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Article(id=1322923318424249050, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923268038078806, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.04.007, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339097839, onlineDateStr=2026-10-30, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339097839, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339097838, creator=13701087609, updateTime=1793339097838, updator=13701087609, issue=Issue{id=1322923268038078806, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='4', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1744214400000', pubDateStr='2025-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339085826, creator='13701087609', updateTime=1793340586453, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929562572686061, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923268038078806, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929562572686062, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923268038078806, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=37, endPage=40, ext={EN=ArticleExt(id=1322923320378794715, articleId=1322923318424249050, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Study on Modified Zuogui Pill（左归丸加减）Combined with Moxibustion in Treatment of Kidney Yin Deficiency Type of Diminished Ovarian Reserve, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the effect of Modified Zuogui Pill（左归丸加减）combined with moxibustion in the treatment of kidney Yin deficiency type of diminished ovarian reserve，and to explore whether moxibustion combined with medicine can improve the therapeutic effect of kidney Yin deficiency type of diminished ovarian reserve.

Methods

A total of 60 patients meeting the diagnostic criteria for kidney Yin deficiency type of diminished ovarian reserve in the gynecological outpatient department of Huaibei Hospital of Traditional Chinese Medicine of Anhui Province from January 2022 to December 2022 were collected as research subjects，and were randomly divided into treatment group and control group，with 30 patients in each group. The control group received moxibustion treatment，and the treatment group received Modified Zuogui Pill and moxibustion treatment. Both groups were treated for 3 consecutive menstrual cycles. The levels of serum estradiol（E2），follicle-stimulating hormone（FSH）and luteinizing hormone（LH）of the two groups were measured before and after treatment. Basal sinus follicle count and endometrial thickness were monitored before and after treatment，and TCM syndrome scores of the two groups were recorded before and after treatment.

Results

The total effective rate of the treatment group and the control group was 93.33% and 73.33%，respectively（P<0.05）. After treatment，the level of E2，endometrial thickness and sinus follicle count in the treatment group were higher than those in the control group，and the levels of FSH，LH and the scores of small abdominal pain during menstruation，delayed menstruation and dark color or purple were lower than those in the control group（P<0.05）.

Conclusion

Zuogui Pill combined with moxibustion has significant curative effect in the treatment of kidney Yin deficiency type of diminished ovarian reserve，symptoms and hormone levels are significantly improved，which is suitable for popularization and application.

, authors=Ruiqin JIAO, Yuting BO, Xiaoxiao WANG, Yu ZHANG, authorsList=Ruiqin JIAO, Yuting BO, Xiaoxiao WANG, Yu ZHANG, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923321700000484, articleId=1322923318424249050, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退的研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

观察左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退的效果，探讨灸药结合能否提升肾阴虚型卵巢储备功能减退患者的治疗效果。

方法

收集2022年1月—2022年12月安徽省淮北市中医院妇科门诊符合肾阴虚型卵巢储备功能减退诊断标准的60例患者作为研究对象，随机分为治疗组和对照组，每组30例，对照组接受艾灸治疗，治疗组接受左归丸加减联合艾灸治疗，均连续治疗3个月经周期。比较两组治疗疗效，检测两组治疗前后血清雌二醇（Serum estradiol，E2）、促卵泡生成素（Follicle-stimulating hormone，FSH）及促黄体生成素（Luteinizing hormone，LH）水平，于治疗前和治疗后监测基础窦卵泡计数以及子宫内膜厚度，分别于治疗前后记录两组中医证候积分。

结果

治疗组与对照组总有效率分别为93.33%（28/30）和73.33%（22/30）（P<0.05），治疗后治疗组E2水平、子宫内膜厚度以及窦卵泡计数高于对照组，FSH、LH、经期小腹痛、月经延后以及颜色黯或紫评分低于对照组（P<0.05）。

结论

左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退疗效显著，患者症状改善明显，激素水平得到显著改善，适合推广应用。

, authors=焦瑞芹, 博玉婷, 王晓晓, 张宇, authorsList=焦瑞芹, 博玉婷, 王晓晓, 张宇, authorCompany=null, correspAuthors=null, authorNote=

焦瑞芹（1977-），女，安徽砀山人，副主任中医师，学士，研究方向：中医药治疗妇科疾病。

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焦瑞芹（1977-），女，安徽砀山人，副主任中医师，学士，研究方向：中医药治疗妇科疾病。

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焦瑞芹（1977-），女，安徽砀山人，副主任中医师，学士，研究方向：中医药治疗妇科疾病。

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组别例数痊愈显效有效无效总有效
对照组307（23.33）10（33.33）5（16.67）8（26.67）22（73.33）
治疗组3012（40.00）13（43.33）3（10.00）2（6.67）28（93.33）
χ2值4.320
P值0.038
), ArticleFig(id=1322923326984823560, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=CN, label=表1, caption=

两组肾阴虚型卵巢储备功能减退患者疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痊愈显效有效无效总有效
对照组307（23.33）10（33.33）5（16.67）8（26.67）22（73.33）
治疗组3012（40.00）13（43.33）3（10.00）2（6.67）28（93.33）
χ2值4.320
P值0.038
), ArticleFig(id=1322923327068709641, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间FSH/（U·L-1）LH/（U·L-1）E2/（pg·mL-1）
对照组30治疗前17.95±1.6812.47±1.2223.18±2.55
治疗后9.25±1.558.87±0.7938.25±3.47
t值20.84713.56619.168
P值<0.001<0.001<0.001
治疗组30治疗前17.86±1.5312.53±1.1223.69±2.35
治疗后7.05±0.88a6.88±0.68a52.05±4.58a
t值33.54623.61830.175
P值<0.001<0.001<0.001
), ArticleFig(id=1322923327165178634, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=CN, label=表2, caption=

两组肾阴虚型卵巢储备功能减退患者治疗前后血清激素水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间FSH/（U·L-1）LH/（U·L-1）E2/（pg·mL-1）
对照组30治疗前17.95±1.6812.47±1.2223.18±2.55
治疗后9.25±1.558.87±0.7938.25±3.47
t值20.84713.56619.168
P值<0.001<0.001<0.001
治疗组30治疗前17.86±1.5312.53±1.1223.69±2.35
治疗后7.05±0.88a6.88±0.68a52.05±4.58a
t值33.54623.61830.175
P值<0.001<0.001<0.001
), ArticleFig(id=1322923327257453323, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间窦卵泡计数/（个）子宫内膜厚度/（cm）
对照组30治疗前2.19±0.480.33±0.14
治疗后5.05±0.410.49±0.14
t值24.8154.426
P值<0.001<0.001
治疗组30治疗前2.25±0.420.32±0.11
治疗后7.58±1.25b0.72±0.21b
t值20.8939.242
P值<0.001<0.001
), ArticleFig(id=1322923327341339404, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=CN, label=表3, caption=

两组肾阴虚型卵巢储备功能减退患者治疗前基础窦卵泡计数以及子宫内膜厚度比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间窦卵泡计数/（个）子宫内膜厚度/（cm）
对照组30治疗前2.19±0.480.33±0.14
治疗后5.05±0.410.49±0.14
t值24.8154.426
P值<0.001<0.001
治疗组30治疗前2.25±0.420.32±0.11
治疗后7.58±1.25b0.72±0.21b
t值20.8939.242
P值<0.001<0.001
), ArticleFig(id=1322923327442002701, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间经期小腹痛月经延后颜色黯或紫
对照组30治疗前4.65±0.394.35±0.394.74±0.44
治疗后2.52±0.172.68±0.162.35±0.38
t值27.42221.69922.516
P值<0.001<0.001<0.001
治疗组30治疗前4.62±0.414.38±0.444.77±0.43
治疗后1.81±0.15c1.86±0.14c1.51±0.19c
t值35.25429.89337.982
P值<0.001<0.001<0.001
), ArticleFig(id=1322923327538471694, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923318424249050, language=CN, label=表4, caption=

两组肾阴虚型卵巢储备功能减退患者治疗前后中医症状评分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间经期小腹痛月经延后颜色黯或紫
对照组30治疗前4.65±0.394.35±0.394.74±0.44
治疗后2.52±0.172.68±0.162.35±0.38
t值27.42221.69922.516
P值<0.001<0.001<0.001
治疗组30治疗前4.62±0.414.38±0.444.77±0.43
治疗后1.81±0.15c1.86±0.14c1.51±0.19c
t值35.25429.89337.982
P值<0.001<0.001<0.001
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左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退的研究
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焦瑞芹 , 博玉婷 , 王晓晓 , 张宇
中华中医药学刊 | 国家项目点击 2025,43(4): 37-40
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中华中医药学刊 |国家项目点击 2025 , 43 (4) : 37 -40
左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退的研究
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焦瑞芹（1977-），女，安徽砀山人，副主任中医师，学士，研究方向：中医药治疗妇科疾病。

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焦瑞芹（1977-），女，安徽砀山人，副主任中医师，学士，研究方向：中医药治疗妇科疾病。

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焦瑞芹, 博玉婷, 王晓晓, 张宇
作者信息
  • 淮北市中医医院，安徽　淮北　235000
作者简介:

焦瑞芹（1977-），女，安徽砀山人，副主任中医师，学士，研究方向：中医药治疗妇科疾病。

Study on Modified Zuogui Pill（左归丸加减）Combined with Moxibustion in Treatment of Kidney Yin Deficiency Type of Diminished Ovarian Reserve
Ruiqin JIAO, Yuting BO, Xiaoxiao WANG, Yu ZHANG
Affiliations
  • Huaibei Hospital of Traditional Chinese Medicine, Huaibei 235000, Anhui, China
出版时间: 2025-04-10 doi: 10.13193/j.issn.1673-7717.2025.04.007
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摘要
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目的

观察左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退的效果，探讨灸药结合能否提升肾阴虚型卵巢储备功能减退患者的治疗效果。

方法

收集2022年1月—2022年12月安徽省淮北市中医院妇科门诊符合肾阴虚型卵巢储备功能减退诊断标准的60例患者作为研究对象，随机分为治疗组和对照组，每组30例，对照组接受艾灸治疗，治疗组接受左归丸加减联合艾灸治疗，均连续治疗3个月经周期。比较两组治疗疗效，检测两组治疗前后血清雌二醇（Serum estradiol，E2）、促卵泡生成素（Follicle-stimulating hormone，FSH）及促黄体生成素（Luteinizing hormone，LH）水平，于治疗前和治疗后监测基础窦卵泡计数以及子宫内膜厚度，分别于治疗前后记录两组中医证候积分。

结果

治疗组与对照组总有效率分别为93.33%（28/30）和73.33%（22/30）（P<0.05），治疗后治疗组E2水平、子宫内膜厚度以及窦卵泡计数高于对照组，FSH、LH、经期小腹痛、月经延后以及颜色黯或紫评分低于对照组（P<0.05）。

结论

左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退疗效显著，患者症状改善明显，激素水平得到显著改善，适合推广应用。

左归丸  /  艾灸  /  肾阴虚型卵巢储备功能减退  /  雌激素  /  卵泡
Objective

To observe the effect of Modified Zuogui Pill（左归丸加减）combined with moxibustion in the treatment of kidney Yin deficiency type of diminished ovarian reserve，and to explore whether moxibustion combined with medicine can improve the therapeutic effect of kidney Yin deficiency type of diminished ovarian reserve.

Methods

A total of 60 patients meeting the diagnostic criteria for kidney Yin deficiency type of diminished ovarian reserve in the gynecological outpatient department of Huaibei Hospital of Traditional Chinese Medicine of Anhui Province from January 2022 to December 2022 were collected as research subjects，and were randomly divided into treatment group and control group，with 30 patients in each group. The control group received moxibustion treatment，and the treatment group received Modified Zuogui Pill and moxibustion treatment. Both groups were treated for 3 consecutive menstrual cycles. The levels of serum estradiol（E2），follicle-stimulating hormone（FSH）and luteinizing hormone（LH）of the two groups were measured before and after treatment. Basal sinus follicle count and endometrial thickness were monitored before and after treatment，and TCM syndrome scores of the two groups were recorded before and after treatment.

Results

The total effective rate of the treatment group and the control group was 93.33% and 73.33%，respectively（P<0.05）. After treatment，the level of E2，endometrial thickness and sinus follicle count in the treatment group were higher than those in the control group，and the levels of FSH，LH and the scores of small abdominal pain during menstruation，delayed menstruation and dark color or purple were lower than those in the control group（P<0.05）.

Conclusion

Zuogui Pill combined with moxibustion has significant curative effect in the treatment of kidney Yin deficiency type of diminished ovarian reserve，symptoms and hormone levels are significantly improved，which is suitable for popularization and application.

Zuogui Pill（左归丸）  /  Moxibustion  /  kidney Yin deficiency type of diminished ovarian reserve  /  estrogen  /  follicle
焦瑞芹, 博玉婷, 王晓晓, 张宇. 左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退的研究. 中华中医药学刊, 2025 , 43 (4) : 37 -40 . DOI: 10.13193/j.issn.1673-7717.2025.04.007
Ruiqin JIAO, Yuting BO, Xiaoxiao WANG, Yu ZHANG. Study on Modified Zuogui Pill（左归丸加减）Combined with Moxibustion in Treatment of Kidney Yin Deficiency Type of Diminished Ovarian Reserve[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (4) : 37 -40 . DOI: 10.13193/j.issn.1673-7717.2025.04.007
正文
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卵巢储备功能（ovarian reserve，OR）反映了卵巢的功能状态，在卵巢皮质部分的原始卵泡，其通常处于静止状态，当其开始发育和生长，其形成卵细胞的个数反映了卵巢的储备功能[1-2]。卵巢储备功能下降（diminished ovarian reserve，DOR）指的是卵母细胞的数量减少，质量下降，其发育为成熟卵细胞的能力降低，最终影响妇女的生育能力，同时机体激素的水平下降。临床上患者主要表现为月经稀少、闭经，严重者甚至发生不孕[3-4]。中医认为，DOR的主要致病因素为淫邪、情志、环境、生活以及体质等。中医认为，上述因素侵袭人体之后，是否发病受患者自身体质的状态决定[5]。左归丸出自《景岳全书》，具有胞宫充养、精血充盛之功效，在缓解DOR症状上有明显效果[6]。艾灸则具有活血行气、散寒温经之功效，有相关研究表明，通过艾灸，可对下丘脑-垂体-卵巢轴以及内分泌激素的分泌具有调节作用，从而对月经周期进行调节，维持女性生理功能效果显著[7]。临床上将中药与艾灸联合治疗DOR的研究较为少见，因此本研究将左归丸配合艾灸作为主要方法，以此证明灸药结合的治疗方案能否进一步提高治疗DOR、改善卵巢储备功能，为临床治疗DOR提供参考依据，具体如下。
1　对象与方法
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1.1　研究对象
收集2022年1月—2022年12月安徽省淮北市中医院妇科门诊符合肾阴虚型卵巢储备功能减退诊断标准的60例患者作为研究对象。纳入标准：（1）符合相关诊断标准，西医诊断标准：参照2016年美国生殖医学协会《中重度卵巢过度刺激综合征的预防和治疗的临床指南》[8]相关标准，中医诊断标准：参照2012年中医药管理局《中医病证诊断疗效标准》[9]相关标准；（2）女性患者；（3）年龄20～40岁；（4）近3个月未接受过激素类药物治疗；（5）排除其他原因造成的不孕症；（6）对本研究知情，自愿参与本次研究。排除标准：（1）原发性闭经；（2）先天性生殖系统发育异常；（3）合并心、脑、血管、肝脏、内分泌、造血系统原发疾病；（4）合并恶性肿瘤；（5）异常阴道流血；（6）对相关药物及治疗不耐受；（7）正在参加其他临床试验。根据患者就诊顺序进行1～60编号，简单随机分为治疗组和对照组，每组30例，治疗组年龄20～40岁，平均（33.58±2.97）岁；病程3个月～3年，平均（1.22±0.29）年。对照组年龄20～40岁，平均（32.97±2.88）岁；病程4个月～3年，平均（1.23±0.32）年。两组患者基线资料比较，差异无统计学意义（P>0.05），组间具有可比性。本研究经医院伦理委员会审核批准（文件号：2021LCHB06）。
1.2　方法
对照组：采用单纯艾灸治疗，选取穴位神阙、关元、肾俞、三阴交、中脘，随证加减：焦虑抑郁者加太冲、阳陵泉，潮热盗汗者加涌泉穴，失眠多梦加神门、太溪穴。灸法操作：患者取合适体位，选取穴位，采用温和灸方法，即点燃一段艾条，对准腧穴部位，以其中心3 cm半径内的范围，距皮肤3～5 cm，保持局部温热感受而不灼热最合适，每个穴位各灸15 min，以皮肤保持红晕潮湿为宜。艾灸治疗自月经周期结束第10天开始，隔日1次，1个月经周期作为1个疗程，治疗3个月经周期。治疗组：在对照组艾灸治疗基础上，加用左归丸联合治疗，方剂组成：熟地黄24 g，山药12 g，山茱萸12 g，牛膝12 g，菟丝子13 g，龟板胶12 g，鹿角胶22 g随证加减：失眠多梦者加酸枣仁、夜交藤等；腰膝酸软者加补骨脂、杜仲等；焦虑抑郁者加郁金、香附、合欢皮等；潮热盗汗者加知母、地骨皮等；神疲乏力者加党参、黄芪等。饭前1 h温水冲泡均匀后口服，1剂/d，分早晚2次服用。共治疗3个月经周期，月经周期第5天开始服药，经期停药。
1.3　观察指标
（1）疗效比较[10]：①治愈：患者月经周期、经量恢复正常，症状完全消失，窦卵泡数正常，中医症状积分减小≥95%；②显效：月经来潮，周期缩短，经量增多，症状在一定程度上有所缓解，窦卵泡数接近正常水平，70%≤中医症状积分减小<95%；③有效：偶有月经来潮，经量稍有增加，窦卵泡数目有增加但未达正常范围，30%≤中医症状积分减小<70%；④无效：月经未来潮，中医症状积分减少<30%。总有效率＝（治愈＋显效＋有效）/例数×100.00%。（2）血清激素水平：于治疗前一月经周期内和治疗后一月经周期内，月经第2～3天抽取静脉血标本，采用美国贝克曼库尔特自动化学发光仪检测血清雌二醇（Serum estradiol，E2）、促卵泡生成素（Follicle-stimulating hormone，FSH）及促黄体生成素（Luteinizing hormone，LH）水平，作为两组治疗前后的血清激素水平，闭经患者在B超检测未见优势卵泡以及子宫内膜厚度≤5 mm时进行检测。（3）于治疗前一月经周期内和治疗后一月经周期内，在行经期的第3～5天查妇科彩超，测定基础窦卵泡计数、子宫内膜厚度，闭经者在B超检测未见优势卵泡、子宫内膜厚度≤5 mm时测定。（4）中医症状评分：根据《中药新药临床研究指导原则（试行）》[11]进行评分，分数越高则表明症状越严重。
1.4　统计学方法
本研究采用SPSS 23.0对数据进行统计学处理，计量资料以表示，组内治疗前后比较采用配对样本t检验，组间比较采用独立样本t检验，计数资料以百分比（%）表示，组间以χ2检验进行比较，若P<0.05则差异具有统计学意义。
2　结果
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2.1　疗效比较
治疗组与对照组总有效率分别为93.33%和73.33%（P<0.05）。详见表1。
2.2　治疗前后血清激素水平比较
治疗后两组E2水平均明显高于本组治疗前，治疗组高于对照组（P<0.05），治疗后两组血清FSH、LH均明显低于本组治疗前，其中治疗组低于对照组（P<0.05）。详见表2。
2.3　治疗前基础窦卵泡计数以及子宫内膜厚度比较
治疗后两组子宫内膜厚度以及窦卵泡计数均高于本组治疗前，治疗组明显高于对照组（P<0.05）。详见表3。
2.4　治疗前后中医症状评分比较
治疗后两组经期小腹痛、月经延后以及颜色黯或紫评分均明显低于本组治疗前，治疗组明显低于对照组（P<0.05）。详见表4。
3　讨论
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现代医学针对DOR治疗的研究不多，大多数研究认为卵巢功能衰退属于不可逆的改变，对于早期患者，应积极查明病因，对于可以明确病因的患者，则采取消除病因的方法或启动卵巢保护措施[12-13]。而对于无法查明病因的患者，则需尽快使用激素治疗。在以往研究中已经证实了及时的激素补充治疗可以有效延缓卵巢早衰的发生，有助于患者卵巢功能的恢复。
西医认为，通常情况下DOR的发病主要是卵巢合成性激素的能力下降，相应的下丘脑-垂体轴的负反馈机制也有所下降，雌激素水平降低[14]。中医研究认为女性的所有生殖器官统称为胞宫，乃奇恒之腑。我国古代医学文献中并没有关于卵巢储备功能的相关记载，但是从其临床表现来说，DOR可归为中医学中的“月经病”“闭经”等。中医认为本病与肾脏具有密切关联，经水受肾气充盈的影响非常明显，女子月经来潮与肾脏关系密切[15]。相关研究发现大部分DOR女性辨证为肾虚[16-18]。理论上来说，肾藏精，精血互生，此乃孕育的基本条件。解小慧等[19]研究认为卵巢功能下降的核心病机为肾精亏虚。中医药治疗主要依靠辨证论治、中医药干预月经节律等，具有较为满意的效果，一方面能控制患者的症状，另一方面也能预防其进一步的发展。
本研究针对治疗组患者，在应用艾灸治疗的基础上，联合应用左归丸加减治疗，结果显示，治疗组与对照组总有效率分别为93.33%和73.33%（P<0.05），治疗后两组子宫内膜厚度以及窦卵泡计数均高于本组治疗前，其中治疗组明显高于对照组（P<0.05），治疗后两组经期小腹痛、月经延后以及颜色黯或紫评分均明显低于本组治疗前，其中治疗组明显低于对照组（P<0.05）。艾灸可明显改善局部循环，并且具有温通经脉的作用，现代医学针对艾灸的研究中表明，艾灸可以对患者的激素水平发挥调节作用，实现改善卵巢功能的效果，其作用机制主要依靠对下丘脑-垂体-卵巢轴的干预。左归丸出自张景岳的《景岳全书》，方中熟地黄、山茱萸、山药具有滋补肝肾之功效；牛膝具有活血益阴之功效，引诸药下行发挥疗效；龟板胶、鹿角胶均乃血肉有情之品，二者共同发挥益精填髓之效[20-21]；菟丝子与牛膝搭配，发挥益阴补阳，阳中求阴的效果[22-24]。本研究对失眠多梦者加酸枣仁、夜交藤等；腰膝酸软者加补骨脂、杜仲等；焦虑抑郁者加郁金、香附、合欢皮等；潮热盗汗者加知母、地骨皮等；神疲乏力者加党参、黄芪等。全方补而不滞，具有调养冲任之功效。本研究中治疗组在艾灸治疗的基础上，配合左归丸加减治疗，进一步提升了治疗效果，在总有效率以及中医证候积分方面效果更加明显。本研究还发现，在治疗后两组血清E2水平均明显高于本组治疗前，其中治疗组高于对照组（P<0.05），治疗后两组血清FSH、LH均明显低于本组治疗前，其中治疗组低于对照组（P<0.05），表明在艾灸治疗的基础上，联合应用左归丸，在调节性激素方面效果进一步提升，现代药理学研究发现，山茱萸具有通利血脉和散寒温经的效果，有利于促性腺激素的分泌，在调节性激素平衡方面效果显著[25-26]。
由于本研究主要根据患者近期的症状判定疗效，而缺乏对中药整体药效系统全面而深入的研究，受到时间和条件的限制，由于病例数以及疗程还有差距，导致研究存在一定局限性。本次研究未进行相关动物实验，因此针对左归丸对改善卵巢功能和激素水平以及调整内分泌等具体的机制还需进一步研究证实。
综上所述，左归丸加减联合艾灸治疗肾阴虚型卵巢储备功能减退疗效显著，患者症状改善明显，激素水平得到显著改善，适合推广应用。
基金
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  • 国家中医药管理局中医药古籍文献传承专项(GZY-KJS-2021-029)
  • 安徽中医药大学科研基金项目(2021LCHB06)
文献
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参考文献 引证文献
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2025年第43卷第4期
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doi: 10.13193/j.issn.1673-7717.2025.04.007
  • 首发时间：2026-10-30
  • 出版时间：2025-04-10
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国家中医药管理局中医药古籍文献传承专项(GZY-KJS-2021-029)
安徽中医药大学科研基金项目(2021LCHB06)
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    淮北市中医医院，安徽　淮北　235000
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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