卵巢早衰的中医临床治疗及研究

1、卵巢早衰中医临床治疗及研究（Study of TCM on Premature Ovarian Failure） 朱玲广州中医药大学第一从属医院妇科Dr. ling ZhuDepartment of Gynecology. the First Affiliated Hospital; Guangzhou University of TCMMar/22/New York. USA第1页广州中医药大学中医妇科学介绍国家级重点学科（年-今）国家级重点专科（年-今）国家级精品课程（20）中医妇科学博士点（1986年，首批）中医妇科学硕士点（1981年，首批）广东省重点学科（-今）广东省“211工程”建

2、设重点学科（20-今）“全国最正确医院排名妇产科”中名列第8，居全国中医妇科之首（卫生部医疗产业调研中心及美国斯路塞恩企业20公布调研结果）第2页广州中医药大学中医妇科学介绍第一代学科带头人、首任教研室主任罗元恺教授是全国首批中医妇科学博士生导师。第二代学科带头人:欧阳惠卿教授是广东省名中医，全国第三批名老中医药教授学术继承工作导师。第三代学科带头人、现任教研室主任罗颂平教授是罗元恺教授学术继承人，国务院学位委员会第5、6届学科评议组组员，国家级“有突出贡献中青年教授”。第3页卵巢早衰相关研究基金起源Correlated study funds sources of POF 国家自然科学基金（

3、No：30400607）（.1-.12）项目责任人National Natural Science Foundation of China （No：30400607）（.1-.12）广东省中医药局基金（No：403021） （.1-.12）项目责任人Fund by Bureau of TCM , GuangDong province （No：403021） （.1-.12）第4页卵巢早衰概述卵巢早衰是指女性在40岁之前出现闭经，卵泡刺激素(FSH)及黄体生成素(LH)水平升高(FSH40IU/L），雌激素水平降低一个综合征。 卵巢早衰发病率为0.3%3%，占原发性闭经20%25%，继发性闭经1

4、0%20%。无遗传原因、无医源性原因POF在青少年中也不少见。The term premature ovarian failure（POF） describes a stop in the normal functioning of the ovaries in a woman younger than age 40. It is also known as hypergonadotropic hypogonadism. Amenorrhea is a frequent syndrome. The characterstics of the patients hormone are high

5、follicle stimulating hormone (FSH40IU/L） and luteotrophic hormone(LH), but low estrogen.The disease rate is 0.3%3%， occupy 20%25% in primary amenorrhea，10%20% in secondary amenorrhea。第5页卵巢早衰病因学研究study of etiology on POF(1)医源性原因 iatrogenic factor心理原因 psychologic factor遗传原因 hereditary factor免疫学原因 immu

6、nology factor 抗卵巢抗体。代谢原因 metabolism factor高半乳糖血症环境原因和感染原因 environmental factor and affectoi吸烟、腮腺炎以及严重化脓性、结核性和淋菌性盆腔炎也可能造成POF。特发性 unknown factor第6页卵巢早衰病因学研究 study of etiology on POF(2)我们研究表明：POF患者较之正常妇女外周血CD8+T细胞增高、CD4+/CD8+比值下降，二者相比有显著性差异（P0.05）。Our study indicate: the serum CD8+T cells with POF incr

7、ease than normal one, the ratio of CD4+/CD8+ decrease. 第7页卵巢早衰病因学研究 study of etiology on POF(3)七情致病 seven modes of emotions六淫 six exopathogens先天不足 inherent deficiency 金刃、药食所伤 surgery, medicines 其中：七情 seven modes of emotions(38 例/122例,占31.15%)药品、疾病原因 medicines and diseases(39例/122例,占31. 97%)情志及药品、疾病双

8、重原因 both seven modes of emotions and medicines and diseases(6例/122例,占4.92%)无因可查 no cause can be find(39例/122例,占31. 97%)（滕秀香，4月）第8页卵巢早衰病机特点 Pathogenetic characteristic of POF肾虚，气血不足，肝郁血瘀renal deficiency, insufficiency of qi and blood, stagnation of liver-qi and blood stasis第9页卵巢早衰证候特点characteristic o

9、f syndrome of POF (1)证候syndrome病例数Case number 百分率(%)percentage证候syndrome病例数Case number 百分率(%)percentage肝郁肾虚stagnation of liver-QI and renal deficiency4133.61肾虚血瘀renal deficiency and blood stasis 108.20肝肾阴虚hepatic and renal yin deficiency2218.03肝郁脾虚stagnation of liver-QI with deficiency of the spleen

10、97.38（滕秀香，4月）第10页卵巢早衰证候特点characteristic of syndrome of POF (2)证候syndrome病例数Case number 百分率(%)percentage证候syndrome病例数Case number 百分率(%)percentage脾肾阳虚asdthenic splenonephro-yang1915.57心肾不交carduonephric cisharmony10.82热盛伤津consumption of body-fluidcaused by excessive heat1915.57脾虚湿困splenasthenic fluid-r

11、etention10.82（滕秀香，4月）第11页卵巢早衰证候特点characteristic of syndrome of POF (2)症状由高到低依次为：闭经amenorrhea（105例/122例，86.07%）潮热汗出hectic fever and sweating（83例/122例，68.03 %）性欲冷淡sexual desire indifference（52例/122例，42.62 %）心慌flustered（47例/122例，38.52 %）眠欠安insomnia（42例/122例，34.43 %）烦躁restlessness（37例/122例，33.03 %）阴道干涩（

12、29例/122例，23.77 %）大便干（22例/122例，18.03 %）带下量少（13例/122例，10.66 %）阴毛脱落（13例/122例，11.02 %）（滕秀香，4月） 症状由高到低依次为：闭经menorrhea（19例/20例，100%）多梦dreamful sleep（18例/20例，90%）阴道干涩vaginal unsmooth 润滑（17例/20例，85%）腰膝酸软（16例/20例，80%）烦燥restlessness（6例/122例，80%）精神抑郁ademosyne（13例/20例，65%）心悸（8例/20例，40%）潮热（7例/20例，35%）（朱玲、罗颂平，7月）

13、第12页卵巢早衰治疗Treatment on POF辨证：肾虚为本，气血亏虚为主，兼肝郁血瘀。differentiation of symptoms and signs:renal deficiency, insufficiency of qi and blood, stagnation of liver-qi and blood stasis治疗大法：补肾调阴阳，益气养血，兼疏肝活血。用药注意阴阳转化关系。Method of treatment: Tonifying kidney and balance yin and yang , nourishing qi and blood, disp

14、erse the depressed liver-energy and promoting blood flow第13页滋补肝肾（阳中求阴），兼疏肝活血（1）invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow蔡某，女，36岁，已婚，205月10日初诊。停经六个月余Menolipsis more than 6 months.患者既往月经规则。于始因压力较大，情绪波动较大出现月经频发，一月两行，未曾在意，后出现月经推后，量少，经人提醒，于年8月外院检验内分泌：FS

15、H：53.1IU/L，LH：37.8 IU/L，E2：140.12 pmol/L，PRL：10.3ug/L。予补佳乐治疗。2010月外院复查内分泌：FSH：78.3IU/L，LH：56.2 IU/L，E2：220.12 pmol/L。LMP：2011月2日。The womans menstruation was regular before 2003. Since then her menstruation was irregular because of stronger stress and instable emotions. After polymenorrhea, oligomeno

16、rrhea occurred. She went to hospital to check serum hormones. Her hormones were: FSH：53.1IU/L，LH：37.8 IU/L，E2：140.12 pmol/L，PRL：10.3ug/L。She was treated by Progynova(estradiol valerate)。She rechecked hormones on Oct. 2007：FSH：78.3IU/L，LH：56.2 IU/L，E2：220.12 pmol/L。LMP：Nov-2-2007。第14页已育一女。体型较瘦，眠差梦多，较

17、烦燥。眼眶黯。舌尖红边有瘀点，薄白苔，细脉。体格检验：第二性征正常，外阴已产式，阴道畅，宫颈光，宫体前，常大，无压痛，质中，活动，双附件无及显著异常。G1P1Thin, insomnia, dreamful sleep ,restlessness, eye sockets dim. red tip of tongue with edge petechia, thin and whitish fur, small puls. 滋补肝肾（阳中求阴），兼疏肝活血（2）invigorate the liver and kidney, disperse the depressed liver-energ

18、y and promoting blood flow第15页滋补肝肾（阳中求阴），兼疏肝活血（3）invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow诊疗：卵巢早衰Diagnose: POF.辨证：阴虚内热，兼肝郁血瘀differentiation of symptoms and signs: yin asthenia generating intrinsic heat, congestion of the liver.治法：滋补肝肾（阳中求阴），兼疏肝活血Me

19、thod of treatment: invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow左归丸加减 Zuogui Pill生地ShenDi 15g 山茱萸ShanZhuYu 12g 黄精HuangJing 20g 菟丝子TuSiZi 15g 鹿角胶luJiao glue 9g（烊化melting）龟板胶GuiBan glue 9g （烊化melting）川牛膝 NiuXi 15g 郁金YuJin 15g 柴胡CaiHu 10g 白芍BaiShao 10g 夜交

20、藤YeJiaoTen 15g 甘草GanChao 6g第16页5月24日二诊：烦燥好转，仍未经潮，仍梦多易醒，大便较烂，舌黯红苔白脉略细，于前方去鹿角胶、黄精之滋腻，加合欢皮15g, 川芎10g增强宁心安神，解郁活血之功。returned visit on May-24-:Less Restlessness , insomnia, dreamful sleep, no menstruation，Loose stools. Dark and red tip of tongue, thin and whitish fur, small puls. Removed 鹿角胶luJiao glue 9g

21、（烊化melting）, 黄精HuangJing 20g,added合欢皮HeHuanPi 15g, 川芎Chuan Xiong 10g in order to calm the nerves and disperse the depressed liver-energy and promoting blood flow.生地ShenDi 15g 山茱萸ShanZhuYu 12g 菟丝子TuSiZi 15g 龟板胶GuiBan glue 9g （烊化melting）川牛膝 NiuXi 15g 郁金YuJin 15g 柴胡CaiHu 10g 白芍BaiShao 10g 夜交藤YeJiaoTen

22、15g 甘草GanChao 6g 合欢皮HeHuanPi 15g, 川芎Chuan Xiong 10g 滋补肝肾（阳中求阴），兼疏肝活血（4）invigorate the liver and kidney, disperse the depressed liver-energy and promoting blood flow第17页滋补肝肾（阳中求阴），兼疏肝活血（5）invigorate the liver and kidney, nourishing qi and blood, disperse the depressed liver-energy and promoting blood

23、 flow6月7日三诊：睡眠好转，二便调，但仍未经潮，略烦燥，乳房胀。舌暗红苔薄黄脉略滑。returned visit on June-7-:sleep better. Normal urine and stool. No menstruation restlessness, spargosis. Dark red tongue, thin and yellow fur, slippery pulse治法：行气活血，补肾疏肝，宁心安神Method of treatment: promoting qi to activate blood，invigorate the kidney and dis

24、perse the depressed liver-energy.桃仁TaoRen 15g 益母草YiMuChao 15g 川芎ChuanXiong 10g 当归DangGui 10g 生地ShenDi 15g 菟丝子TuSiZi 15g 川牛膝 NiuXi 15g 郁金YuJin 15g 柴胡CaiHu 10g 白芍BaiShao 10g 夜交藤YeJiaoTen 15g合欢皮HeHuanPi 15g 甘草GanChao 6g第18页6月13日四诊：服药第5天，月经来潮，但量少，色鲜红，无痛经， 乳胀缓解，感腰酸不适。舌尖红苔白脉滑。前方去川牛膝、郁金、夜交藤、合欢皮15，加路路通15g，水

25、蛭3g、女贞子15g、旱莲草15g活血通络，养阴填精，三剂。服药后月经量增多，5天净.returned visit on June-13-: menstruation came after taking medicine, but less. Removed川牛膝 NiuXi 15g , 郁金YuJin 15g, 夜交藤YeJiaoTen 15g, 合欢皮HeHuanPi 15g, add 路路通LuLuTong 15g，水蛭ShuiZhi 3g, 女贞子NvZhenZi 15g, 旱莲草HanLianChao 15g. Taking the medicine, her menstrual b

26、lood volume became more. 桃仁TaoRen 15g 益母草YiMuChao 15g 川芎ChuanXiong 10g 当归DangGui 10g 生地ShenDi 15g 菟丝子TuSiZi 15g 柴胡CaiHu 10g 白芍BaiShao 10g 甘草GanChao 6g路路通LuLuTong 15g，水蛭ShuiZhi 3g, 女贞子NvZhenZi 15g. 旱莲草HanLianChao 15g滋补肝肾（阳中求阴），兼疏肝活血（6）invigorate the liver and kidney, disperse the depressed liver-ener

27、gy and promoting blood flow第19页继予左归丸调经至今，月经40-50天一行。11月30日复查FSH：13.6IU/L，LH：10.7 IU/L，E2：289.43 pmol/L。up to now, she is taking ZuoGui pill to regulate menstruation. Her cycle is 40-50 days.She rechecked hormones on 30-Nov-:FSH：13.6IU/L，LH：10.7 IU/L，E2：289.43 pmol/L。滋补肝肾（阳中求阴），兼疏肝活血（7）invigorate the

28、 liver and kidney, disperse the depressed liver-energy and promoting blood flow第20页滋阴降火，养血活血通络（1）nourishing yin to lessen fire，tonifying blood and promoting blood circulation to remove meridian obstruction吴某，女，39岁，年8月13日初诊。停经5月余9月因经期延长（10-15天）行取环术，术后经期6-7天，周期正常，今年三月突然月经停闭不行，LMP：年3月19日，内分泌：FSH：97.27I

29、U/L，LH：32.44IU/L，E2： 20 pmol/L，P:0.35nmol/L,PRL:6.78ug/L。现潮热眠差，肢麻，纳差。舌淡苔白脉细关滑。诊疗：卵巢早衰辨证：阴虚火旺，血虚血瘀治法：滋阴降火，养血活血通络熟地15g 菟丝子20g 山萸肉12g 女贞子15g 麦冬12g地骨皮12g 杜仲15g 丹参20g 赤芍15g 郁金15g鸡血藤30g 牛膝15g25/8二诊：潮热肢麻缓解，仍眠差。舌淡苔白脉略弦。菟丝子20g 熟地15g 仙灵脾10g 丹参20g 赤芍15g 郁金15g珍珠母30g 菖蒲10g 茯苓15g 甘草6g第21页滋阴降火，养血活血通络（2）nourishing

30、yin to lessen fire，tonifying blood and promoting blood circulation to remove meridian obstruction17/9 三诊：LMP：8/9-13/9，量不多，色鲜红。菟丝子20g 熟地15g 仙灵脾10g 郁金15g 丹参20g 赤芍15g当归10g 牛膝15g 鸡血藤30g 珍珠母30g 石菖蒲10g 远志6g13/10 四诊：LMP：13/10-17/10，腹胀纳差，白带多，梦多易醒，夜尿2-3次，时有心慌，舌边尖红苔白脉细数。菟丝子20g 熟地15g 山萸肉12g 女贞子15g 麦冬12g 杜仲15g

31、牛膝15g 鸡血藤30g丹参20g 赤芍15g 郁金15g第22页滋阴降火，养血活血通络（3）nourishing yin to lessen fire，tonifying blood and promoting blood circulation to remove meridian obstruction23/10五诊：LMP：13/10-17/10，量中，色鲜红，小腹隐痛，偶心慌，头晕，眠差，舌红少苔脉细。菟丝子20g 熟地15g 山萸肉12g 制首乌15g黄精30g 白芍15g 丹参15g 郁金15g石菖蒲10g 茯苓15g 牛膝15g 鸡血藤30g22/11六诊：LMP：10/11-

32、13/10，时头晕，无心慌，无烦燥，纳眠可，二便调，舌淡苔白脉细两关略滑。12/11内分泌：FSH：6.66IU/L，LH：6.08 IU/L，E2：256 pmol/L，P:4.35nmol/L,T:0.88nmol/L。菟丝子20g 山萸肉12g 杜仲15g 枸杞子15g 山药15g 丹参15g 赤芍15g 郁金15g鸡血藤30g 当归10g 制首乌15g 川芎10g第23页相关研究（1）Related study (1)加味左归丸治疗卵巢早衰继发性闭经30例 基本方:熟地15g,淮山药15g,山茱萸10g,枸杞子15g,菟丝子15g,川牛膝20g,鹿角胶10g,炙龟板10g,阿胶6g,女

33、贞子15g,当归15g,柴胡10g。面色萎黄,神疲乏力,脉细弱者,加黄芪30g,党参15g;胸胁胀闷,脉弦细者,加制香附15g,广郁金15g;纳食不香,脾运不健者,加焦山楂15g,六神曲15g,茯苓15g。3个月为1个疗程。1个疗程后, 痊愈15例,好转13例,无效2例,总有效率93.33%。30 patients with secondary amenorrhea were treated by Zuogui pill. One course of treatment every 3 months.15 patients were recovery after One course of t

34、reatment,13 cases were improved and 2 ones useless. Its total effective rate is 93.33 %. (朱也君,) 第24页相关研究（2）Related study (2)免疫性 POF小鼠卵巢间质可见淋巴细胞浸润,外周血FSH升高,E2下降,AoAb阳性,卵母细胞生长分化因子-9（growth and differentiation factor-9,GDF-9）mRNA阳性细胞数降低,生长卵泡及成熟卵泡数降低。左归丸能减缓POF小鼠外周血FSH升高,提升体内E2水平,抑制AoAb产生,提升卵母细胞GDF-9 mRN

35、A阳性细胞数,使生长卵泡及成熟卵泡数增加,早期用药比后期用药作用显著。Ovarian interstitial of the immune POF(growth and differentiation factor-9,GDF-9) mice occurred lymphocytes infiltration. The positive cell number of GDF-9 mRNA of oocytes decreased. The growing follicles and mature follicles decreased obviously. ZuoGui Pill could

36、normal the increase of FSH and the decrease of E2，inhibit the produce of AoAb, rise the positive cell number of GDF-9 mRNA of oocytes, increase the number of growing follicles and mature follicles, release the damages of ovarian inflammation. It can treat immune premature ovarian failure.第25页相关研究（3）

37、Related study (3)免疫性POF小鼠卵巢小卵泡、间质FasL表示均显著增强, Bcl-2表示减弱，Bax表示增强，卵泡颗粒细胞凋亡率增高，颗粒细胞线粒体嵴排列紊乱、空泡化，卵泡膜细胞形态失常，颗粒细胞凋亡，卵母细胞透明带厚薄不匀，卵泡凋亡过分，卵巢衰竭。左归丸小鼠小卵泡FasL表示减弱，卵泡过分凋亡受到抑制，卵巢功效得以保护。The expression of Fas protein in great folliculus and small ones decreased obviously in POF mice. The expression of FasL protein

38、in small folliculus and stroma increased obviously in model mice. The expression of Fas protein in great folliculus and small ones increased obviously in the mice of different dosage ZGP. The expression of Fas protein increased in stroma but the expression of FasL protein decreased in small follicul

39、us in the mice of low dosage ZGP. The expression of Fas protein in stroma also increased obviously in the mice of high dosage ZGP. The differences were significant compared with the model mice.第26页温肾补脾（阴中求阳），疏肝养血活血Warming the kidney and spleen, disperse the depressed liver-energy(, tonifying and pro

40、moting blood flow钟某，30岁，已婚，4月18日初诊。月经稀发1年余，停经2月。患者1年前因怀孕50天行人工流产，术后出现月经稀发，经用西药行人工周期后月经来潮，停人工周期2月则停经，末次月经为2月17日，孕2产1人流1。现症见腰膝酸软，怕冷，阴道干涩，性欲冷淡，纳差，二便调，舌质淡红、苔白，脉弦细。内分泌示:FSH：47. 7IU/L，LH：23. 14IU/L，PRL：5. 8p,g/L，E2： 230pmoL/L, P：3.879nmoL/L, T：1. 09nmoL/L。诊疗：卵巢早衰。辨证：脾肾亏虚，肝郁血疲，胞宫失养.治法：补肾健脾，疏肝养血活血。党参30g,菟丝子

41、、何首乌各20g，仙灵脾、当归、川芎、仙茅、柴胡各1Og，肉苁蓉、熟地黄、黄芪、白芍各15g。守方加减治疗4月后，月经来潮、量少，自觉阴道分泌物渐增多，性欲较前好转。复查:FSH 22. 87IU/L, LH 9.10IU/L, E2 399pmoL/L，继续治疗2月，月经规律来潮，量可，4-5天洁净。检测BBT呈双相。第27页二仙汤加味治疗卵巢早衰42例临床观察42 patients with secondary amenorrhea were treated by Erxian soup 药品组成:仙茅、仙灵脾、巴戟天、知母、当归、黄柏、牡丹皮、黄精各15g,紫草30g。服药3月为1个疗程

42、,治疗结束3个月后作内分泌检验(FSH、E2、LH等)及阴道超声。治愈14例,好转19例,未愈9例,总有效率为78.5%。E2、FSH、LH治疗后显著改进,与治疗前相比,差异有显著意义(P0.05)。治疗后临床症状总改进率为77%,差异有显著意义(P0.05) （段玮玮等，）One course of treatment every 3 months.14 patients were recovery after treatment,19cases were improved and 2 useless. Its total effective rate is 78.5 %. 第28页二仙汤加

43、味治疗卵巢早衰42例临床观察42 patients with secondary amenorrhea were treated by Erxian soup 加减:烦躁、焦虑者：加柴胡、郁金、莲子，失眠者：加酸枣仁、合欢皮、夜交藤,记忆力减退者：加石菖蒲,头晕者：加天麻、钩藤、石决明、白芍,头痛：加川芎、白芷,汗出尤剧者：加浮小麦、糯稻根、生牡蛎,五心烦热者：加生地黄、龟板、地骨皮,气短乏力者：加党参、黄芪,心悸者可：加龙骨、丹参、茯神。第29页相关研究Related study 当代药理 研究表明 the study at now indicate：仙茅 中含有仙茅苷成份,能增强机体免疫机

44、能；There is curculigoside in curculiginis rhizoma, which can increase the immune ability .淫羊藿（仙灵脾）含有雌激素样作用,可使雌性大鼠卵巢、子宫增重,使雄性大鼠睾酮分泌增加; Epimedium has the function like estrogen. This weight ovaries and uterum. Promoting the secrete of testosterone第30页相关研究Related study 巴戟天含有维生素E而有增强卵巢功效、抗衰老作用;There is v

45、itamin E in morinda root , which promotes the functions of ovaries and antidotal. 当归含有兴奋子宫及抗维生素E缺乏作用,并能增加肝组织耗氧量;angelica root can excite uterum and normal low vitamin E. 紫草虽为凉血之品,但含有抑制脑垂体促性腺激素分泌作用,对妇女围绝经期因为卵巢功效减退,失去对脑垂体功效反馈抑制,造成促性腺激素分泌增加所出现围绝经期综合征含有很好疗效。Lithospermi radix normal the secretion of Gn.

46、第31页针灸(1) acupuncture and moxibustion主穴：关元、中极、大赫、子宫、肾俞及胸5-腰4 夹脊穴肝肾阴虚者：加三阴交、 阴陵泉、肝俞、阴郄、复溜、太溪。脾肾阳虚者：加脾俞、命门、地机。手法：补法,先用指弹进针,得气后留针20分钟。脾肾阳虚者温针灸，出针后背俞及夹脊穴拔火罐510分钟。疗程：20次为1疗程、休息5 7天进行下1疗程，6个疗程为限。 结果：84例POF患者总有效率达90.4%。main point：Guanyuan，Zhongji， Dahe，uterus，Shenshu, hepatic and renal yin deficiency: add

47、Sanyinjiao, Yinlingquan, Ganshu(Liver Shu), Yinxi, Fuliu. Taixiasdthenic splenonephro-yang: add Pishu, Mingmen, Dijireinforcing method. Keeping 20 minutes. Every 20 is a course of treatment. Take a rest for 5-7days between two course of treatment. Not exceed 6 course of treatment.（沙桂娥等，1998年）第32页针灸（

48、2-1） acupuncture and moxibustion取穴：A组：关元、归来、子宫、中极、三阴交、足三里、血海、太冲、太溪。 B组:隔俞、肝俞、脾俞、肾俞、关元俞。两组穴位交替 使用。手法：关元、三阴交、太溪、肾俞、关元俞用补法,其余平补平泻法,得气后留针30min,每隔10min行针1次,阳虚者加以温针灸,隔日1次。关元、太溪、肾俞、关元俞：补肾气、滋肾阴,足三里、脾俞、肝俞、太冲：健脾疏肝,三阴交：补肾健脾疏肝,归来、子宫、中极：养血活血,功效：补肾健脾、疏肝活血之功。main point：Acupoints A:Guanyuan，Guilai, uterus，Zhongji，

49、Sanyinjiao, Zhusanli, Taichong, Taixi Acupoints B:Geshu， Ganshu(Liver Shu), Pishu, Shenshu, Guanyuanshu ，Above two acupoints can be used alternately第33页针灸（2-2）疗程：3个月为1疗程, 2个疗程为限,每疗程之间休息1周。结果：60例卵巢早衰者治愈13例（月经恢复正常,兼症消失,血清FSH、LH、E2正常）；好转14例（月经间断来潮,兼症改进,血清FSH、LH、E2靠近正常）,未愈3例（月经一直未潮,兼症依然,血清FSH、LH、E2无较大改变

50、）,总有效率为90%。（杨晓虹等，）第34页针灸（3）归肾丸合热敏灸治疗卵巢早衰32例，痊愈8例,显效9例,有效10例,无效5例,总有效率为86.50% 。归肾丸方剂组成:熟地、淮山各30g,枸杞子、菟丝子各20g,当归、川芎、香附、杜仲、山萸肉、茯苓、巴戟天、制首乌、黑芝麻各12gMoxibustion points, which is temperature sensitive , combined with Guishen Pill treat 32 patients with POF, 8 patients were recovery after treatment,19 cases were improved and 5 useless. Its total effective rate is 86.5 %. （蒋贵林等，） 归肾丸能使POF大鼠 LH 含量降低, 使 E2 含量升高。卵巢组织形态学观察可见归肾丸能显著改进病理状态下大鼠卵巢形态结构和功效。（张军武,年)第35页西医治疗 Treatment of west medicine激素替换治疗（hormone replacement therapy, HRT）卵巢移植 ovary transplantation卵子捐赠 ovum donation第36页 卵