中醫對孕婦子癇前症治療之臨床心得

Clinical experience of traditional Chinese medicine in the treatment of preeclampsia

10.6718/TJCM.202403_30(1).0010

陳玉娟(Yu-Chuan Chen)；沈俐伶(Li-Ling Shen)

preeclampsia ； placental growth factor (PlGF) ； pregnancy-associated plasma protein A (PAPP-A) ； uterine artery blood flow resistance ； traditional Chinese medicine ； antepartum hemorrhage ； placental abruption ； placenta praevia

台北市中醫醫學雜誌

30卷1期（2024 / 03 / 17）

91 - 96

繁體中文;英文

本癇（癲）前症於台灣地區的發生率約為2～8%，是造成孕產婦死亡的三大原因之一。在妊娠11周左右的初唐檢測（抽血加透明帶檢查）時，很多孕婦會加做子癇前症早期風險評估，胎盤生長因子（PlGF）、懷孕相關血漿蛋白A（PAPP-A）篩檢，搭配子宮動脈血流阻力評估胎盤的功能，一旦發現子癇前症高風險，婦產科醫師會給予阿斯匹靈減少血流阻力，可以想像成類似中藥的”活血化瘀”藥。中醫古籍中有觀察到這些現象，傳統中醫認為胎元不固，屬胎漏、胎動不安的範疇，原因可能是母體氣血虛弱、先天腎氣不足、血瘀、血熱、感染、外傷、手術等，現代醫學又加入了試管植入的人為因素，必須根據病因不同，隨症治之。文中舉列一案例，妊娠13周突然大出血的34歲孕婦，經辨證施治後，於36周產下一子。相較於西方主流醫學的治療，中醫的治療相對多元且彈性，除了補腎健脾養血外，我們還有疏肝、清熱、活血祛瘀、升提止血等方法可以使用。

The incidence of preeclampsia in Taiwan is about 2-8%, and it is one of the three major causes of maternal death. During the early pregnancy test around 11 weeks of pregnancy, many pregnant women will undergo early preeclampsia risk assessment, placental growth factor (PlGF), and pregnancy-associated plasma protein A (PAPP-A) screening. The examination is combined with the uterine artery blood flow resistance to evaluate the function of the placenta. Once a high risk of preeclampsia is found, the obstetrician and gynecologist will give aspirin to reduce the blood flow resistance, which can be imagined as a drug promoting blood circulation and removing blood stasis in traditional Chinese medicine. These phenomena have been observed in ancient Chinese medicine books. While the fetal is not solid can be categorized as antepartum hemorrhage, placental abruption and placenta praevia. The reasons may be maternal qi and blood insufficient, congenital insufficient of kidney qi, blood stasis, blood heat, infection, trauma, and surgery, etc. Modern medicine has added the artificial factor of test tube implantation, which must be treated according to the cause of the disease. This article cites a case of a 34-year-old pregnant woman suffered sudden heavy bleeding at 13 weeks of pregnancy. After syndrome differentiation and treatment in NUWA TCM clinic, she gave birth to a son at 36 weeks. Compared with the treatment of mainstream Western medicine, the treatment of traditional Chinese medicine is relatively diverse and flexible. In addition to nourishing the kidneys, strengthening the spleen and nourishing the blood, we can also use methods such as soothing the liver, clearing away heat, activating blood circulation and removing blood stasis, and lifting to stop bleeding.