中醫治療原發性痛經病例報告

A Case Report of Dysmenorrhe with Chinese Medicine Treatment

10.7102/JTCIM.201612_14(2).0007

楊雅淳(Ya-Chun Yang)；洪舒玨(Shu-Chueh Hung)；廖麗蘭(Li-Lang Liao)

痛經 ； 婦科疾病 ； 中藥

中醫內科醫學雜誌

14卷2期（2016 / 12 / 01）

56 - 66

繁體中文

痛經是婦科常見病之一，可分為原發性痛經及繼發性痛經。原發性痛經是指無器質性病變，但在月事來潮時伴有下腹痙攣痛、頭暈、盜汗、噁心、腹瀉、全身無力等不適症狀。據流行病學統計， 近乎16~93% 育齡女性及2~29%的學齡女性曾有原發性痛經之困擾。在西醫治療方面，主要有口服止痛藥、口服避孕藥及手術此三種方式，使用口服止痛藥及避孕藥的常規治療療效高，但仍有20~25%女性對於此兩種治療方式無效。在此篇醫案報告中，此25歲女性病患經來第1-2天下腹悶痛已10年。11歲初經來潮時原無經痛困擾，但自15歲開始課業壓力漸重，開始有行經下腹痛困擾，自述疼痛評估分數自15歲至今皆為VAS : 8 。此病患經血量偏多伴有血塊，經色鮮紅， 質偏黏。平日無腹部不過、下腹痛及異常分泌物等症狀。經前一周易胸脹、腹瀉。飲食嗜甜、喜食冰，茹素。由中醫觀點來看，此病患嗜食冰飲，損傷脾陽致使脾胃寒濕，素體感寒而易發寒凝血瘀，經來腰疼腹痛伴月經血塊;課業壓力易使肝鬱氣滯， 氣滯日久易致瘀血內停。綜合上述症狀，中醫採取的治療方式是以活血化瘀、溫中健脾來改善寒凝血瘀的情形。經幾週治療下，患者自述疼痛評估分數由VAS : 8降為VAS : 0，故提出病例探討之。

Dysmenorrhea is commonly categorized into two types; primary and secondary. PD is defined as painful menses with cramping sensation in the lower abdomen that is often accompanied by other symptoms, such as sweating, headache, nausea, vomiting, diarrhea, and tremulousness. In adolescents the prevalence of PD varies between 16% and 93%, with severe pain perceived in 2% to 29% of the studied girls. Medical treatment for dysmenorrhea includes anti-inflammatory drugs (NSAIDs), OCP or surgical intervention. The efficacy of conventional treatments using NSAIDs and OCP is high. However, failure rate may reach up to 20% to 25%. This 25-year-old patient had suffered from dysmenorrhea in the first and second day of the menstrual period for over 10 years. Due to the discomfort of dysmenorrhea, she visited the gynecologists, and the diagnosis was uteritis when she was 16. Since the therapeutic effect wasn't obvious, she didn't use western medicine since then. The menstruation amount of the patient was abundant, which was red, thick and accompanied with clots. She has neither abdomen discomfort nor discharge problem in usual days. She suffered from diarrhea and breast tenderness before the menstruation. In the perspective of Chinese traditional medicine, the patient favored sweet and iced flavor, which easily caused cold and blood stagnation. Too much academic stress caused liver depression and qi stagnation. As mentioned above, the treatment of Chinese traditional medicine is to promote the blood circulation and remove the stagnation to improve the blood circulation. By doing so, the VAS score fell down from 8 to 0.

1. De Sanctis, V,Soliman, A,Bernasconi, S,Bianchin, L,Bona, G,Bozzola, M,Buzi, F,De Sanctis, C,Tonini, G,Rigon, F,Perissinotto, E.(2015).Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge.Pediatr Endocrinol Rev.,13(2),512-20.
2. Sun, Lan,Liu, Lina,Zong, Shaobo,Wang, Zhengzhong,Zhou, Jun,Xu, Zhiliang,Ding, Gang,Xiao, Wei,Kou, Junping(2016).Traditional Chinese medicine Guizhi Fuling capsule used for therapy of dysmenorrhea via attenuating uterus contraction.Journal of Ethnopharmacology,191,273-279.
3. Yeh, Lan Lan Liang,Liu, Jah-Yao,Liu, Yu-Shen,Lin, Kao-Si,Tsa, Te-Feng,Wang, Li-Hsiang(2009).Anemia-Related Hemogram, Uterine Artery Pulsatility Index, and Blood Pressure for the Effects of Four-Agents-Decoction (Si Wu Tang) in the Treatment of Primary Dysmenorrhea.The Journal of Alternative and Complementary Medicine,15(5),531-538.
4. 吳龍源。痛經的病因病機及中醫辨證分型治療文獻探討。北市中醫會刊，15(2)
5. 陳立德(2003)。中醫婦科學。弘祥出版社。
6. 葉宗仁。『經痛』的論治與預防。台中縣中醫會刊，32
7. 嚴秀娟、黃宏庭。運用臟腑病機四要素分析裡寒氣鬱型痛經病例討論。中醫婦科醫學雜誌，16，95-101。