傅青主肝鬱致胎產病症病理機轉之探討

The Study of 'Fu Qing Zhu Gynecology' about the Etiology and Pathogenesis of Stagnation Syndrome

鬱症是中醫辨證理論相當重要的課題，本文主旨在探討《傅青主女科》中肝鬱病機所致胎產的相關病症。材料與方法：本文以人民衛生出版社2006年出版之《傅青主女科》為研究資料藍本，以關鍵字「肝」、「鬱」、「肝氣」做全文搜尋，將傅青主於種子、妊娠、正產、難產、小產及產後六門胎產相關病症條文，彼此做交叉比對分析，探求傅青主對肝鬱病機致胎產病症的觀點。結果：《傅青主女科》中，胎產病症六門49條條文中，鬱症相關條文占了8條，分別是身瘦不孕、嫉妒不孕、妊娠惡阻、妊娠子懸脅疼、妊娠多怒墮胎、大怒小產、產後四肢浮腫、產後鬱結乳汁不通，至於正產門及難產門則未列有肝鬱相關病機者。討論：肝鬱病機對胎、產、育的病症有一定的影響，輕則不孕，重則胎墮，而且有肝鬱體質的婦女，一旦懷孕了，從早期的妊娠嘔吐及懷孕期的脅痛，即便是產後也仍會發生四肢浮腫、奶水不足或腫脹乳腺炎等嚴重影響生活品質的病症；房事後不舒服為診斷肝鬱導致不孕的重要症狀，而嫉妒會閉塞胞胎之門，兩者應納入中醫不孕症問診及常規衛教之中。結論：《傅青主女科》治療肝鬱的思想及辨證，與現今生活型態下婦女的諸多病症，頗為合拍，實具有臨床診病很高的參考價值，而防治肝鬱致胎、產、育諸病症之良法，宜由調經做起。

tagnation syndrome is a very important topic in the concept and proof of Traditional Chinese Medicine (TCM). This article aims to explore the ”Fu Qing Zhu Gynecology” discourse on stagnation syndrome and the derivation of the etiology and pathogenesis related to women's childbirth diseases.This research article is based on the book Fu Qing Zhu Gynecology published in 2006 by People's Medical Publishing House. The search showed that in the six childbirth related chapters in Fu Qing Zhu Gynecology, there were a total of 49 syndrome clauses in discourse and among there, 8 clauses were related to the stagnation syndrome.The pathogenic mechanism of liver stagnation has certain impact on diseases pertaining to fertility, pregnancy, and childbirth, including infertility and abortion. Any woman with liver stagnation who later becomes pregnant will occur many syndromes affect the quality of life. One important symptom that could be used to diagnose infertility due to liver stagnation is the discomfort after intercourse. Besides, jealousy could also lead to infertility. Both of these should be covered in Traditional Chinese Medicine during physician consultation on infertility and during routine health education. It is very likely that liver stagnation coexists with other disease mechanisms, which leads to an oblivion, of its pathogenic impact during diagnosis in Tradition Chinese Medicine.The concept as well as its proof about liver stagnation and its treatment in Fu Qing Zhu Gynecology are in general agreement with the diagnoses of many modern woman disease symptoms nowadays. They are highly valuable as a reference to clinical diagnosis of gynecological diseases. In essence, the concept suggests that the best preventative treatment of fertilization, pregnancy and childbirth disease symptoms, included by liver stagnation should always start with the optimization of menstruation.