子宮內膜異位證體質證型診斷指標之研究

陳建霖
財團法人長庚紀念醫院
目的: 子宮內膜異位症可以說是中醫婦科門診中最常見的疾病之一. 其發生率約在10%至20%之間, 其臨床常見的症狀有三, 即痛經, 不孕症及性交疼痛. 大約有1/3到1/2的生育年齡期的女性，經痛的原因是子宮內膜異位症；而患有內膜異位症的患者中, 約有30%至50%的人會發生不孕症. 而約有25%-40%比例會發生性交疼痛. 因此子宮內膜異位症對婦女本身的健康造成極大的傷害. 近代醫學對此的治療, 從賀爾蒙的治療, 到積極的手術治療, 雖然可以解決一部份的問題, 但是高復發率確讓這疾病, 被識為「惡性的良性疾病」. 過去許多的中醫臨床經驗, 顯示中醫藥在治療與保健子宮內膜異位症有一定的療效. 而優良的治療效果, 建立在確實的辨證基礎之上. 過去對此疾病的辨證治療, 主要分有氣滯血瘀, 寒凝血瘀, 腎虛血瘀, 氣虛血瘀與瘀熱互結等. 中國大陸各地的醫家對此提出許多不同的辨證觀點與治療方藥. 中醫治病強調「異法方宜」, 那麼臺灣的內膜異位症婦女的辨證是否有其異於大陸地區的特點呢? 過去的臨床經驗似乎有這樣的傾向, 所以在追求好的治療效果之先, 我們希望對臺灣的子宮內膜異位症患者的辨證體質, 作一完整的研究. 因此我們計劃綜合過去發表的對子宮內膜異位症治療的辨證資料, 設計出中醫辨證的問卷調察表, 結合以本院婦產科確診的子宮內膜異位症患者為對象, 進行子宮內膜異位症體質證型特點的研究. 期能發現台灣地區子宮內膜異位症的體質特點, 從而為尋求良好的中醫治療, 打下堅實的基礎. 實施方法: 1. 歸納分析以發表有關子宮內膜異位症中醫辨證治療報告, 參考學者專家經驗與學識, 設立子宮內膜異位症體質辨證調查表; 2. 與西醫婦產科專家合作, 由物理診查, 超音波檢查, 血液CA125值等, 確定子宮內膜異位症; 3. 對子宮內膜異位症進行中醫望聞問切四診診查工作; 4. 分析子宮內膜異位症台灣地區中醫辨證分型的分布狀況; 5. 分析子宮內膜異位症台灣地區中醫證型之症的特色; 6. 研究子宮內膜異位症患者體質證型診斷指標.
關鍵字：子宮內膜異位症；中醫；辨證

Studying of the characteristic of the different Symptoms of endometriosis according the Chinese medical differential diagnosis

Chien-Lin Chen
Chang Gung Memorial Hospital
Studying of the characteristic of the different Symptoms of endometriosis according the Chinese medical differential diagnosis Chien-Lin Chen, Division of Gynecology and Pediatrics, Center for Chinese Medicine, Chang Gung Memorial Hospital, Taiwan Abstract Endometriosis is a common gynecological disorder that generally gives rise to pelvic pain, infertility and dyspareunia. The general incidence is around 10-20%. The treatments of this disease were the use of hormones or surgery. However, the side-effects of these treatments and high recurrent rate make the strategy to overcome the endometriosis seem difficult. So, to fine an other treatment of endometriosis is important. Traditionally, several particular TCM formulas such as "Shao Fu Zhu Yu Tang" have been used for endometriotic patients for the treatment of common symptoms including pelvic pain, dyspareunia (pain on intercourse) and dysmenorrhoea (painful period) which are identified among the patients. However, these widely used formulas do not alleviate clinical symptoms in all cases, and recurrence rate is relatively high, suggesting that careful and systemic approach of classification is necessary with regard to the heterogeneity of endometriotic patients.
關鍵字：endometriosis；TCM；symptom