Professor Zhang Xiaofeng's Experience in Treating Follicular Maldevelopment with Kidney Deficiency and Liver Depression

: Follicular maldevelopment is a common disease in women of childbearing age. Professor Zhang has been engaged in gynecological clinical work for more than 30 years. After long-term clinical practice, it is believed that the disease is more common with kidney deficiency and liver depression. The liver collects blood, the kidney collects essence, and the essence and blood intermingle. The liver and kidney breed each other, so that the follicle can develop and mature, the liver qi line can reach, the Qi and blood can be connected, the veins can be smooth, and the follicle can be discharged smoothly. This article summarizes Professor Zhang's clinical experience and effective prescription in the treatment of follicular maldevelopment. ,


Introduction
Follicular maldevelopment (FM) is a disease in which the size and function of follicles fail to reach the level of mature follicles, and follicle development arrest, atresia or ovulation of immature follicles occur, leading to infertility and recurrent abortion. In recent years, the incidence of this disease has been increasing year by year [1] . Some studies have reported that the incidence of infertility caused by follicular dysplasia is 27%, [2] as many as 86.7% of women with primary infertility have ovulation of small follicles [3] , and 73.2% of women with spontaneous abortion have follicular dysplasia [4] . Therefore, the treatment of poor development of follicle directly affects the prevention and control of infertility and spontaneous abortion.

TCM's understanding of FM
There is no relevant record of follicular maldevelopment in ancient Chinese medicine books. However, the disorder of menstrual cycle and the change of menstrual period length, low conception rate, infertility and other clinical manifestations caused by follicular dysplasia can be classified as "premenstrual period", "late menstrual period", "amenorrhea", "infertility" and other categories.
Traditional Chinese medicine thinks: "The kidney of the main insects, the sealing of the hidden, fine place also." Refers to the kidney for the innate, the essence of Tibetan diarrhea, reproductive energy are its main. Ovum is the essence of reproduction, which is stored in the kidney and nourished by it. The normal discharge of ovum depends on the agitation of kidney Yang. Luo Yuankai believes that [5] the reproductive axis composed of kidney, Tiangui and Chongren is closely related to women's menstruation and pregnancy. If kidney essence is insufficient, Tiangui cannot come as scheduled, resulting in impermeability of Ren pulse, insufficiency of chong pulse, menstrual cycle disorder, and inability to take spermatozoa into pregnancy.
The spleen, as the acquired essence, nourish the innate essence through the water and grain refinement produced by the splenic Yang. Physiologically, the two viscera nourish each other and promote each other. The function of splenic Yang depends on THE warm and normal function of the kidney Yang. The spleen and kidney can perform their respective duties to provide guarantee for the development of the egg. Professor Liu Minru, a master of traditional Chinese medicine, believes that the diagnosis and treatment of follicular dysplasia and infertility should be based on the kidney, and the spleen and kidney are involved. Shenling Bai Shu Powder is commonly used to treat patients with follicular maldevelopment and has achieved significant curative effect [6] .
"Jingyue Complete book · Women rules" said: "women with blood, blood is the main, the regulation"; Many ancient books also pointed out that women's diseases often lie in qi and blood. Follicle development also requires adequate vaginal blood as the basis. Teng Guizhen [7] used the method of invigorating Qi and nourishing blood to treat follicular maldevelopment, and the total effective rate was 98%, which could significantly reduce the occurrence of side effects and improve the curative effect after clinical observation.
In the book Acupuncture and Moxibustion A and B Classics · Women's Miscellaneous Diseases, Huangfumi, a medical scholar of the Jin Dynasty, said: " Female infertility, because of blood stasis in the body can not be discharged, Guan Yuan plays a leading role." This is the earliest record of blood stasis infertility. Dong Yuhong [8] believes that for a long time, kidney deficiency will be mixed with blood stasis, blood stasis and collaterals, which will affect the essence of reproduction, so that pregnancy is difficult.
"Danxi Heart Law" points out: "If a fat woman is suffering from excessive thickness, eating and drinking excessively, and the menstruation is not regulated, and she won't be able to conceive a fetus, then the body fat is overflowing and the uterus is blocked". Phlegm is sticky and greasy, wet and can be phlegm, phlegm dampness block, Qi machine is not smooth, flush Qi and blood operation disorder, follicle cannot nourish, so stunted. Professor Hou Lihui [9] summarized the treatment experience and put forward the theory of infertility caused by phlegm and blood stasis in the cell palace. Kidney deficiency is the origin, phlegm and blood stasis is the standard, leading to follicular maldevelopment.
"Fu Qing master female branch · seed" said: "A woman who has the embrace of evil and can not bear children, people think that the heart of heaven is also, who knows is the liver qi stagnant." It is pointed out that liver depression can also lead to infertility. The physiological function of liver main dredge can smooth the operation of qi machine and meridians. Soothing the liver, Qi and blood, smooth veins, follicle can be discharged smoothly. Professor Han Bailing [10] believes that liver depression is an important pathogenesis of infertility. If the Qi mechanism of the liver is unobstructed, the qi and blood are harmonized, and the qi and blood are mutually fertilized, it is easy to become pregnant.

Western medicine's understanding of FM
At present, the specific pathogenesis of follicular dysplasia is not completely clear. The hypothalamic-pituitar-ovarian axis (HPOA) regulates follicle development and maturation. The hypothalamus secretes gonadotropin-releasing hormone (GnRH), and the pituitary begins to secrete gonadotropin (Gn) after receiving instructions: These include follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Under Gn stimulation, ovaries undergo periodic ovulation accompanied by periodic changes in sex hormones (estradiol E2, progesterone P and a small amount of testosterone T). At the same time, sex hormones secreted by ovaries play a feedback role on the synthesis and secretion of hormones by hypothalamus and pituitary. So that FSH, LH also have periodic changes. [11][12] The process of follicle development is not only regulated by reproductive endocrine, but also influenced by related genes and cytokines, among which the abnormality of any molecule or signal pathway may cause the disorder of follicle development [13][14] . At the same time, ovarian blood perfusion may also affect the normal growth and development of follicles. Ovarian blood supply comes from ovarian artery and uterine artery, and insufficient ovarian blood supply will also lead to egg hypotrophy and dysplasia [15] .

The clinical experience of Professor Zhang Xiaofeng
Professor Zhang Xiaofeng has been engaged in gynecological clinical work for a long time. After long-term clinical practice, he found that follicular maldevelopment of kidney deficiency and liver depression was more common. Professor Zhang believes that women belong to Yin and take blood as the foundation. In addition, women are born with liver, liver collects blood, kidney collects essence, essence and blood interchangeover, liver and kidney are homologous, and chong Ren's two veins are all subordinate to liver and kidney. Kidney AND liver are "mother" and "son" relationship, liver, blood and kidney essence, one Rong Rong, both damage, related, son disease and mother. Kidney essence is the fundamental generation of menstruation, and there is "water out of the kidney" said, but the essence must be changed into blood, hidden in the liver, injection in the chong pulse, can be transformed into menstruation. At the same time, although the essence of blood, but also rely on the blood of the replenishment; Between essence and blood, liver and kidney, breed and complement each other. Between liver and kidney, one main dredges and the other main clots, which are mutually restricted and complement each other. The uterus is well stored and discharged, the liver and blood are exuberant, the cell palace is transmitted, the kidney essence is nourished, and the follicle can develop and mature. Qi and blood are connected, and the veins are smooth, so that the follicle can be discharged smoothly and arrive menstruation. "Female branch Authentic" mentioned that "male strong and female classics, there is also the way of children" According to the different stages of the female menstrual cycle, it can be divided into menstrual period, late menstrual period, intermenstrual period and premenstrual period. In the treatment of follicular maldevelopment, the tutor follows the menstrual cycle and carries out treatment in cycles. The menstrual period is the transformation period from Yang to Yin, the blood chamber is open, and the blood flow is down, so as to promote blood circulation, remove blood stasis, and welcome new life. Prescription: self-made Zhuyu Meridian soup. Angelica sinensis 12g, sauteed radix paeoniae 15g, Chuanxiong 10g, safflower 10g, Salvia miltiorrhiza 15g, caulis spatholobi 20g, Zelan 15g, Astragalus membranaceus 30g, Motherwort 15g, vinegar Xiangfu 10g, Cyathula officinalis 15g, Tangerine peel 10g, Poria coing 15g, licorice 6g.

Clinical medical record
The patient was a 34-year-old female, married. Come before November 5, 2021. Chief Complaint: no contraception no pregnancy for 3 years. The patient had irregular menstrual cycles in recent years, sometimes early, sometimes delayed, but all within 1 week. The day of treatment was the 17th day of the menstrual cycle. The fifth day of menstruation was clean, with little volume, dark color and no lumps, accompanied by premenstrual breast distension and lumbar acid. Normal leucorrhea, normal diet and sleep, two stool normal. The tongue is dark red with thin white moss and fine veins. The patient underwent salpingography in 2019 and was found to have bilateral patency of fallopian tubes. Previously, ovulation monitoring for 2 cycles indicated poor follicle growth and ovulation of small follicles. The patient was too busy to monitor ovulation every time, so he did not monitor ovulation again. Now because of the desire for a son, so come to see a doctor. Follicle monitoring on the same day showed that the endometrial thickness was 0.9cm, and a large follicle was seen on the left side: 1.6x1.4cm, and the rest was (-). Diagnosis: infertility, dialectical for kidney deficiency and liver depression. Treatment: The egg breaking formula designed by the professor was selected. 3 doses, and asked the patient to arrange room in recent two days. On the second visit 4 days later, the patient complained of no discomfort after taking the medication. On the same day, follicle monitoring showed that large follicles had been discharged. If the follicle has been discharged, use the self-designed luteal stimulating soup. 12 agent. On the third visit 19 days later, the patient was on a business trip during menstruation due to work requirements, so he failed to see the doctor on time. The day of the visit was the 7th day of the menstrual cycle. The patient complained that the menstrual period was clean on the 5th day, with normal color measurement, mild breast distension before menstruation, and no obvious lumbar acid. Prescription with selfdesigned decoction, 6 doses. On the fourth diagnosis, on the 13th day of the menstrual cycle, follicle monitoring showed that the thickness of the endometrium was 0.8cm, and a large follicle was seen on the left, about 1.4x1.4cm in size. Choose self -made bubble soup, add 20g of amethyst and fry first. 5. On the fifth diagnosis, on the 18th day of the menstrual cycle, follicle monitoring showed that the endometrial thickness was 1.0cm, and a large follicle was seen on the left side, about 1.8x1.6cm in size. The formula is self-designed egg breaking formula. 3. Ask the patient to share the same room. On the sixth diagnosis, the menstrual cycle was 21 days. Ovulation monitoring showed that the dominant follicle had been discharged. Use self-designed luteal body promoting soup. 12 agent. At the time of the seventh diagnosis, the patient had been amenorrhea for 42 days, and self-examination of urine HCG (+). Then check blood HCG, confirm pregnancy, give fetal protection treatment.

Conclusion
Usually, follicular dysplasia is associated with kidney deficiency, phlegm and blood stasis. However, Professor Zhang believes that the development of follicle is not only the kidney deficiency of this dirty, should pay attention to emotional influence, that is, closely related to the liver function. "Wan's female Branch" said: "such as impatient and angry, blame its injury liver to move the pulse of Ren." Depression and anger, liver qi stagnation, drainage disorders, affect the viscera qi machine rise and fall, Qi and blood disorders, damage rushed Ren. Required demands of women with the progress of the society, more and more high, not only face the family pressure, and at the same time under the working pressure, workplace under the multiple pressure, anxiety, depression, emotional problems, such as follow, so zhang think follicular dysplasia is more common clinical kidney liver depression type, professor in the treatment of these diseases, The cycle therapy of tonifying kidney and relieving liver has a significant clinical effect. This article summarizes Professor Zhang's experience and provides a new research idea and method for the treatment of this disease with traditional Chinese medicine.