| 引用本文: |
聂灿, 曹乐乐, 陈长梦, 方庆霞, 辛雪艳, 黄欲晓, 朱馥丽.从“疝瘕外障精施不受”理论探讨TCRA术后内膜容受性降低的辨治思路[J].湖南中医药大学学报,2026,46(5):1006-1010[点击复制] |
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| 从“疝瘕外障精施不受”理论探讨TCRA术后内膜容受性降低的辨治思路 |
| 聂灿,曹乐乐,陈长梦,方庆霞,辛雪艳,黄欲晓,朱馥丽 |
| (中国中医科学院西苑医院, 北京 100091) |
| 摘要: |
| 宫腔粘连松解术（TCRA）后子宫内膜容受性降低，易致反复种植失败、生化妊娠及早期流产等不良孕产结局，成为临床的棘手问题。《傅青主女科》“疝瘕外障精施不受”理论旨在阐述“任督亏虚为本，疝瘕外障为标”的核心病机。本文基于该理论，将TCRA术后内膜容受性降低的病机阐释为“任督亏虚-疝瘕外障-精施不受”的演变过程，并根据术后不同阶段的特点，提出分期论治：术后早期以益气消癥、破血逐瘀为法；备孕期以益肾填精、温阳活血为法；孕早期以温肾固胎、养中微通为法。以期为TCRA术后内膜容受性降低的临床治疗提供理论依据与辨证思路。 |
| 关键词: 宫腔粘连松解术|内膜容受性|疝瘕外障|精施不受|傅青主女科 |
| DOI：10.3969/j.issn.1674-070X.2026.05.019 |
| 投稿时间：2026-01-29 |
| 基金项目:中国中医科学院科技创新工程项目（CI2021 A02409）；中国中医科学院西苑医院能力提升项目（XYZX0101-48）。 |
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| Pattern differentiation and treatment of decreased endometrial receptivity after TCRA based on the theory of "hernia-like abdominal mass as an external barrier leading to infertility despite sperm deposition" |
| NIE Can, CAO Lele, CHEN Changmeng, FANG Qingxia, XIN Xueyan, HUANG Yuxiao, ZHU Fuli |
| (Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China) |
| Abstract: |
| Decreased endometrial receptivity (ER) following transcervical resection of adhesions (TCRA) predisposes patients to adverse pregnancy outcomes, such as recurrent implantation failure, biochemical pregnancy, and early miscarriage, posing a challenging clinical issue. The theory of "hernia-like abdominal mass as an external barrier leading to infertility despite sperm deposition' from Fu Qing Zhu Nü Ke (FU Qingzhu's Gynecology) aims to elucidate the core pathogenesis of "deficiency of the Ren and Du meridians as the root cause, and hernia-like abdominal mass as an external barrier as the secondary manifestation." Based on this theory, this article interprets the pathogenesis of decreased ER after TCRA as a progressive process of "deficiency of the Ren and Du meridians→hernia-like abdominal mass as an external barrier→infertility despite sperm deposition." According to the characteristics of different postoperative stages, a stage-based treatment strategy is proposed: in the early postoperative stage, the principle is to supplement qi, resolve masses, break blood stasis, and expel static blood; during the pregnancy-preparation stage, the focus is on enriching kidney essence, warming yang, and circulating blood; in the early pregnancy stage, the approach involves warming the kidney to stabilize the fetus, nourishing the middle jiao, and mildly unblocking the meridians. This aims to provide a theoretical basis and differentiation ideas for the clinical management of decreased ER after TCRA. |
| Key words: transcervical resection of adhesions|endometrial receptivity|hernia-like abdominal mass as an external barrier|infertility despite sperm deposition|Fu Qing Zhu Nü Ke (FU Qingzhu's Gynecology) |
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