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Article(id=1322926165329060152, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.07.046, 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=1793339776594, onlineDateStr=2026-10-30, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339776594, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339776594, creator=13701087609, updateTime=1793339776594, updator=13701087609, issue=Issue{id=1322925862630339452, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='7', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1752076800000', pubDateStr='2025-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339704424, creator='13701087609', updateTime=1793340532184, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929334587105328, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929334587105329, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=229, endPage=231, ext={EN=ArticleExt(id=1322926165509415225, articleId=1322926165329060152, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Application Effect of Oral Administration of Tongguan Xiaozheng Decoction（通管消癥汤）and Huangjin Powder（黄金散）in Tubal Obstructive Infertility and Its Effect on Levels of Inflammatory Factors, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the application effect of oral and external use of Tongguan Xiaozheng Decoction（通管消癥汤）and Huangjin Powder（黄金散）in tubal obstructive infertility and its effect on the levels of inflammatory factors.

Methods

From January 2020 to December 2021，120 patients with tubal obstructive infertility after tubal interventional recanalization in the hospital were selected and divided into two groups according to the random number table method，with 60 patients in each group. The patients in the control group were treated with conventional western medicine，enema and external application therapy. The patients in the observation group were treated with Tongguan Xiaozheng Decoction on the basis of the control group. After 3 months of treatment，the clinical efficacy，TCM symptom scores，the levels of inflammatory factors interleukin-6（IL-6），interleukin-8（IL-8）and tumor necrosis factor-α（TNF-α）were compared between the two groups. The tubal patency rate and intrauterine pregnancy rate were observed after 12 months of follow-up.

Results

The total effective rate of the observation group was 95.00%（57/60），which was significantly higher than that of the control group（83.33%，50/60）. The difference between the two groups was statistically significant（P<0.05）. After treatment，the scores of abnormal vaginal discharge，lumbosacral pain，stringy pulse and white tongue coating in the two groups were significantly decreased，and those in the observation group were significantly lower than the control group（P<0.05）. After treatment，the levels of IL-6，IL-8 and TNF-αin the two groups were significantly decreased，and the levels in the observation group were significantly lower than those in the control group（P<0.05）. At 12 months after treatment，the tubal patency rate and intrauterine pregnancy rate in the observation group were 91.67%（55/60）and 33.33%（20/60），and those in the control group were 81.67%（49/60）and 23.33%（14/60）. There was no significant difference between the two groups（P>0.05）.

Conclusion

The application effect of oral and external use of Tongguan Xiaozheng Decoction and Huangjin Powder in tubal obstructive infertility is satisfactory. It can reduce the levels of serum inflammatory factors. It is an effective treatment plan and worthy of application.

, authors=Ying CHEN, Wenxia DU, Ying CAO, authorsList=Ying CHEN, Wenxia DU, Ying CAO, authorCompany=null, correspAuthors=Wenxia DU, 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=1322926166369247552, articleId=1322926165329060152, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症应用效果及对炎症因子水平的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

研究通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症中的应用效果及对炎症因子水平的影响。

方法

选取2020年1月—2021年12月于医院进行输卵管介入再通术后的输卵管阻塞性不孕症患者120例，按照随机数字表法均分为两组，每组60例，对照组患者进行常规西药及灌肠、外敷疗法治疗，观察组患者在对照组基础上联合通管消癥汤内服治疗。治疗3个月后比较两组患者的临床疗效、中医症状积分、炎症因子［白细胞介素-6（interleukin-6，IL-6）、白细胞介素-8（interleukin-8，IL-8）和肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）］水平，治疗结束后跟踪随访12个月观察输卵管通畅率及宫内妊娠率。

结果

观察组总有效率95.00%（57/60），显著高于对照组总有效率（83.33%，50/60），组间差异有统计学意义（P<0.05）。治疗后两组带下异常、腰骶酸痛、脉弦细涩、舌黯苔白症状积分均显著降低，且观察组显著低于对照组（P<0.05）。治疗后两组IL-6、IL-8和TNF-α水平均显著降低，且观察组显著低于对照组（P<0.05）。治疗结束后12个月观察组输卵管通畅率及宫内妊娠率分别为91.67%（55/60）、33.33%（20/60），对照组分别为81.67%（49/60）、23.33%（14/60），组间差异无统计学意义（P>0.05）。

结论

通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症中的应用效果满意，能够降低患者血清炎症因子水平，是有效的治疗方案，值得应用。

, authors=陈影, 杜文霞, 曹颖, authorsList=陈影, 杜文霞, 曹颖, authorCompany=null, correspAuthors=杜文霞, authorNote=

陈影（1986-），女，河南新蔡人，主治医师，硕士，研究方向：妇科生殖内分泌。

, correspAuthorsNote=
杜文霞（1977-），女，河南巩义人，副主任医师，硕士，研究方向：中医妇科血症、炎症。E-mail：。
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陈影（1986-），女，河南新蔡人，主治医师，硕士，研究方向：妇科生殖内分泌。

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journalId=1255847919539208197, articleId=1322926165329060152, doi=null, pmid=null, pmcid=null, year=2021, volume=16, issue=17, pageStart=2542, pageEnd=2547, url=null, language=null, rfNumber=［22］, rfOrder=21, authorNames=樊佳, 刘晓谦, 彭博, journalName=世界中医药, refType=null, unstructuredReference=樊佳，刘晓谦，彭博，等. 中药鸡内金的现代研究进展［J］. 世界中医药，2021，16（17）：2542-2547., articleTitle=中药鸡内金的现代研究进展, refAbstract=null), Reference(id=1322926174300676476, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, doi=null, pmid=null, pmcid=null, year=2021, volume=53, issue=1, pageStart=77, pageEnd=81, url=null, language=null, rfNumber=［23］, rfOrder=22, authorNames=王楠, 顾笑妍, 吴怡, journalName=江苏中医药, refType=null, unstructuredReference=王楠，顾笑妍，吴怡，等. 鸡内金的临床应用及药理作用研究概况［J］. 江苏中医药，2021，53（1）：77-81., articleTitle=鸡内金的临床应用及药理作用研究概况, refAbstract=null), Reference(id=1322926174388756861, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, doi=null, pmid=null, pmcid=null, year=2021, volume=39, issue=5, pageStart=243, pageEnd=246, url=null, language=null, rfNumber=［24］, rfOrder=23, authorNames=吴芳, 郭勇义, 贺亚蕾, journalName=中华中医药学刊, refType=null, unstructuredReference=吴芳，郭勇义，贺亚蕾. 通管消癥汤内服结合灌肠、外敷疗法对输卵管阻塞性不孕症IL-6、IL-8和TNF-α水平的影响［J］. 中华中医药学刊，2021，39（5）：243-246., articleTitle=通管消癥汤内服结合灌肠、外敷疗法对输卵管阻塞性不孕症IL-6、IL-8和TNF-α水平的影响, refAbstract=null), Reference(id=1322926174476837246, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=1, pageStart=104, pageEnd=107, url=null, language=null, rfNumber=［25］, rfOrder=24, authorNames=冯艳奇, journalName=河南中医, refType=null, unstructuredReference=冯艳奇. 温经通络汤治疗输卵管阻塞性不孕症40例［J］. 河南中医，2020，40（1）：104-107., articleTitle=温经通络汤治疗输卵管阻塞性不孕症40例, refAbstract=null)], funds=[Fund(id=1322926170911678821, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, awardId=162102310102, language=CN, 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journalId=1255847919539208197, articleId=1322926165329060152, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治愈有效无效总有效
观察组605（8.33）52（86.67）3（50.00）57（95.00）
对照组602（3.33）48（80.00）10（16.67）50（83.33）
χ2值4.227
P值0.040
), ArticleFig(id=1322926170236395870, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, language=CN, label=表1, caption=

两组输卵管阻塞性不孕症患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治愈有效无效总有效
观察组605（8.33）52（86.67）3（50.00）57（95.00）
对照组602（3.33）48（80.00）10（16.67）50（83.33）
χ2值4.227
P值0.040
), ArticleFig(id=1322926170366419295, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间带下异常腰骶酸痛脉弦细涩舌黯苔白
观察组60治疗前1.98±0.572.06±0.381.87±0.622.03±0.49
治疗后0.84±0.101.02±0.290.91±0.221.12±0.25
t1值15.25913.07414.1839.728
P1值<0.001<0.001<0.001<0.001
对照组60治疗前2.01±0.632.11±0.431.90±0.731.99±0.51
治疗后1.24±0.191.42±0.301.18±0.161.35±0.20
t2值9.06410.4299.9417.916
P2值<0.001<0.001<0.001<0.001
两组治疗前比较t3值0.2740.6750.2430.438
P3值0.7850.5010.8090.662
两组治疗后比较t4值14.4317.4267.6885.565
P4值<0.001<0.001<0.001<0.001
), ArticleFig(id=1322926170467082592, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, language=CN, label=表2, caption=

两组输卵管阻塞性不孕症患者中医症状积分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间带下异常腰骶酸痛脉弦细涩舌黯苔白
观察组60治疗前1.98±0.572.06±0.381.87±0.622.03±0.49
治疗后0.84±0.101.02±0.290.91±0.221.12±0.25
t1值15.25913.07414.1839.728
P1值<0.001<0.001<0.001<0.001
对照组60治疗前2.01±0.632.11±0.431.90±0.731.99±0.51
治疗后1.24±0.191.42±0.301.18±0.161.35±0.20
t2值9.06410.4299.9417.916
P2值<0.001<0.001<0.001<0.001
两组治疗前比较t3值0.2740.6750.2430.438
P3值0.7850.5010.8090.662
两组治疗后比较t4值14.4317.4267.6885.565
P4值<0.001<0.001<0.001<0.001
), ArticleFig(id=1322926170576134497, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间IL-6IL-8TNF-α
观察组60治疗前54.18±5.9079.80±6.9470.33±6.08
治疗后30.11±4.0339.81±3.7036.27±4.61
t1值25.11446.27135.093
P1值<0.001<0.001<0.001
对照组60治疗前55.02±6.1380.18±6.4669.80±5.79
治疗后39.24±3.9545.30±4.2841.32±5.01
t2值16.76134.86628.812
P2值<0.001<0.001<0.001
两组治疗前比较t3值0.7650.3100.489
P3值0.4460.7570.626
两组治疗后比较t4值12.5337.5175.756
P4值<0.001<0.001<0.001
), ArticleFig(id=1322926170668409186, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, language=CN, label=表3, caption=

两组输卵管阻塞性不孕症患者血清IL-6、IL-8和TNF-α水平比较（±s）

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组别例数时间IL-6IL-8TNF-α
观察组60治疗前54.18±5.9079.80±6.9470.33±6.08
治疗后30.11±4.0339.81±3.7036.27±4.61
t1值25.11446.27135.093
P1值<0.001<0.001<0.001
对照组60治疗前55.02±6.1380.18±6.4669.80±5.79
治疗后39.24±3.9545.30±4.2841.32±5.01
t2值16.76134.86628.812
P2值<0.001<0.001<0.001
两组治疗前比较t3值0.7650.3100.489
P3值0.4460.7570.626
两组治疗后比较t4值12.5337.5175.756
P4值<0.001<0.001<0.001
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组别例数输卵管通畅率宫内妊娠率
观察组6055（91.67）20（33.33）
对照组6049（81.67）14（23.33）
χ2值2.5961.477
P值0.1070.224
), ArticleFig(id=1322926170806821220, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926165329060152, language=CN, label=表4, caption=

两组输卵管阻塞性不孕症患者输卵管通畅率及宫内妊娠率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数输卵管通畅率宫内妊娠率
观察组6055（91.67）20（33.33）
对照组6049（81.67）14（23.33）
χ2值2.5961.477
P值0.1070.224
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通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症应用效果及对炎症因子水平的影响
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陈影 , 杜文霞 , 曹颖
中华中医药学刊 | 省级项目平台 2025,43(7): 229-231
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中华中医药学刊 |省级项目平台 2025 , 43 (7) : 229 -231
通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症应用效果及对炎症因子水平的影响
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陈影, 杜文霞 , 曹颖
作者信息
  • 河南省中医院，河南 郑州 450000
通讯作者:
杜文霞（1977-），女，河南巩义人，副主任医师，硕士，研究方向：中医妇科血症、炎症。E-mail：。
作者简介:

陈影（1986-），女，河南新蔡人，主治医师，硕士，研究方向：妇科生殖内分泌。

Application Effect of Oral Administration of Tongguan Xiaozheng Decoction（通管消癥汤）and Huangjin Powder（黄金散）in Tubal Obstructive Infertility and Its Effect on Levels of Inflammatory Factors
Ying CHEN, Wenxia DU , Ying CAO
Affiliations
  • Henan Provincial Hospital of Traditional Chinese Medicine，Zhengzhou 450000，Henan，China
出版时间: 2025-07-10 doi: 10.13193/j.issn.1673-7717.2025.07.046
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摘要
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目的

研究通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症中的应用效果及对炎症因子水平的影响。

方法

选取2020年1月—2021年12月于医院进行输卵管介入再通术后的输卵管阻塞性不孕症患者120例，按照随机数字表法均分为两组，每组60例，对照组患者进行常规西药及灌肠、外敷疗法治疗，观察组患者在对照组基础上联合通管消癥汤内服治疗。治疗3个月后比较两组患者的临床疗效、中医症状积分、炎症因子［白细胞介素-6（interleukin-6，IL-6）、白细胞介素-8（interleukin-8，IL-8）和肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）］水平，治疗结束后跟踪随访12个月观察输卵管通畅率及宫内妊娠率。

结果

观察组总有效率95.00%（57/60），显著高于对照组总有效率（83.33%，50/60），组间差异有统计学意义（P<0.05）。治疗后两组带下异常、腰骶酸痛、脉弦细涩、舌黯苔白症状积分均显著降低，且观察组显著低于对照组（P<0.05）。治疗后两组IL-6、IL-8和TNF-α水平均显著降低，且观察组显著低于对照组（P<0.05）。治疗结束后12个月观察组输卵管通畅率及宫内妊娠率分别为91.67%（55/60）、33.33%（20/60），对照组分别为81.67%（49/60）、23.33%（14/60），组间差异无统计学意义（P>0.05）。

结论

通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症中的应用效果满意，能够降低患者血清炎症因子水平，是有效的治疗方案，值得应用。

输卵管阻塞性不孕症  /  灌肠  /  外敷  /  通管消癥汤  /  炎症因子
Objective

To study the application effect of oral and external use of Tongguan Xiaozheng Decoction（通管消癥汤）and Huangjin Powder（黄金散）in tubal obstructive infertility and its effect on the levels of inflammatory factors.

Methods

From January 2020 to December 2021，120 patients with tubal obstructive infertility after tubal interventional recanalization in the hospital were selected and divided into two groups according to the random number table method，with 60 patients in each group. The patients in the control group were treated with conventional western medicine，enema and external application therapy. The patients in the observation group were treated with Tongguan Xiaozheng Decoction on the basis of the control group. After 3 months of treatment，the clinical efficacy，TCM symptom scores，the levels of inflammatory factors interleukin-6（IL-6），interleukin-8（IL-8）and tumor necrosis factor-α（TNF-α）were compared between the two groups. The tubal patency rate and intrauterine pregnancy rate were observed after 12 months of follow-up.

Results

The total effective rate of the observation group was 95.00%（57/60），which was significantly higher than that of the control group（83.33%，50/60）. The difference between the two groups was statistically significant（P<0.05）. After treatment，the scores of abnormal vaginal discharge，lumbosacral pain，stringy pulse and white tongue coating in the two groups were significantly decreased，and those in the observation group were significantly lower than the control group（P<0.05）. After treatment，the levels of IL-6，IL-8 and TNF-αin the two groups were significantly decreased，and the levels in the observation group were significantly lower than those in the control group（P<0.05）. At 12 months after treatment，the tubal patency rate and intrauterine pregnancy rate in the observation group were 91.67%（55/60）and 33.33%（20/60），and those in the control group were 81.67%（49/60）and 23.33%（14/60）. There was no significant difference between the two groups（P>0.05）.

Conclusion

The application effect of oral and external use of Tongguan Xiaozheng Decoction and Huangjin Powder in tubal obstructive infertility is satisfactory. It can reduce the levels of serum inflammatory factors. It is an effective treatment plan and worthy of application.

tubal obstructive infertility  /  enema  /  external application  /  Tongguan Xiaozheng Decoction（通管消癥汤）  /  inflammatory factors
陈影, 杜文霞, 曹颖. 通管消癥汤内服联合黄金散外用在输卵管阻塞性不孕症应用效果及对炎症因子水平的影响. 中华中医药学刊, 2025 , 43 (7) : 229 -231 . DOI: 10.13193/j.issn.1673-7717.2025.07.046
Ying CHEN, Wenxia DU, Ying CAO. Application Effect of Oral Administration of Tongguan Xiaozheng Decoction（通管消癥汤）and Huangjin Powder（黄金散）in Tubal Obstructive Infertility and Its Effect on Levels of Inflammatory Factors[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (7) : 229 -231 . DOI: 10.13193/j.issn.1673-7717.2025.07.046
正文
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我国不孕不育发病率为7% ～10%[1]，《健康中国行动（2019—2030年）》提出要进一步加强生殖健康教育，普及不孕不育防治健康知识，提高广大群众生殖健康水平。随着生活节奏的加快，女性工作压力越来越大，致使不孕症发病率逐年升高，引起临床上相关学者的关注[2]。育龄女性无避孕正常性生活至少12个月而未怀孕称为不孕症，女性不孕症患者中，输卵管因素占20.0% ～32.8%，并且发病率一直呈现上升趋势[3-4]。输卵管介入再通术是快速治疗输卵管堵塞的有效方法，其虽能够修复输卵管外形等，却对慢性炎症导致的功能障碍无显著改善效果[5]。近年来研究表明中医治疗在恢复输卵管功能方面具有一定优势，可以通过中药灌肠、外敷、汤剂口服等多种用药方案纠正和保护输卵管功能，提高妊娠率[6-8]。本研究分析通管消癥汤内服结合灌肠、外敷疗法在输卵管阻塞性不孕症中的应用效果及对炎症因子水平的影响，现对相关病例情况进行总结并报道如下。
1　资料与方法
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1.1　一般资料
选取2020年1月—2021年12月于医院进行输卵管介入再通术后的输卵管阻塞性不孕症患者120例。纳入标准：均符合第9版《妇产科学》中输卵管阻塞性不孕症诊断标准[1]，综合患者症状并经临床检查及输卵管造影确诊；符合《中医妇科学》中瘀滞胞宫证辨证标准[9]；年龄21～40岁；顺利进行输卵管介入再通术的术后患者。排除标准：先天性生殖系统畸形患者；明确盆腔、宫腔内病变患者；生殖系统感染患者；合并严重心、肝、肾等器质性疾病患者。依据随机数字表法将所有患者均分为两组，每组60例。对照组患者年龄25～40岁，平均（32.40±5.68）岁；输卵管阻塞病变部位单侧24例，双侧36例；不孕症病程1～6年，平均（3.06±1.57）年。观察组患者年龄26～40岁，平均（32.79±6.02）岁；输卵管阻塞病变部位单侧22例，双侧38例；不孕症病程1～7年，平均（3.14±1.49）年。两组患者的一般资料进行比较，差异均无统计学意义（P>0.05），具有可比性。两组所有患者均知情同意研究内容并自愿参与配合研究项目，此次研究内容经过医院所属医学伦理委员会审核批准进行。
1.2　方法
对照组患者进行常规西药及灌肠、外敷疗法治疗，患者月经干净后3～7 d，确定输卵管疏通后向输卵管注入输卵管通液，输卵管通液由庆大霉素8万U、透明质酸1500 U、地塞米松5 mg加入0.9%氯化钠溶液30～50 mL制成。术后口服头孢拉定胶囊和甲硝唑，甲硝唑每次1片（0.2 g/片）、每日3次，头孢克洛缓释胶囊每次2粒（0.125 g/粒）、每日2次，1个疗程服药3 d；以金黄散颗粒剂20 g用60 mL开水充分溶解均匀，待温度适宜后对排空大便的患者进行保留灌肠操作，每日1次，药液肠道内保留12 h，1个疗程10 d；以中成药金黄散颗粒剂30 g加水10 mL、蜂蜜10 g加热调拌制成外敷药剂，平铺于10 cm×20 cm纱布上，冷却至45℃左右外敷并胶布固定于患侧输卵管体表投影处，每日1次，每次外敷12 h，1个疗程10 d。以上治疗总疗程均为3个月。
观察组患者在对照组基础上联合通管消癥汤内服治疗，药物组分：桃仁10 g，红花10 g，当归15 g，川芎10 g，赤芍15 g，炒白芍15 g，鸡血藤20 g，路路通15 g，丝瓜络10 g，柴胡10 g，穿山甲6 g，根据患者情况酌情加减方药用量，加水煎服400 mL，分别于每日早、晚饭后30 min温服200 mL，1个疗程14 d。总疗程3个月。
1.3　观察项目
（1）临床疗效：根据《中医病证诊断疗效标准》[10]判定，临床症状消失并且妊娠为治愈，临床症状有所好转但未妊娠、超声检查有卵泡排出为有效；症状及各项检查均无明显改善且超声检查卵泡未发育或发育不佳或有卵泡却没有排出为无效。总有效率＝（治愈＋有效）例数/总例数×100%。（2）中医症状积分：对带下异常、下腹刺痛、腰骶酸痛、脉弦细涩、舌黯苔白症状根据《中药新药临床研究指导原则》[11]中方法进行积分评估，0分无该症状、1分轻微症状、2分中度症状、3分重度症状。（3）炎症因子：分别在治疗前及治疗3个月后，于清晨空腹状态下采集两组患者静脉血5 mL，常规离心处理取血清样本，采用酶联免疫试剂法检测白细胞介素-6（interleukin-6，IL-6）、白细胞介素-8（interleukin-8，IL-8）和肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平。（4）输卵管通畅率及宫内妊娠率：治疗结束后跟踪随访12个月观察输卵管通畅率及宫内妊娠率。
1.4　统计学方法
研究采用SPSS 22.0统计软件包对数据资料进行分析，以例（%）表示计数资料，采用χ2检验，计量资料呈正态分布、以表示，采用t检验，若P<0.05则差异有统计学意义。
2　结果
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2.1　临床疗效比较
观察组总有效率显著高于对照组，组间比较差异有统计学意义（P<0.05）。见表1。
2.2　中医症状积分比较
治疗前两组患者的带下异常、腰骶酸痛、脉弦细涩、舌黯苔白症状积分比较差异均无统计学意义（P>0.05）；治疗后两组带下异常、腰骶酸痛、脉弦细涩、舌黯苔白症状积分均显著降低，且观察组显著低于对照组（P<0.05）。见表2。
2.3　炎症因子水平比较
治疗前两组患者的血清IL-6、IL-8和TNF-α水平比较差异均无统计学意义（P>0.05）；治疗后两组IL-6、IL-8和TNF-α水平均显著降低，且观察组显著低于对照组（P<0.05）。见表3。
2.4　输卵管通畅率及宫内妊娠率比较
治疗结束后12个月观察组输卵管通畅率及宫内妊娠率分别为91.67%、33.33%，对照组分别为81.67%、23.33%，组间差异无统计学意义（P>0.05）。见表4。
3　讨论
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中医学认为输卵管堵塞性不孕属“癥瘕”“断续”“不孕”等范畴，其病因病机多系先天禀赋虚弱，或后天情志失司，或房事不节、多次受孕及流产等，导致体内脏腑、气血功能失常，加之外感邪气或体内素有邪气侵袭，进而形成湿瘀内阻、气滞血瘀、瘀浊内滞等证候，致使人体胞络隧道闭塞不通，导致精卵不能顺利结合，无法形成受精卵而受[12-14]。治疗方面，在兼顾扶正的同时，注意清除体内湿邪为关键。考虑到输卵管堵塞性不孕病情复杂，病程长短不同，体质强弱有明显差异，临床表现各异，且多有兼症，单一疗法很难达到满意的效果。本研究观察组综合中药口服、灌肠及外敷方法对输卵管堵塞性不孕症内外兼治，效果更佳。
输卵管阻塞性不孕症灌肠及外敷所用金黄散颗粒由姜黄、大黄、黄柏、苍术、厚朴、陈皮、甘草、生天南星、白芷、天花粉组成。其中，姜黄行气破瘀、止痛，大黄清火泻热毒、活血水肿、行瘀血，黄柏清热燥湿、解毒消肿，苍术燥湿辟秽，厚朴燥湿消痰，陈皮燥湿化痰，甘草缓急止痛、解毒，且能调和调药，生天南星燥湿化痰、消肿散结，白芷散湿止痛、消肿排脓，天花粉排脓消肿，以上各药物组分在灌肠和外敷时可以共同发挥活血化瘀、通络止痛、祛湿消肿的功效，有助于疏通输卵管、提高患者受孕率[15-16]。观察组增加通管消癥汤内服，根据《石室秘录》载：“任督之间，倘有症瘕之证，则精不能施，因外有所障也”，由于症瘕积聚，阻于脉络，以致精不得施，婚后无子，症瘕之成，大都为气滞或血瘀，《神农本草经》云：“瘀去自能有子也”[17-18]。通管消癥汤中，桃仁活血祛瘀，红花活血通经、去瘀止痛，当归补血活血、调经止痛、润燥滑肠，川芎活血行气、祛风止痛，赤芍清热凉血、散瘀止痛，炒白芍养血柔肝、缓中止痛、敛阴收汗，鸡血藤行血补血，路路通祛风活络、利水通经，丝瓜络祛风通络、活血通乳，柴胡和解少阳、和解表里、疏肝升阳，穿山甲活血消癥、通经、消肿排脓。吴芳等[19]研究提示通管消癥汤中各药物同用可有效改善患者盆腔局部的微循环及组织营养，同时可有效松解输卵管粘连，降低再阻塞率，改善输卵管内的环境。现代药理学研究表明通管消癥汤中，桃仁氰苷中的苦杏仁苷具有抗炎作用，黄酮类、甾醇类等成分可调节内分泌紊乱[20]；川芎具有抗炎镇痛活性[21]；鸡内金中的挥发油和黄酮类物质有抗炎作用，黄酮类物质可以缓解痛经、同时还能调节女性内分泌等[22-23]；因此增加通管消癥汤内服能够更好地改善炎症因子及性激素水平，促进患者症状改善[24-25]。
综上所述可见，通管消癥汤内服结合灌肠、外敷疗法在输卵管阻塞性不孕症中的应用效果满意，能够降低患者血清炎症因子水平，是有效的治疗方案，值得应用。
基金
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  • 河南科技攻关计划项目(162102310102)
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2025年第43卷第7期
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doi: 10.13193/j.issn.1673-7717.2025.07.046
  • 首发时间：2026-10-30
  • 出版时间：2025-07-10
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河南科技攻关计划项目(162102310102)
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    河南省中医院，河南 郑州 450000

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杜文霞（1977-），女，河南巩义人，副主任医师，硕士，研究方向：中医妇科血症、炎症。E-mail：。
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2种不同金属材料的力学参数
科
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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