中醫診斷多囊性卵巢徵候群的臨床與實驗室檢驗表現
徐明義
台北市立萬芳醫院-委託財團法人私立台北醫學大學辦理
多囊性卵巢症候群（PCOS）是一種結合了內分泌、生殖、新陳代謝等功能性障礙的症候群。它常見於育齡中的婦女，盛行率約3~10﹪。在臨床上病人常因不孕症、月經不規則及雄性素過高症狀（如多毛、青春痘、肥胖等）而來到門診接受治療。但在近二十年來，因著醫學的進步，PCOS的患者被觀察到其罹患糖尿病及早發性冠狀動脈疾病的危險性較正常人偏高。而有將近40﹪PCOS患者會出現葡萄糖耐性不良及糖尿病的症狀，也容易出現胰島素抵抗、雄性肥胖、脂質代謝障礙等問題。
中醫學上本來無多囊性卵巢症候群（PCOS）的病名，根據本病徵的臨床表現可歸屬于月水不利、月經後期、月經過少、閉經、不孕等範疇。在西醫上對多囊性卵巢症候群可以概分為肥胖型PCOS及非肥胖型PCOS，並依此給予合適的治療方法。中醫對於疾病的治療，向來是依病人體質分型及臨床症狀給予不同的治療方法，亦即証型指導臨床的治療。
多囊性卵巢症候群（PCOS）在中醫上目前沒有統一的體質証型分類，一般可以粗略分為主要證型:腎虛證、腎陰虛證、腎陽虛證、脾虛證、痰濕證、血瘀證、氣滯證等。並依這些証型給予不同治療方法。但這些分型與西醫對PCOS的分類並沒有直接的相關性。
在查閱台灣地區及國外地區後的文獻期刊後，並沒有搜尋到關於多囊性卵巢症候群（PCOS）的中醫証型與西醫實驗室檢查及臨床表現的有意義相關性文獻發表。而主要的原因就是PCOS是一種多病因多樣表現的疾病，所以無法以傳統的單一証型來分析PCOS的體質分型。
本計畫希望藉由門診中PCOS病人的實驗室檢查數據及臨床表現，來分析各種中醫體質PCOS的西醫檢查特點，並將PCOS病患重新體質証型分類，這些病患將重新被分類為幾種混和型証型，而這些新的PCOS証型分類將與西醫的臨床檢查及臨床表現具有高度的對應性，並期待從這些的新的分類來探討PCOS的中醫治療模式。
關鍵字：多囊性卵巢綜合症、中醫診斷、辨証分型、臨床表現
Laboratory and Clinical presentation of Diagnosis of Polycystic Ovary Syndrome in Chinese Medicine
Hsu Ming-I
Aim:
Polycystic ovary syndrome (PCOS) is a complex syndrome that combined with endocrine, reproduction, and metabolic disorders. The prevalence of PCOS had been estimated as 3- 10 %. The syndrome of PCOS had been performed in both laboratorial work-up and traditional Chinese medicine (TCM). To evaluate the correlation between TCM syndrome and their laboratory and clinical presentation in women with PCOS, we perform this proscpective study.
Method:
One hundred and six patients were recruited from outpatient clinicof Wan Fang Hospital from Jan. 2011 to Sep. 2011. Sixty five of them were diagnosed as PCOS and forty-one as non-PCOS. The diagnosis of seven TCM syndrome and whole laboratorial with clinical evaluation were applied to every studied patients.
The diagnostic criteria: base on 2003 Rotterdam diagnostic criteria which were contained with three criteria: ovulatory dysfunction, polycystic ovary morphology, and hyper androgenism. TCM diagnostic criteria were base on the guideline of TCM treatment.
Results and Discussion:
1. Phlegm dampness is the most common phenotype in Taiwanese women with PCOS, more than 60% (43/71) phlegm dampness could be diagnosed as PCOS, furthermore, women diagnosed as phlegm dampness phenotype had higher BMI than who did not.
2. Kidney asthenia is the pathologic condition of PCOS.
3. LH/FSH ratio might be an important key marker to differentiate kidney yin asthenia and kidney yang asthenia phenotype.
4. Obesity is the major predictive factor for the insulin resistance.
However, further results should be pending until more data corrected.
關鍵字：Polycystic Ovary Syndrome, Traditional Chinese Medicine Diagnosis, Syndrome Differentiation, Clinical Characteristic
