“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败疗效观察

兰柔; 刘韵韵; 肖秋凯; 李月梅

doi:10.13703/j.0255-2930.20221111-k0002

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“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败疗效观察

临床研究 | 更新时间：2024-06-03

- “通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败疗效观察
- Observation of the therapeutic effect of Tongyuan needling combined with jingyu herb-separated moxibustion on recurrent implantation failure of kidney deficiency and blood stasis
- 中国针灸 2023年43卷第12期页码：1405-1410
- 作者机构：
  
  1.广州中医药大学第一临床医学院，广东广州510405
  2.广州市第八人民医院中医康复科，广东广州510405
- 作者简介：
  
  李月梅，主任医师。E-mail： liyuemei71@163.com
- 基金信息：
  
  广东省“登峰计划”高水平医院建设资助项目(211010010716)
- DOI：10.13703/j.0255-2930.20221111-k0002
  中图分类号： R246.3
- 收稿：2022-11-11，
  
  网络首发：2023-09-25，
  
  纸质出版：2023-12-12
- 稿件说明：
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兰柔,刘韵韵,肖秋凯等.“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败疗效观察[J].中国针灸,2023,43(12):1405-1410.

LAN Rou,LIU Yun-yun,XIAO Qiu-kai,et al.Observation of the therapeutic effect of Tongyuan needling combined with jingyu herb-separated moxibustion on recurrent implantation failure of kidney deficiency and blood stasis[J].Chinese Acupuncture & Moxibustion,2023,43(12):1405-1410.
兰柔,刘韵韵,肖秋凯等.“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败疗效观察[J].中国针灸,2023,43(12):1405-1410. DOI： 10.13703/j.0255-2930.20221111-k0002.

LAN Rou,LIU Yun-yun,XIAO Qiu-kai,et al.Observation of the therapeutic effect of Tongyuan needling combined with jingyu herb-separated moxibustion on recurrent implantation failure of kidney deficiency and blood stasis[J].Chinese Acupuncture & Moxibustion,2023,43(12):1405-1410. DOI： 10.13703/j.0255-2930.20221111-k0002.

摘要

目的

在常规激素替代周期方案行冻融胚胎移植基础上，观察“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败（RIF）患者的临床疗效。

方法

将60例拟行冻融胚胎移植的肾虚血瘀型RIF患者随机分为联合治疗组（30例）和西药组（30例）。西药组在移植周期采用常规激素替代方案进行子宫内膜准备；在西药组治疗基础上，联合治疗组采用“通元针法”加精玉药灸治疗，“通元针法”取“通督调神”A组穴位（大椎、肝俞、肾俞等督脉腧穴及背俞穴为主）及“引气归元”B组穴位（中脘、气海、关元等任脉腧穴及腹募穴为主），两组穴位交替针刺，每次取一组穴位，于针刺后隔药灸神阙穴（药粉由养精种玉汤方化裁调配而成），隔日1次，每周治疗3次，至移植日。比较两组患者妊娠结局指标［人绒毛膜促性腺激素（β-HCG）阳性率、临床妊娠率］，以及治疗前后两组患者中医证候评分、血清雌二醇（E

）及孕酮（P）含量、子宫内膜厚度及类型、子宫内膜血流指数［搏动指数（PI）及阻力指数（RI）］。

结果

治疗后，联合治疗组临床妊娠率为40.0%（12/30），高于西药组的16.7%（5/30，

0.05）；两组患者β-HCG阳性率比较差异无统计学意义（

0.05）。治疗后，两组患者血清E

、P含量较治疗前升高（

0.05），子宫内膜厚度较治疗前增加（

0.05），中医证候评分、PI、RI较治疗前降低（

0.05）；联合治疗组A型内膜比例较治疗前升高（

0.05）。除E

、P含量外，联合治疗组以上指标均优于西药组（

0.05）。

结论

在常规激素替代周期方案行冻融胚胎移植基础上，“通元针法”联合精玉药灸治疗可以有效改善肾虚血瘀型RIF患者临床症状，增加子宫内膜血流及子宫内膜厚度，提高子宫内膜容受性，从而改善妊娠结局。

Abstract

Objective

To observe the therapeutic effect of

Tongyuan

needling combined with

jingyu

herb-separated moxibustion on the patients with recurrent implantation failure (RIF) of kidney deficiency and blood stasis undergoing frozen embryo transfer of the conventional hormone replacement therapy cycle.

Methods

Sixty RIF of kidney deficiency and blood stasis patients who planned for frozen embryo transfer were randomly divided into a combined treatment group (30 cases) and a western medication group (30 cases). In the western medication group

the conventional hormone replacement therapy was performed for endometrial preparation during transfer cycle. On the basis of treatment as the western medication group

in the combined treatment group

Tongyuan

needling combined with

jingyu

herb-separated moxibustion was adopted. Regarding

tongyuan

needling

the acupoint prescription for

Tongdu Tiaoshen

(promoting the governor vessel and regulating the spirit

e.g. Dazhui [GV 14

]

Ganshu [BL 18

]

Shenshu [BL 23

]

and back-

shu

points) and that for

Yinqi Guiguan

(conducting

back to the primary

e.g. Zhongwan [CV 12

]

Qihai [CV 6

]

Guanyuan [CV 4

]

and front-

points) were selected. Acupuncture was delivered at these two prescriptions alternatively each time. After acupuncture

the herb-separated moxibustion (in which

the herbal powder was prepared with the modified

Yangjing Zhongyu

decoction for cultivating the kidney essence and promoting pregnancy) was operated at Shenque (CV 8). This combined therapy was delivered once every two days

3 sessions a week till the day of embryo transfer. The pregnancy outcomes (positive rate of human chorionic gonadotropin [β-HCG

]

and clinical pregnancy rate) were compared between the two groups

as well as the TCM syndrome score

serum estradiol (E

) and progesterone (P) levels

endometrial thickness and type

endometrial blood flow index (pulsatility index [PI

]

resistance index [RI

]

) before and after treatment.

Results

After treatment

the clinical pregnancy rate of the combined treatment group was 40.0% (12/30)

higher than that of the western medication group (16.7%

5/30

0.05); and the difference in the positive rate of β-HCG was not significant statistically between the two groups (

0.05). After treatment

the serum levels of E

and P were elevated (

0.05)

the endometrial thickness was thickened (

0.05); the scores of TCM syndrome

and the levels of PI and RI were reduced (

0.05) when compared with those before treatment in the two groups. The proportion of type A endometrium increased compared with that before treatment in the combined treatment group (

0.05). Except the levels of E

and P

the above indexes in the combined treatment group were superior to the western medication group (

0.05).

Conclusion

On the basis of frozen embryo transfer of conventional hormone replacement cycle

the intervention of

Tongyuan

needling combined with

jingyu

herb-separated moxibustion can effectively relieve the clinical symptoms

increase the endometrial blood flow and its thickness

and improve the endometrial receptivity

thereby ameliorate pregnancy outcomes in RIF patients of kidney deficiency and blood stasis.

关键词

Keywords

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