中西醫整合辨證論治卵巢過度刺激症候群

An Integrated Approach to Ovarian Hyperstimulation Syndrome Using Western Medicine and Traditional Chinese Medicine

林舜穀(Shun-Gu Lin) ； 陳曉萱(Hsiao-Hsuan Chen) ； 賴榮年(Jung-Nien Lai)

《北市醫學雜誌》 9卷1期 (2012/03) Pp. 1-10

https://doi.org/10.6200/TCMJ.2012.9.1.01

摘要

卵巢過度刺激證導因於大劑量排卵藥物引起卵巢的強烈反應，是人工受孕療法最嚴重的併發症之一。隨著台灣接受人工生殖的婦女越來越多，卵巢過度刺激症候群的患者也逐年增加；卵巢過度刺激證在過去的中醫典籍中沒有記載，中醫師除了依循辨證論治的原則外，應將現代醫學病理機轉的整合，更能明確掌握治療策酪。刺激排卵藥的作用是刺激卵泡發育及排出，由中醫觀點來看是在特別促進腎陽功能，以增加卵泡數量以及促使卵母細胞破卵排出。而卵巢刺激症候群發病時血管內皮生長因子大量分泌，大幅擴大微血管通透性，則可視為心火過亢迫血妄行的病機。血液在火熱蒸迫下離經而出，成為富含大量白蛋白的腹水，且腹水成為繼發病因，上凌心肺而導致心陽虛衰，甚至危及生命。因此，卵巢過度刺激症候群的辨證為火熱迫血妄行的實熱證，治療應以清熱瀉火配伍疏肝理氣為主。

關鍵字

卵巢過度刺激症候群 ； 人工生殖 ； 排卵藥物 ； 辨證論治 ； 中西醫整合醫療

並列摘要

Ovarian hyperstimulation syndrome (OHSS) is one of the most severe life-threatening complications of fertility medication and obviously it was never documented in ancient Chinese medicine books. Facing this new disease, TCM doctors need to better integrate scientific approaches with traditional Chinese approaches in order to develop an appropriate treatment strategy. According to the theory of Traditional Chinese Medicine, a clinical presentation involving multiple luteinized cysts within the ovaries represents the results of hyperactivity of Kidney-Yang, while ovulation stimulation is similar to an excessive rise in Liver-Yang. In addition, the central feature of clinically significant OHSS is the development of vascular hyperpermeability and a resulting shift of fluids into the third space, which is equivalent to a mechanism involving excessive rising of the Heart- Yang. Therefore, OHSS should be categorized into Yang-Zhang and the principle of diuretics combined with the purging of heat from the liver and heart needs to be taken into consideration when treating OHSS at an early stage.

並列關鍵字

ovarian hyperstimulation syndrome ； infertility treatment ； ovulation induction ； integrative approach ； integrative medicine ； traditional Chinese medicine ； TCM