婦科中藥方劑研究第三報 痛經

Studies on Gynecological Chinese Medicinal Prescriptions III Dysmenorrhea

楊捷凱(J-Kay Yang)

指導教授 ： 許淳森 ； 楊玲玲

臺北醫學大學/藥學院/生藥學研究所/碩士(1999年)

摘要

痛經亦即月經困難(Dysmenorrhea)是婦科臨床上常見困擾女性的問題。在美國，初經後女性 30-60%曾經歷痛經相關症狀所引起的不適，估計因此每年喪失工作時間 60億小時，顯示痛經不僅嚴重影響女性生活品質，更造成生產力的減少及龐大經濟損失。 痛經的發生與病人體內前列腺素F2a（PGF2a）的增加有著密切關係，因此西醫臨床上，常以非類固醇類口服止痛劑（NSAIDs；Nonsteroidal anti-inflammatory drugs）治療，但暫時止痛後常會再復發，且亦伴隨肝、腎與腸胃等副作用；另一具有悠久使用歷史之中藥方劑，雖廣為東方各國臨床醫師所用，但卻缺乏科學性之理證。 本研究以系統性科學考證方式分兩部份進行探討：第一部份青春期少女之痛經問題探討，以問卷統計方式調查分析痛經盛行率、應對行為，與中醫辨證分佈情形，以供公共衛生及臨床研究參考；針對台北市 907位國中少女所作問卷，統計結果顯示65.65%曾有過程度不同之痛經體驗，因而影響日常生活作息者佔22.94%，其中自行購服非處方止痛劑者有12.24%，忍耐而不予處理者佔80.67%，尋求就醫者僅有 2.42%，值得衛教相關單位重視；中醫痛經五大辨證，以佔29.7%之氣滯血瘀為最多，屬寒濕凝滯者次之佔26.1%，再依次為濕熱下注(20.5%)，此三型共佔2/3以上比例，其於中醫病理上皆屬瘀滯相關病因所引起，氣血循環不良為其病因中之通性。 第二部份臨床常用中藥痛經方劑之研究，以桃紅四物湯、桂枝茯苓丸、當歸芍藥散、生化湯、加烏藥湯、通痢煎、當歸四逆湯、延胡索湯、溫經湯、小建中湯、加味逍遙散、八珍湯等十二種方劑之 50%酒精萃取物，對大白鼠離體子宮進行評估，結果顯示生化湯、溫經湯、當歸芍藥散對自發性子宮平滑肌收縮無統計上明顯之影響，但對PGF2a誘導之收縮卻呈有意義之抑制。乃進一步以 ACh、Ergonovine、Propranolol、Oxytocin、高鉀去極化誘導子宮平滑肌收縮，探討方劑之拮抗活性，與對鈣離子管道之作用；結果顯示三方劑於子宮平滑肌皆有多重作用點特性，而其PGF2a與ACh之拮抗特性與痛經治療用藥-NSAIDs與Acetylcholine antagonist有相似作用，而與KCl之拮抗 作用則有穩定子宮平滑肌細胞膜電生理性質的作用，可降低膜電位變化所產生收縮，有穩定子宮平滑肌細胞膜電生理性質的特性，應為治療痛經時療效相關之作用點。

關鍵字

痛經 ； 問卷調查 ； 離體子宮 ； 中藥方劑

並列摘要

Dysmenorrhea is a common gynecologic complaint. After their first menstrual period, 30-60% of American women suffer from some level of discomfort. It is estimated that 6 billion work hours are lost in this manner every year in the U.S. - which equals to an economic loss near US $200 million. Dysmenorrhea is not only a problem for women but one which also affects quality of life and even reduces productivity. Dysmenorrhea is directly related to elevated levels of PGF2-alpha (prostaglandins F2-alpha) and it was managed by using Nonsteroidal anti-inflammatory drugs in Western medicine. Though efficacy of the latter is rapid, there are many side effects to the liver, kidney, and digestive system. The anti-inflammatory effect is short term and such drugs are unable to provide long term cure. Because of this, Chinese medicine therapy is being considered as a feasible alternative. The experience of generations of our ancestors vouches for its efficacy and it now requires the formal recognition of modern medical science.In this regard, there has been little formal research on the clinical application of Chinese prescriptions for dysmenorrhea and it motivated us to design this project. The project was divided into two stages. In the first stage, a questionnaire survey, with statistical analysis, was conducted upon adolescents. The project investigated the percentage and severity of menstrual pain within this group. We also used traditional Chinese medical diagnosis to develop additional information for the reference of public health and clinical research. In the second stage, 12 frequently used classical Chinese medicine prescriptions were selected. A 50% alcohol solution was used to extract active ingredients and create a freeze-dried product. This was applied to subside in vitro spontaneous contraction and prostaglandins F2-alpha induced contraction of rat uterine smooth muscle. An assessment was performed to empirically determine the efficacy of the individual prescriptions. We used Acetylcholine, Ergonovine, Propranolol Oxytocin, and KCl for analyzing the physiological mechanisms of these prescriptions.The results suggest that Anti- PGF2-alpha and ACh are the major mechanism for treating dysmenorrhea of Dang-Gui Shao-Yao San, Wen-Jing Tang and Sheng-Hua Tang. And the Anti-KCl-depolarization contraction maybe the auxiliary mechanism of the curative effect.

並列關鍵字

Dysmenorrhea ； Questionnaire ； In Vitro Uterus ； Traditional Chinese Prescription

參考文獻

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