基于仝小林院士"态靶辨证"诊疗模式探析输卵管性不孕症诊疗思路OA

Dampness-heat,cold-dampness,qi stagnation,and deficiency of kidney essence are pathogenic factors for tubal infertility.The disease mechanism presents a progressive process in three phases:the initial stage involves external dampness-heat and internal accu-mulation of dampness,depression,and stasis obstructing the uterine vessels.This leads to prolonged blockage,causing qi and blood stag-nation and vessel obstruction.Ultimately,chronic obstruction results in kidney essence deficiency,worsening the disease.From the per-spective of"state-target differentiation,"the occurrence and development of tubal infertility can be categorized into three phases and five states:early phase(dampness-heat state,cold-dampness state,stagnation state),mid-phase(stasis state),and late phase(defi-ciency state).The core pathology of tubal infertility is internal blood stasis;thus,the clinical treatment should focus on promoting blood circulation and resolving stasis and dredging collaterals.In clinical practice,for treating the dampness-heat state,the main approach is to clear heat and eliminate dampness,resolve blood stasis and dredge collaterals,using formulas like Pudingteng Anti-Inflammatory Decoc-tion.For cold-dampness state,warming the meridians and dispelling cold is key,using Lower Abdominal Stasis-Expelling Decoction.For stagnation state,moving qi and alleviating pain,resolving blood stasis and dredging collaterals is essential,using Expelling Stasis Below the Diaphragm Decoction.For the stasis state,the focus is on invigorating blood and dispelling stasis and dredging collaterals,utilizing such formulas as Blood-Nourishing and Channel-Unblocking Decoction,Peach Kernel and Carthamus Four Substances Decoction,with additional drugs such as Zaojiaoci(Spina Gleditsiae),Lulutong(Fructus Liquidambaris),Biejia(Carapax Trionycis)and Zhifuzi(Ra-dix Aconiti Lateralis Praeparata),etc.For the deficiency state,the treatment should focus on tonifying kidney qi and promoting blood circulation to resolve stasis,using Golden Cabinet's Kidney Qi Pills combined with Blood Mansion Stasis-Expelling Decoction,and Jun-jun Decoction.