卵巢早衰（prematureovarianfailure,pof）

1、,卵巢早衰的中醫(yī)臨床治療及研究（Study of TCM on Premature Ovarian Failure）,朱玲廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院婦科Dr. ling ZhuDepartment of Gynecology. the First Affiliated Hospital; Guangzhou University of TCM,Mar/22/2009,New York. USA,廣州中醫(yī)藥大學(xué)中醫(yī)婦科學(xué)簡(jiǎn)介,國(guó)

2、家級(jí)重點(diǎn)學(xué)科（2002年-今）國(guó)家級(jí)重點(diǎn)專(zhuān)科（2002年-今）國(guó)家級(jí)精品課程（2005年）中醫(yī)婦科學(xué)博士點(diǎn)（1986年，首批）中醫(yī)婦科學(xué)碩士點(diǎn)（1981年，首批）廣東省重點(diǎn)學(xué)科（2000年-今）廣東省“211工程”建設(shè)重點(diǎn)學(xué)科（2003年-今）“全國(guó)最佳醫(yī)院排名——婦產(chǎn)科”中名列第8，居全國(guó)中醫(yī)婦科之首（衛(wèi)生部醫(yī)療產(chǎn)業(yè)調(diào)研中心及美國(guó)斯路塞恩公司2005年發(fā)布的調(diào)研結(jié)果）,廣州中醫(yī)藥大學(xué)中醫(yī)婦科學(xué)簡(jiǎn)介,第一代學(xué)科帶頭人、首任

3、教研室主任羅元愷教授是全國(guó)首批中醫(yī)婦科學(xué)博士生導(dǎo)師。第二代學(xué)科帶頭人:歐陽(yáng)惠卿教授是廣東省名中醫(yī)，全國(guó)第三批名老中醫(yī)藥專(zhuān)家學(xué)術(shù)繼承工作的導(dǎo)師。第三代學(xué)科帶頭人、現(xiàn)任教研室主任羅頌平教授是羅元愷教授的學(xué)術(shù)繼承人，國(guó)務(wù)院學(xué)位委員會(huì)第5、6屆學(xué)科評(píng)議組成員，國(guó)家級(jí)“有突出貢獻(xiàn)的中青年專(zhuān)家”。,卵巢早衰相關(guān)研究基金來(lái)源Correlated study funds sources of POF,國(guó)家自然科學(xué)基金（No：3040060

4、7）（2005.1-2007.12）項(xiàng)目負(fù)責(zé)人National Natural Science Foundation of China （No：30400607）（2005.1-2007.12）廣東省中醫(yī)藥局基金（No：403021） （2004.1-2005.12）項(xiàng)目負(fù)責(zé)人Fund by Bureau of TCM , GuangDong province （No：403021） （2004.1-2005.12）,卵巢早衰

5、概述,卵巢早衰是指女性在40歲之前出現(xiàn)閉經(jīng)，卵泡刺激素(FSH)及黃體生成素(LH)水平升高(FSH>40IU/L），雌激素水平降低的一種綜合征。 卵巢早衰的發(fā)病率為0.3%～3%，占原發(fā)性閉經(jīng)的20%～25%，繼發(fā)性閉經(jīng)的10%～20%。無(wú)遺傳因素、無(wú)醫(yī)源性因素的POF在青少年中也不少見(jiàn)。The term premature ovarian failure（POF） describes a stop in the norma

6、l functioning of the ovaries in a woman younger than age 40.  It is also known as hypergonadotropic hypogonadism. Amenorrhea is a frequent syndrome. The characterstics of the patients’ hormone are high follicle stim

7、ulating hormone (FSH>40IU/L） and luteotrophic hormone(LH), but low estrogen.The disease rate is 0.3%～3%， occupy 20%～25% in primary amenorrhea，10%～20% in secondary amenorrhea。,卵巢早衰病因?qū)W研究study of etiology on POF(1),醫(yī)源

8、性因素 iatrogenic factor心理因素 psychologic factor遺傳因素 hereditary factor免疫學(xué)因素 immunology factor 抗卵巢抗體。代謝因素 metabolism factor高半乳糖血癥環(huán)境因素和感染因素 environmental factor and affectoi吸煙、腮腺炎以及嚴(yán)重的化膿性、結(jié)核性和淋菌性盆腔

9、炎也可能造成POF。特發(fā)性 unknown factor,,,卵巢早衰病因?qū)W研究 study of etiology on POF(2),我們的研究表明：POF患者較之正常婦女外周血CD8+T細(xì)胞增高、CD4+/CD8+比值下降，二者相比有顯著性差異（P<0.05）。Our study indicate: the serum CD8+T cells with POF increase than normal one,

10、 the ratio of CD4+/CD8+ decrease.,卵巢早衰病因?qū)W研究 study of etiology on POF(3),七情致病 seven modes of emotions六淫 six exopathogens先天不足 inherent deficiency 金刃、藥食所傷 surgery, medicines 其中：七情 seven modes of emotions(38 例/122例,占3

11、1.15%)藥物、疾病因素 medicines and diseases(39例/122例,占31. 97%)情志及藥物、疾病雙重因素 both seven modes of emotions and medicines and diseases(6例/122例,占4.92%)無(wú)因可查 no cause can be find(39例/122例,占31. 97%)（滕秀香，2008年4月）,卵巢早衰的病機(jī)特點(diǎn) Pathogen

12、etic characteristic of POF,腎虛，氣血不足，肝郁血瘀renal deficiency, insufficiency of qi and blood, stagnation of liver-qi and blood stasis,卵巢早衰證候特點(diǎn)characteristic of syndrome of POF (1),,（滕秀香，2008年4月）,卵巢早衰證候特點(diǎn)characteristic of

13、syndrome of POF (2),,（滕秀香，2008年4月）,卵巢早衰證候特點(diǎn)characteristic of syndrome of POF (2),癥狀由高到低依次為：閉經(jīng)amenorrhea（105例/122例，86.07%）潮熱汗出hectic fever and sweating（83例/122例，68.03 %）性欲淡漠sexual desire indifference（52例/122例，42.62 %

14、）心慌flustered（47例/122例，38.52 %）眠欠安insomnia（42例/122例，34.43 %）煩躁restlessness（37例/122例，33.03 %）陰道干澀（29例/122例，23.77 %）大便干（22例/122例，18.03 %）帶下量少（13例/122例，10.66 %）陰毛脫落（13例/122例，11.02 %）（滕秀香，2008年4月）,癥狀由高到低依次為：閉經(jīng)menorrh

15、ea（19例/20例，100%）多夢(mèng)dreamful sleep（18例/20例，90%）陰道干澀vaginal unsmooth 潤(rùn)滑（17例/20例，85%）腰膝酸軟（16例/20例，80%）煩燥restlessness（6例/122例，80%）精神抑郁ademosyne（13例/20例，65%）心悸（8例/20例，40%）潮熱（7例/20例，35%）（朱玲、羅頌平，2004年7月）,卵巢早衰治療Treatment

16、 on POF,辨證：腎虛為本，氣血虧虛為主，兼肝郁血瘀。differentiation of symptoms and signs:renal deficiency, insufficiency of qi and blood, stagnation of liver-qi and blood stasis治療大法：補(bǔ)腎調(diào)陰陽(yáng)，益氣養(yǎng)血，兼疏肝活血。用藥注意陰陽(yáng)轉(zhuǎn)化的關(guān)系。Method of treatment: Tonify

17、ing kidney and balance yin and yang , nourishing qi and blood, disperse the depressed liver-energy and promoting blood flow,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（1）invigorate the liver and kidney, disperse the depressed liver-energy and pr

18、omoting blood flow,蔡某，女，36歲，已婚，2008年5月10日初診。停經(jīng)半年余Menolipsis more than 6 months.患者既往月經(jīng)規(guī)則。于2003年始因壓力較大，情緒波動(dòng)較大出現(xiàn)月經(jīng)頻發(fā)，一月兩行，未曾在意，后出現(xiàn)月經(jīng)推后，量少，經(jīng)人提醒，于2005年8月外院檢查內(nèi)分泌：FSH：53.1IU/L，LH：37.8 IU/L，E2：140.12 pmol/L，PRL：10.3ug/L。予補(bǔ)佳樂(lè)治

19、療。2007年10月外院復(fù)查內(nèi)分泌：FSH：78.3IU/L，LH：56.2 IU/L，E2：220.12 pmol/L。LMP：2007年11月2日。The woman’s menstruation was regular before 2003. Since then her menstruation was irregular because of stronger stress and instable emotions.

20、After polymenorrhea, oligomenorrhea occurred. She went to hospital to check serum hormones. Her hormones were: FSH：53.1IU/L，LH：37.8 IU/L，E2：140.12 pmol/L，PRL：10.3ug/L。She was treated by Progynova(estradiol valerate)

21、。She rechecked hormones on Oct. 2007：FSH：78.3IU/L，LH：56.2 IU/L，E2：220.12 pmol/L。LMP：Nov-2-2007。,,已育一女。體型較瘦，眠差夢(mèng)多，較煩燥。眼眶黯。舌尖紅邊有瘀點(diǎn)，薄白苔，細(xì)脈。體格檢查：第二性征正常，外陰已產(chǎn)式，陰道暢，宮頸光，宮體前，常大，無(wú)壓痛，質(zhì)中，活動(dòng)，雙附件無(wú)及明顯異常。G1P1Thin, insomnia, dreamful

22、sleep ,restlessness, eye sockets dim. red tip of tongue with edge petechia, thin and whitish fur, small puls.,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（2）invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood f

23、low,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（3）invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow,診斷：卵巢早衰Diagnose: POF.辨證：陰虛內(nèi)熱，兼肝郁血瘀differentiation of symptoms and signs: yin asthenia generating in

24、trinsic heat, congestion of the liver.治法：滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血Method of treatment: invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow左歸丸加減 Zuogui Pill生地ShenDi 15g 山茱萸ShanZhuYu

25、12g 黃精HuangJing 20g 菟絲子TuSiZi 15g 鹿角膠luJiao glue 9g（烊化melting）龜板膠GuiBan glue 9g （烊化melting）川牛膝 NiuXi 15g 郁金YuJin 15g 柴胡CaiHu 10g 白芍BaiShao 10g 夜交藤YeJiaoTen 15g 甘草GanChao 6g,,2008年5月24日二診：煩燥好轉(zhuǎn)，仍未經(jīng)潮，仍夢(mèng)多易醒，大便較爛

26、，舌黯紅苔白脈略細(xì)，于前方去鹿角膠、黃精之滋膩，加合歡皮15g, 川芎10g增強(qiáng)寧心安神，解郁活血之功。returned visit on May-24-2008:Less Restlessness , insomnia, dreamful sleep, no menstruation，Loose stools. Dark and red tip of tongue, thin and whitish fur, small puls

27、. Removed 鹿角膠luJiao glue 9g（烊化melting）, 黃精HuangJing 20g,added合歡皮HeHuanPi 15g, 川芎Chuan Xiong 10g in order to calm the nerves and disperse the depressed liver-energy and promoting blood flow.生地ShenDi 15g 山茱萸ShanZhuYu 1

28、2g 菟絲子TuSiZi 15g 龜板膠GuiBan glue 9g （烊化melting）川牛膝 NiuXi 15g 郁金YuJin 15g 柴胡CaiHu 10g 白芍BaiShao 10g 夜交藤YeJiaoTen 15g 甘草GanChao 6g 合歡皮HeHuanPi 15g, 川芎Chuan Xiong 10g,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（4）invigorate the liver

29、and kidney, disperse the depressed liver-energy and promoting blood flow,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（5）invigorate the liver and kidney, nourishing qi and blood, disperse the depressed liver-energy and promoting blood flow,2008年6月

30、7日三診：睡眠好轉(zhuǎn)，二便調(diào)，但仍未經(jīng)潮，略煩燥，乳房脹。舌暗紅苔薄黃脈略滑。returned visit on June-7-2008:sleep better. Normal urine and stool. No menstruation restlessness, spargosis. Dark red tongue, thin and yellow fur, slippery pulse治法：行氣活血，補(bǔ)腎疏肝，寧心安神

31、Method of treatment: promoting qi to activate blood，invigorate the kidney and disperse the depressed liver-energy.桃仁TaoRen 15g 益母草YiMuChao 15g 川芎ChuanXiong 10g 當(dāng)歸DangGui 10g 生地ShenDi 15g 菟絲子TuSiZi 15g 川牛膝 NiuXi

32、15g 郁金YuJin 15g 柴胡CaiHu 10g 白芍BaiShao 10g 夜交藤YeJiaoTen 15g合歡皮HeHuanPi 15g 甘草GanChao 6g,,2008年6月13日四診：服藥第5天，月經(jīng)來(lái)潮，但量少，色鮮紅，無(wú)痛經(jīng)， 乳脹緩解，感腰酸不適。舌尖紅苔白脈滑。前方去川牛膝、郁金、夜交藤、合歡皮15，加路路通15g，水蛭3g、女貞子15g、旱蓮草15g活血通絡(luò)，養(yǎng)陰填精，三劑。服藥后月經(jīng)量增多，5

33、天凈.returned visit on June-13-2008: menstruation came after taking medicine, but less. Removed川牛膝 NiuXi 15g , 郁金YuJin 15g, 夜交藤YeJiaoTen 15g, 合歡皮HeHuanPi 15g, add 路路通LuLuTong 15g，水蛭ShuiZhi 3g, 女貞子NvZhenZi 15g, 旱蓮草HanLia

34、nChao 15g. Taking the medicine, her menstrual blood volume became more. 桃仁TaoRen 15g 益母草YiMuChao 15g 川芎ChuanXiong 10g 當(dāng)歸DangGui 10g 生地ShenDi 15g 菟絲子TuSiZi 15g 柴胡CaiHu 10g 白芍BaiShao 10g 甘草GanChao 6g路路通LuLuTong

35、 15g，水蛭ShuiZhi 3g, 女貞子NvZhenZi 15g. 旱蓮草HanLianChao 15g,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（6）invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow,,繼予左歸丸調(diào)經(jīng)至今，月經(jīng)40-50天一行。2008年11月30日復(fù)查FSH：13.6IU/L，L

36、H：10.7 IU/L，E2：289.43 pmol/L。up to now, she is taking ZuoGui pill to regulate menstruation. Her cycle is 40-50 days.She rechecked hormones on 30-Nov-2008:FSH：13.6IU/L，LH：10.7 IU/L，E2：289.43 pmol/L。,滋補(bǔ)肝腎（陽(yáng)中求陰），兼疏肝活血（7）

37、invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow,滋陰降火，養(yǎng)血活血通絡(luò)（1）nourishing yin to lessen fire，tonifying blood and promoting blood circulation to remove meridian obstruction,吳

38、某，女，39歲，2003年8月13日初診。停經(jīng)5月余2002年9月因經(jīng)期延長(zhǎng)（10-15天）行取環(huán)術(shù)，術(shù)后經(jīng)期6-7天，周期正常，今年三月突然月經(jīng)停閉不行，LMP：2003年3月19日，內(nèi)分泌：FSH：97.27IU/L，LH：32.44IU/L，E2： 20 pmol/L，P:0.35nmol/L,PRL:6.78ug/L?，F(xiàn)潮熱眠差，肢麻，納差。舌淡苔白脈細(xì)關(guān)滑。診斷：卵巢早衰辨證：陰虛火旺，血虛血瘀治法：滋陰降火，養(yǎng)血活

39、血通絡(luò)熟地15g 菟絲子20g 山萸肉12g 女貞子15g 麥冬12g地骨皮12g 杜仲15g 丹參20g 赤芍15g 郁金15g雞血藤30g 牛膝15g25/8二診：潮熱肢麻緩解，仍眠差。舌淡苔白脈略弦。菟絲子20g 熟地15g 仙靈脾10g 丹參20g 赤芍15g 郁金15g珍珠母30g 菖蒲10g 茯苓15g 甘草6g,滋陰降火，養(yǎng)血活血通絡(luò)（2）nourishing yin to lessen fire，tonif

40、ying blood and promoting blood circulation to remove meridian obstruction,17/9 三診：LMP：8/9-13/9，量不多，色鮮紅。菟絲子20g 熟地15g 仙靈脾10g 郁金15g 丹參20g 赤芍15g當(dāng)歸10g 牛膝15g 雞血藤30g 珍珠母30g 石菖蒲10g 遠(yuǎn)志6g13/10 四診：LMP：13/10-17/10，腹脹納差，白帶多，夢(mèng)多易醒，夜

41、尿2-3次，時(shí)有心慌，舌邊尖紅苔白脈細(xì)數(shù)。菟絲子20g 熟地15g 山萸肉12g 女貞子15g 麥冬12g 杜仲15g 牛膝15g 雞血藤30g丹參20g 赤芍15g 郁金15g,滋陰降火，養(yǎng)血活血通絡(luò)（3）nourishing yin to lessen fire，tonifying blood and promoting blood circulation to remove meridian obstruction,23/

42、10五診：LMP：13/10-17/10，量中，色鮮紅，小腹隱痛，偶心慌，頭暈，眠差，舌紅少苔脈細(xì)。菟絲子20g 熟地15g 山萸肉12g 制首烏15g黃精30g 白芍15g 丹參15g 郁金15g石菖蒲10g 茯苓15g 牛膝15g 雞血藤30g22/11六診：LMP：10/11-13/10，時(shí)頭暈，無(wú)心慌，無(wú)煩燥，納眠可，二便調(diào)，舌淡苔白脈細(xì)兩關(guān)略滑。12/11內(nèi)分泌：FSH：6.66IU/L，LH：6.08 IU/L，E

43、2：256 pmol/L，P:4.35nmol/L,T:0.88nmol/L。菟絲子20g 山萸肉12g 杜仲15g 枸杞子15g 山藥15g 丹參15g 赤芍15g 郁金15g雞血藤30g 當(dāng)歸10g 制首烏15g 川芎10g,相關(guān)研究（1）Related study (1),加味左歸丸治療卵巢早衰繼發(fā)性閉經(jīng)30例 基本方:熟地15g,淮山藥15g,山茱萸10g,枸杞子15g,菟絲子15g,川牛膝20g,鹿角膠10g,炙龜

44、板10g,阿膠6g,女貞子15g,當(dāng)歸15g,柴胡10g。面色萎黃,神疲乏力,脈細(xì)弱者,加黃芪30g,黨參15g;胸脅脹悶,脈弦細(xì)者,加制香附15g,廣郁金15g;納食不香,脾運(yùn)不健者,加焦山楂15g,六神曲15g,茯苓15g。3個(gè)月為1個(gè)療程。1個(gè)療程后, 痊愈15例,好轉(zhuǎn)13例,無(wú)效2例,總有效率93.33%。30 patients with secondary amenorrhea were treated by Zu

45、ogui pill. One course of treatment every 3 months.15 patients were recovery after One course of treatment,13 cases were improved and 2 ones useless. Its total effective rate is 93.33 %. (朱也君,2008),相關(guān)研究（2）Related study (

46、2),免疫性 POF小鼠卵巢間質(zhì)可見(jiàn)淋巴細(xì)胞浸潤(rùn),外周血FSH升高,E2下降,AoAb陽(yáng)性,卵母細(xì)胞生長(zhǎng)分化因子-9（growth and differentiation factor-9,GDF-9）mRNA陽(yáng)性細(xì)胞數(shù)減少,生長(zhǎng)卵泡及成熟卵泡數(shù)減少。左歸丸能減緩POF小鼠外周血FSH升高,提高體內(nèi)E2水平,抑制AoAb產(chǎn)生,提高卵母細(xì)胞GDF-9 mRNA陽(yáng)性細(xì)胞數(shù),使生長(zhǎng)卵泡及成熟卵泡數(shù)增加,早期用藥比后期用藥作用顯著。Ovari

47、an interstitial of the immune POF(growth and differentiation factor-9,GDF-9) mice occurred lymphocytes infiltration. The positive cell number of GDF-9 mRNA of oocytes decreased. The growing follicles and mature follicles

48、 decreased obviously. ZuoGui Pill could normal the increase of FSH and the decrease of E2，inhibit the produce of AoAb, rise the positive cell number of GDF-9 mRNA of oocytes, increase the number of growing follicles and

49、mature follicles, release the damages of ovarian inflammation. It can treat immune premature ovarian failure.,相關(guān)研究（3）Related study (3),免疫性POF小鼠卵巢小卵泡、間質(zhì)FasL表達(dá)均明顯增強(qiáng), Bcl-2表達(dá)減弱，Bax表達(dá)增強(qiáng)，卵泡顆粒細(xì)胞凋亡率增高，顆粒細(xì)胞線(xiàn)粒體嵴排列紊亂、空泡化，卵泡膜細(xì)胞形態(tài)失

50、常，顆粒細(xì)胞凋亡，卵母細(xì)胞透明帶厚薄不勻，卵泡凋亡過(guò)度，卵巢衰竭。左歸丸小鼠小卵泡FasL表達(dá)減弱，卵泡過(guò)度凋亡受到抑制，卵巢功能得以保護(hù)。The expression of Fas protein in great folliculus and small ones decreased obviously in POF mice. The expression of FasL protein in small folliculus

51、and stroma increased obviously in model mice. The expression of Fas protein in great folliculus and small ones increased obviously in the mice of different dosage ZGP. The expression of Fas protein increased in stroma b

52、ut the expression of FasL protein decreased in small folliculus in the mice of low dosage ZGP. The expression of Fas protein in stroma also increased obviously in the mice of high dosage ZGP. The differences were signifi

53、cant compared with the model mice.,,溫腎補(bǔ)脾（陰中求陽(yáng)），疏肝養(yǎng)血活血Warming the kidney and spleen, disperse the depressed liver-energy(, tonifying and promoting blood flow,鐘某，30歲，已婚，2003年4月18日初診。月經(jīng)稀發(fā)1年余，停經(jīng)2月。患者1年前因懷孕50天行人工流產(chǎn)，術(shù)后出現(xiàn)月經(jīng)稀發(fā)

54、，經(jīng)用西藥行人工周期后月經(jīng)來(lái)潮，停人工周期2月則停經(jīng)，末次月經(jīng)為2月17日，孕2產(chǎn)1人流1?，F(xiàn)癥見(jiàn)腰膝酸軟，怕冷，陰道干澀，性欲淡漠，納差，二便調(diào)，舌質(zhì)淡紅、苔白，脈弦細(xì)。內(nèi)分泌示:FSH：47. 7IU/L，LH：23. 14IU/L，PRL：5. 8p,g/L，E2： 230pmoL/L, P：3.879nmoL/L, T：1. 09nmoL/L。診斷：卵巢早衰。辨證：脾腎虧虛，肝郁血疲，胞宮失養(yǎng).治法：補(bǔ)腎健脾，疏肝養(yǎng)血活

55、血。黨參30g,菟絲子、何首烏各20g，仙靈脾、當(dāng)歸、川芎、仙茅、柴胡各1Og，肉蓯蓉、熟地黃、黃芪、白芍各15g。守方加減治療4月后，月經(jīng)來(lái)潮、量少，自覺(jué)陰道分泌物漸增多，性欲較前好轉(zhuǎn)。復(fù)查:FSH 22. 87IU/L, LH 9.10IU/L, E2 399pmoL/L，繼續(xù)治療2月，月經(jīng)規(guī)律來(lái)潮，量可，4-5天干凈。檢測(cè)BBT呈雙相。,二仙湯加味治療卵巢早衰42例臨床觀察42 patients with secondar

56、y amenorrhea were treated by Erxian soup,藥物組成:仙茅、仙靈脾、巴戟天、知母、當(dāng)歸、黃柏、牡丹皮、黃精各15g,紫草30g。服藥3月為1個(gè)療程,治療結(jié)束3個(gè)月后作內(nèi)分泌檢查(FSH、E2、LH等)及陰道超聲。治愈14例,好轉(zhuǎn)19例,未愈9例,總有效率為78.5%。E2、FSH、LH治療后明顯改善,與治療前相比,差異有顯著意義(P<0.05)。治療后臨床癥狀總改善率為77%,差異有顯

57、著意義(P<0.05) （段瑋瑋等，2008年）One course of treatment every 3 months.14 patients were recovery after treatment,19cases were improved and 2 useless. Its total effective rate is 78.5 %.,二仙湯加味治療卵巢早衰42例臨床觀察42 patie

58、nts with secondary amenorrhea were treated by Erxian soup,加減:煩躁、焦慮者：加柴胡、郁金、蓮子，失眠者：加酸棗仁、合歡皮、夜交藤,記憶力減退者：加石菖蒲,頭暈者：加天麻、鉤藤、石決明、白芍,頭痛：加川芎、白芷,汗出尤劇者：加浮小麥、糯稻根、生牡蠣,五心煩熱者：加生地黃、龜板、地骨皮,氣短乏力者：加黨參、黃芪,心悸者可：加龍骨、丹參、茯神。,相關(guān)研究Rel

59、ated study,現(xiàn)代藥理 研究表明 the study at now indicate：仙茅 中含有的仙茅苷成分,能增強(qiáng)機(jī)體的免疫機(jī)能；There is curculigoside in curculiginis rhizoma, which can increase the immune ability .淫羊藿（仙靈脾）具有雌激素樣作用,可使雌性大鼠卵巢、子宮增重,使雄性大鼠睪酮分泌增加; Epimedium ha

60、s the function like estrogen. This weight ovaries and uterum. Promoting the secrete of testosterone,相關(guān)研究Related study,巴戟天含有維生素E而有增強(qiáng)卵巢功能、抗衰老的作用;There is vitamin E in morinda root , which promotes the functions of ovarie

61、s and antidotal. 當(dāng)歸具有興奮子宮及抗維生素E缺乏的作用,并能增加肝組織的耗氧量;angelica root can excite uterum and normal low vitamin E. 紫草雖為涼血之品,但具有抑制腦垂體促性腺激素分泌的作用,對(duì)婦女圍絕經(jīng)期由于卵巢功能減退,失去對(duì)腦垂體功能的反饋抑制,導(dǎo)致促性腺激素分泌增加所出現(xiàn)的圍絕經(jīng)期綜合征具有較好的療效。Lithospermi radix nor

62、mal the secretion of Gn.,針灸(1) acupuncture and moxibustion,主穴：關(guān)元、中極、大赫、子宮、腎俞及胸5-腰4 夾脊穴肝腎陰虛者：加三陰交、 陰陵泉、肝俞、陰郄、復(fù)溜、太溪。脾腎陽(yáng)虛者：加脾俞、命門(mén)、地機(jī)。手法：補(bǔ)法,先用指彈進(jìn)針,得氣后留針20分鐘。脾腎陽(yáng)虛者溫針灸，出針后背俞及夾脊穴拔火罐5～10分鐘。療程：20次為1療程、休息5～ 7天進(jìn)行下1療程，6個(gè)療程為限

63、。 結(jié)果：84例POF患者總有效率達(dá)90.4%。main point：Guanyuan，Zhongji， Dahe，uterus，Shenshu, hepatic and renal yin deficiency: add Sanyinjiao, Yinlingquan, Ganshu(Liver Shu), Yinxi, Fuliu. Taixiasdthenic splenonephro-yang: add Pishu, M

64、ingmen, Dijireinforcing method. Keeping 20 minutes. Every 20 is a course of treatment. Take a rest for 5-7days between two course of treatment. Not exceed 6 course of treatment.（沙桂娥等，1998年）,針灸（2-1） acupuncture and mox

65、ibustion,取穴：A組：關(guān)元、歸來(lái)、子宮、中極、三陰交、足三里、血海、太沖、太溪。 B組:隔俞、肝俞、脾俞、腎俞、關(guān)元俞。兩組穴位交替 使用。手法：關(guān)元、三陰交、太溪、腎俞、關(guān)元俞用補(bǔ)法,其余平補(bǔ)平瀉法,得氣后留針30min,每隔10min行針1次,陽(yáng)虛者加以溫針灸,隔日1次。關(guān)元、太溪、腎俞、關(guān)元俞：補(bǔ)腎氣、滋腎陰,足三里、脾俞、肝俞、太沖：健脾疏肝,三陰交：補(bǔ)腎健脾疏肝,歸來(lái)、子宮、中極：養(yǎng)血活血,功效：補(bǔ)

66、腎健脾、疏肝活血之功。main point：Acupoints A:Guanyuan，Guilai, uterus，Zhongji， Sanyinjiao, Zhusanli, Taichong, Taixi Acupoints B:Geshu， Ganshu(Liver Shu), Pishu, Shenshu, Guanyuanshu ，Above two acupoints can be used alternatel

67、y,針灸（2-2）,療程：3個(gè)月為1療程, 2個(gè)療程為限,每療程之間休息1周。結(jié)果：60例卵巢早衰者治愈13例（月經(jīng)恢復(fù)正常,兼癥消失,血清FSH、LH、E2正常）；好轉(zhuǎn)14例（月經(jīng)間斷來(lái)潮,兼癥改善,血清FSH、LH、E2接近正常）,未愈3例（月經(jīng)始終未潮,兼癥依然,血清FSH、LH、E2無(wú)較大改變）,總有效率為90%。（楊曉虹等，2008年）,針灸（3）,歸腎丸合熱敏灸治療卵巢早衰32例，痊愈8例,顯效9例,有效10例,無(wú)效5例

68、,總有效率為86.50% 。歸腎丸方劑組成:熟地、淮山各30g,枸杞子、菟絲子各20g,當(dāng)歸、川芎、香附、杜仲、山萸肉、茯苓、巴戟天、制首烏、黑芝麻各12gMoxibustion points, which is temperature sensitive , combined with Guishen Pill treat 32 patients with POF, 8 patients were recovery after