COVID-19感染或疫苗接種後月經失調：病案討論與文獻回顧

新冠肺炎（COVID-19）自爆發以來，在世界各地迅速蔓延與傳播，引發了一場世界性的健康災難。為了達到群體免疫以降低新冠肺炎感染，各國家都推動了疫苗接種計劃，以減少發病率和死亡率。然而，許多民眾質疑其安全性，其中一個疑慮是擔憂COVID-19疫苗是否會對未來的生育能力產生影響。本次分享三個病案，病案1為一37歲女性，主訴施打COVID-19疫苗後月經量減少;病案2為一44歲女性，主訴施打COVID-19疫苗後停經半年;病案3為一位40歲女性，主訴嘗試懷孕半年以上未果，於病史詢問及經相關檢查後發現卵巢儲備量指標：抗穆勒氏賀爾蒙（AMH）在五個月內明顯下降，推測可能與確診Covid-19相關。COVID-19在中醫裡屬於「癘氣」、「時疫」、「瘟疫」範疇，而疫苗是以現代技術來模仿病毒抗原，注射人體來誘發免疫系統產生保護力對抗病毒入侵，故施打疫苗後所造成身體的變化，中醫多以外感風邪，由體表往內部臟腑入侵來論述，最後導致臟腑陰陽氣血失調而影響月經。中醫在探討外來病邪對月經的影響，最早追溯至東漢末年張仲景《傷寒論》中提的「熱入血室」，探討婦人月經週期表邪乘虛入於血室，與血相搏，血結不行干擾血室運行路徑，導致月經週期失調與經血量異常。本次報告欲藉此三則病案探討COVID-19疫苗接種與月經和未來生育能力之間的聯系。

關鍵字

新冠肺炎；疫苗；副作用；月經；熱入血室；抗穆勒氏賀爾蒙；中醫藥

並列摘要

Since the outbreak of the COVID-19 pandemic, it has rapidly spread and become a global health disaster. In order to achieve herd immunity and reduce the incidence and mortality of COVID-19, countries around the world have launched vaccination programs. However, many people have questioned the safety of the vaccines, including concerns about whether the COVID-19 vaccine will affect future fertility. This article presents three cases. Case 1 is a 37-year-old woman who reported a decrease in menstrual flow after receiving the COVID-19 vaccine. Case 2 is a 44-year-old woman who reported amenorrhea for six months after receiving the COVID-19 vaccine. Case 3 is a 40-year-old woman who reported a significant decrease in ovarian reserve (AMH) within five months after being diagnosed with COVID-19 and sought treatment through traditional Chinese medicine to help with pregnancy. In traditional Chinese medicine, COVID-19 belongs to the category of "epidemic disease," "plague," and "pestilence." Vaccines use modern technology to mimic virus antigens, which are injected into the body to induce the immune system to produce protection against virus invasion. Therefore, the changes in the body caused by vaccination are mostly discussed in traditional Chinese medicine as an external contraction of wind evil, invading the body's surface and then affecting the internal organs, leading to an imbalance of Yin and Yang, Qi and Blood, and affecting menstrual cycles. Traditional Chinese medicine traces the impact of external pathogenic factors on menstrual cycles back to Zhang Zhongjing's " Treatise on Febrile Disease Caused by Cold (Shang Han Lun) " in the late Eastern Han Dynasty, where he discusses "heat entering the blood chamber" and how pathogenic factors invade the blood chamber during a woman's menstrual cycle, leading to blood clots and interfering with the normal flow of menstrual blood, resulting in irregular menstrual cycles and abnormal menstrual flow. This article aims to discuss the relationship between COVID-19 vaccination and menstrual cycles and future fertility through these three case studies.

並列關鍵字

COVID-19 ； Vaccines ； COVID-19 Side Effects ； Menstruation ； Heat entering the blood chamber ； AMH ； Traditional Chinese Medicine

參考文獻

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