《中医妇科学》教材对“不孕症”相关认识的演变研究

A Study on the Evolution of the Understanding of Infertility in Textbooks of “Traditional Chinese Medicine Gynecology”

摘要: 目的：查阅整理17部《中医妇科学》教材(以下简称教材)不孕症章节内容，分析比较其异同，探索其演变历程。方法：采用频数分析法研究教材有关不孕症的诊治内容，并与现代研究进行对比分析。结果：1) 教材提出不孕症主要病机为肾气不足，冲任气血失调，常见证型为肾虚证、肝郁证、痰湿内阻证及血瘀证，与现代研究结果一致；2) 教材治疗不孕症以温养肾气，调理气血为主，配合疏肝、理脾、化痰、除湿等，肾阳虚证主方为温胞饮或右归丸，肾气虚证选用毓麟珠，肾阴虚证常用养精种玉汤，肝气郁结证多选开郁种玉汤，瘀滞胞宫证常选少腹逐瘀汤，痰湿阻滞证治以苍附导痰汤或启宫丸，均获得临床研究证据支持；3) 近年来教材提出病证结合与综合干预的不孕症诊疗模式。结论：教材对不孕症的认识逐渐规范化、标准化，内容不断丰富；初学者应以教材为基，借鉴历代医家经验，参考现代临床研究结果，全面认识不孕症的中医诊疗思路。

Abstract: Objective: To review and analyze the content of the infertility chapters in 17 editions of “Traditional Chinese Medicine Gynecology” textbooks (hereinafter referred to as “the textbooks”), compare their similarities and differences, and explore their evolutionary trajectory. Methods: Frequency analysis was employed to study the diagnosis and treatment content related to infertility in the textbooks, followed by a comparative analysis with modern research findings. Results: 1) The textbook proposes that the primary pathogenesis of infertility is attributed to insufficiency of kidney qi and imbalance of qi and blood in the Chong and Ren meridians. Common TCM syndrome patterns include Kidney Deficiency, Liver Qi Stagnation, Phlegm-Dampness Internal Obstruction, and Blood Stasis, which align with modern research conclusions. 2) The primary treatment principles for infertility in the textbooks focus on warming and nourishing kidney qi and regulating qi and blood, supplemented by methods to soothe the liver, regulate the spleen, resolve phlegm, and eliminate dampness. Specific formula applications are: Wen Bao Yin or You Gui Wan for Kidney Yang Deficiency syndrome; Yu Lin Zhu for Kidney Qi Deficiency syndrome; Yang Jing Zhong Yu Tang for Kidney Yin Deficiency syndrome; Kai Yu Zhong Yu Tang for Liver Qi Stagnation syndrome; Shao Fu Zhu Yu Tang for Blood Stasis Obstructing the Uterus syndrome; and Cang Fu Dao Tan Tang or Qi Gong Wan for Phlegm-Dampness Obstruction syndrome. These applications are supported by clinical research evidence. 3) Recent editions of the textbooks propose an integrated diagnostic and treatment model for infertility that combines disease and pattern differentiation with comprehensive intervention. Conclusion: The understanding of infertility in the textbooks has progressively become more standardized and systematic, with continually enriched content. Beginners should base their knowledge on the textbooks, integrate the empirical insights of historical physicians, and reference modern clinical research to develop a comprehensive understanding of the TCM diagnostic and therapeutic approach to infertility.