薛己張介賓調經理論治療不孕症綜述

Treatment of Infertility by the Menses Regulation Theory of Xue Ji and Zhang Jie-Bin

薛己與張介賓為明代婦科學術整合具有理論創見的著名學人，其調經思想均以補脾調肝與益腎為主。薛氏治月經病常用歸脾湯補脾，逍遙散舒肝，六味丸益腎等方法來調治，同時擅長治肝脾鬱怒之證，並首創培土生金法，補氣滋腎法，補火生土法，治療婦人經閉。張氏在調經方面的學術成就，發現脾土虛陷不能攝血者，除脾陽傷可致虛陷，脾陰傷亦可致中氣陷而製壽脾煎主之。其調經注重虛火與實火之辨，臨證更發現有脾腎虛寒的病例，故常用大營煎或理陰煎溫養陽氣、培補真陰。其補腎調經的方法，自製左、右歸丸，旨在培補腎陰與元陽。從文獻資料顯示，薛氏與張氏的調經治病方法，對解決現代臨床婦科內分泌學問題，在理論實踐方面，尤其是不孕症的研究，提供了不少助益。目前中西醫學結合研究，補腎對下視丘－垂體－卵巢車功能失調性月經病的調節，均有良好的療效。然而對無排卵或黃體不健引起的不孕症，經補腎或舒肝法治療仍有一部份不能受孕，此有待更進一步的探討，始能提高妊娠率，而作者認為應從薛己與張介賓的調經理論與用藥方法深入研究。不孕症的研究，其發展方向除目前補腎和舒肝方法外，應重視脾的研究，始合乎中醫理論：月經生理主要與脾、肝、腎密切相關。

Xue Ji and Zhang Jie-Bin were famous Ming Dynasty gynecologists who developed a new approach on the basis of broad research and clear theory. Their concept of regulating the menses (tiao jing) is based on supplementing the spleen and regulating the liver (shu gan), and on boosting the kidney (yi shen).The menses regulation theory of Xue and Zhang is of great help in modern clinical treatment of endocrine disorders. According to combined Western and Chinese medical research, what is called supplementing the kidney in Chinese medicine is very effective in the treatment of menstrual problems due to imbalance of the hypothalamus-pituitary-ovary axis. However, supplementing the kidney or soothing the liver fails to treat some forms of anovulatory infertility or infertility due to unhealthy corpus lateum. Further research is needed if success in this area is to be improved. In the author's opinion, the theories and formulas of Xue and Zhang provide a good starting place for such research.In the search for adequate treatment for infertility, future research should be done not only into supplementing the kidney and soothing the liver but also, and more importantly, into supplementing the spleen, since in Chinese medicine menstruation is intimately related to the traditional concepts of the spleen as well as the those of the kidney and liver.