver is the child of the kidney... Liver qi is depressed kidney gas should not, qi blood cannot fill on time overflow is little by water, late or break or continue ". As it is pointed out in the wanshi woman family, "... Women have no children, mostly because of the tune..."

2.3 Signs of phlegm dampness and blood stasis

Elderly women prolonged child search failed, "long illness into the collaterals", "collaterals disease will be stasis", or prime depression or anger liver injury, emotional injury, liver loss, no right to discharge, qi yu blood stasis or external evil guests in the uterus, evil and blood phase into stasis, stasis of the palace can not ejaculate into pregnancy; Spleen deficiency is insufficient in qi and blood biochemistry, qi is the handsome of blood, qi is sufficient for blood flow, qi deficiency leads to blood stasis, then there is more or less menstrual volume, menstrual late period or prolonged period; Stasis leads to infertility.

"Cure of" phlegm ""... The spleen is the source of phlegm..." ; In Ming dynasty, wang lun first advocated "the origin of phlegm... It's in the kidney." Kidney deficiency, spleen deficiency or liver yu ke spleen, wet into phlegm. Just as in the wanshi women [10] : "only the fat one is full of cream, the door of the ingot treasure is not open... For the disease of childlessness."

3. Treatment based on syndrome differentiation:

Professor luo believes that the dialectical point of old age infertility is to identify the disease location zang-fu, both symptoms and root causes, common syndromes of kidney deficiency, liver stagnation, stagnation of the cell, spleen deficiency phlegm wet syndrome, heart and kidney not to hand in the syndrome. However, in the clinical practice, we should be flexible and dialectical, not stick to the routine, no matter what the disease of the treatment, we should take into account the principle of kidney tonifying and regulating weeks to assist pregnancy, the treatment needs to be kidney tonifying and regulating weeks to assist pregnancy throughout. At the same time, it is also the regulation of scripture. Wan quan, a physician in the Ming dynasty, pointed out in his book wanshi women's department that the reason why women have no children is "mostly due to the lack of regulation of menstruation". Chen xiuyuan, a doctor in the qing dynasty, put forward the theory of "the method of seeds lies in regulating the menstrual cycle" in his "gist of gynecology" [11]. Zhu danxi also mentioned the importance of regulating the menstrual cycle in the treatment of infertility. In the treatment of this disease, professor luo proposed the "three points method" treatment.

4. Three-part therapy

4.1 Points card type

According to the symptoms and signs of the patients, the four diagnosis combined with reference, syndrome differentiation. Kidney qi deficiency in the treatment of kidney qi, warm nourishing and flushing, yu linzhu to add or subtract, nourish qi nourishing blood, make the sperm congestive foot, flushing and nourishing, pregnancy is into; In the case of kidney Yin deficiency, zaogui pill can be added or substracted to regulate the balance of Yin and Yang in the cell palace. Kidney-yang deficiency syndrome should be based on warming kidney-yang, tonifying and tonifying chongren. The person that liver yu qi knot should be with dredge liver to regulate qi adjust classics to treat a law, square can choose free and unrestrained come loose or open yu kind yu tang add reduce wait, make liver body get shu, qi shun blood line. For those with blood stasis, it is necessary to soothe the liver, regulate qi, promote blood circulation and remove blood stasis. For those with spleen deficiency and phlegm dampness, it is necessary to remove phlegm with spleen dampness and help pregnancy by regulating the meridians. Besides, it is also possible to choose cangfu decoction, erchen decoction and sigenzi decoction to reduce phlegm dampness and smooth passage. Blood stasis in the cell palace should be used to promote blood stasis and blood circulation, regulate the menstrual cycle to help pregnancy, can be selected to reduce blood stasis soup, so that blood circulation through the blood to clean up the cell palace stasis, remove blood stasis new. Heart and kidney not to hand in the treatment of kidney nourishing Yin, decrease internal heat ningxin mainly, the choice of six taste dihuang pills added.

4.2 Cycle

Combined with the change of menstrual cycle Yin and Yang timely drug administration to adjust the "kidney qi - tianci - chongren-cell palace" reproductive axis and play a role.

In the menstrual period, the double ninth of the cell palace turns into Yin, which is drained but not stored. Therefore, it is necessary to promote blood circulation and remove blood stasis. In addition, it is necessary to reduce blood circulation by regulating qi and inducing blood. After the late period, Yin long period, the cell palace but not diarrhea, when to kidneyyin, yiqi nourishing blood to the accumulation of blood as the treatment, so that the essence of god flourishing, blood full of gas, eggs can develop, from the guangxi luo's yigong nourishing soup to reduce; Intermenstrual period heavy Yin to Yang, when tonifying kidney qi huoxue, in order to promote the development of mature follicles excretion, to continue to draw kuiroshi tiaojing no. 5 prescription; The early period of the dynamic change of Yang long, the uterus but not diarrhea, Yin and Yang are sheng, in order to prepare the seeds and pregnancy, yu linzhu add and reduce; If already conceived, menstruation stops not tide, essence blood accumulates gather to raise foetus, when with fill kidney to fix foetus treatment, in case kidney gas is insufficient and appear foetus moves restlessness, foetus leaks wait for a disease, can give life foetus pill add reduce.

4.3 Stages

"Plain question · ancient naive treatise" : "wuqi, yangming pulse decline", "qi qi ren pulse deficiency,...... So bad shape and no children also ". Therefore, professor luo believes that patients can be divided into different treatment stages according to their age. Before the age of 40 years old woman, that is, five seven years old, "suqan · blood, gas and form records 24" yun: "... Yang Ming often much gas much blood..." Having yang-ming failure of arteries and veins, the source of qi and blood biochemical lack, this period the body begins to appear attenuation phenomenon, according to a "preventive" and "mutual fund" successively day theory, regulate when up to give priority to, when both kidney essence, make up the deficiency, Yang Ming further attenuation of arteries and veins, affect the essence in kidney, fill the day after tomorrow in the congenital, both for congenital temperature raising the day after tomorrow, the work up to enhance the gets hyperemia, kidney essence is enough active, follow the viscera of main and collateral channels, rechargeable cell palace, so as to achieve the goals of assisted reproduction. "Yin and Yang should be like a big theory" pointed out: "forty years, and Yin and qi from half, living decline"; At the age of 40, Yin qi from half, kidney qi attenuation, conditioning to kidney mainly, both spleen and qi, the day after the support of innate, to enhance the work of kidney tonifying essence. Kidney deficiency is weak root, spleen deficiency is weak source.

5. Examples of medical records

Ms. Wei, 43, received her first diagnosis on June 6, 2017. Her chief complaint was: "the amount of menstruation was less than 3 years, and she did not have contraception and pregnancy for more than 1 year after the operation"; Hpi: patients in a three years ago began to appear menstrual quantity decreases, less than normal 1/3201 April 6 years for embryo TingYu pregnant 2 months, to the local health care of women and children is done, no postoperative contraception is not pregnant, usually menstruation 28 to 30 days, menstruation 7 days clean, Lmp6.5, now on the second day menstruation, quantity is little, color dark red, has a blood clot, with abdominal pain, lumbar acid na mei, mainland, tongue reddish, whitish, arteries and veins. Pregnancy 3 delivery 1 (in 2000 full term natural delivery 1 time, fetal stop qinggong operation 2 times), western medicine diagnosis: advanced age infertility; Diagnosis of traditional Chinese medicine: 1. Advanced age infertility (kidney deficiency and blood stasis); 2. Treatment: tonifying kidney and qi, activating blood circulation and removing blood stasis; Formula: laurel roche tiaojing no. 4 prescription plus or minus 4 doses. After the net treatment to tonify the kidney and spleen, qi and blood, the choice of GUI luo's yigong yangbao soup plus or minus 7. Characteristics: 1, is now over 40 patients, has reached 67, old women and infertility, menstrual quantity decreases, according to the rest of the symptoms and coating on the tongue and pulse condition belong to kidney deficiency, when the kidney replenishing qi, and patients during the menstrual period, when in order to improve the occasion promoting blood circulation to remove blood stasis, regulate the menstrual function, choose guangxi roche regulate the menstrual function to add and subtract, 4 square of peach kernel, saラower, radix angelicae sinensis, rhizoma ligustici wallichii invigorate the circulation of qi and nourishing blood, blood regulate the menstrual function, cowherb seed, lulutong huoxue quyu, dodder, eucommia bark, kidney qi, kidney essence, liquorice and the medicine, the whole party altogether plays invigorating qi and activate blood regulate the menstrual function effect. 2, after the later stage to guiluo yigong nourishing bubble soup 7, when to fill the kidney nourishing film, nourishing Yin bubble; In the reuse of tu si zi kidney Yang, raspberry sex warm taste glycyrrhiza Yang, cooked rehmannia kidney Yin, deer horn cream to help Yang, Yang Yin, angelica, huangjing, codonopsis, atractylodes spleen qi tonic blood, promote the growth of endometrium follicles. "Yang hua qi, Yin shape", the whole good "Yang yi Yin, Yang Yin", tonifying kidney qi nourishing blood, from the root to help pregnancy. Second diagnosis: on June 17, 2017, the patient complained: lmp6.5×7d, small amount, dark red color, blood clot, accompanied by abdominal pain and lumbar acid, nmei ke, erbian tuneup, tongue red, mossy white, pulse fine. Formula: 1. 3 prescriptions of 5 prescriptions of guiluoshi tiaojing (radix angelica sinensis, ligusticum chuanxiong, radix paeoniae alba, peach kernel and saラower); 1. Now the patient is in the intermenstrual period, when the kidney tonifying qi and blood promoting, mainly in the four substances decoction tonifying qi and blood as the base prescription, the use of ripe ground tonifying kidney and Yin, with a small amount of peach kernel, safflower, to help chuanxiong tonifying blood effect. 2, through the early period when to tonify the kidney qi, warm nourishing chong ren, choose yu linzhu yuan.

According to the treatment principle of three-part method, the pregnancy was successfully carried out after 4 cycles of conditioning. The patient returned to the clinic on October 17, 2017:35 days after menopause, Lmp9.12×3d, no abdominal pain, vaginal bleeding and other discomfort, narcan, erbian adjustment. The tongue is light red, mossy white, vein is fine, blood-hcg: 3936mIu/ml, E2:563.7ng/L, P: 51.36ng/L, treatment to tonifying kidney qi, nourishing blood and foetus, formula selected longevity pills and 10 agents of radix codonopsis atractylosum, licorice root, formula thinking: in the formula, semen tu zi tonifying kidney essence, radix codonopsis atractylosum spleen qi, to supplement the nurture support the congenital force, so that the kidney can nourish the Yin foetus; Mulberry parasitic, continue to break the liver and kidney, solid chongren, ejiao nourishing Yin blood, increase such as dodder kidder kidney qi nourishing blood and the effect of fetal fixation, licorice mixed various drugs.

Report card of auxiliary examination on October 24, 2017: Yin chao: intrauterine early pregnancy, see the heart tube beat. Report form of auxiliary examination on December 8, 2017: NT: intrauterine pregnancy, single live fetus, cervical clear thickness (NT) of cardiac canal pulsating (0.88mm). On February 26, 2018, report card of auxiliary examination: three-dimensional b-ultrasonography: medium pregnancy, single live fetus (equivalent to 23 weeks of pregnancy). On June 11, 2018, the patient delivered a baby boy naturally at 38 weeks of gestation in the local people's hospital. The birth weight was 3360g and the length was 52cm.

6. Conclusion

In the treatment of infertility in elderly women, professor luo advocated the "three-part method" and "tonifying kidney, regulating weeks and assisting pregnancy" throughout the treatment according to the theory of "treating the disease for the root" and clinical experience of traditional Chinese medicine, and the clinical efficacy was remarkable. According to literature reports, the curative effect of tonifying kidney and regulating weeks in the treatment of infertility was accurate [12, 13, 14].

In addition, due to the elderly infertility age, ovarian reserve function decline and the desire to urgently seek children and other factors, professor luo also put forward "three propositions, one proposal", one proposal to improve infertility as soon as possible other relevant tests, excluding other factors that cause infertility (such as immunity, uterine fallopian tubes and other factors); Two advocate husband and wife is same tone, just as "department of gynaecology orthodox · guang si general discussion" alleged: "male fine and strong, female classics tone, have the way of the son also"; According to data shows: more than 35 year old woman, the decrease of the quality of the egg, clinical pregnancy rate and planting rate is low, and high pregnancy abortion rate [15, 16], so for patients with the help of assisted reproductive technology, claims timely cuts of traditional Chinese medicine, with the aid of traditional Chinese medicine, increases the chances of assisted conception, according to reports in the literature: traditional Chinese medicine (TCM) in assisted reproductive technology can not only improve the ovarian function, enhance the receptivity of endometrium, and improve the success rate and clinical pregnancy rate and reduce the occurrence of adverse pregnancy such as ovarian hyperstimulation syndrome,18,19,20 [17]. One suggestion: 3 months after successful conception.

In short, as early as possible in the treatment of infertility in old age to improve the relevant examination, couples with the same tune, targeted treatment, pregnancy after fetal fixation can achieve twice the result with half the effort.