保產無憂方適應症與藥理作用之文獻探析

Review: The Indication and Pharmacological Effects of Baochan Wuyou Decoction

保產無憂方為台灣坊間盛傳能安胎與順產的藥方，由十三味中藥組成，是許多中醫師與中藥房常用的方劑。然而，臨床上使用保產無憂方之後出現子宮出血、胎動不安、甚至小產的案例卻時有所聞。有鑒於此，本文搜尋現代醫學安胎的作用機轉、姙娠期生理變化、中藥藥理學等相關文獻，以探討本方的適應證與藥理作用。總結本方的整體功效在於行氣活血，適用於中醫辨證中氣滯血瘀證型的婦女，諸如在西醫診斷中的免疫異常與易凝血體質等。由於姙娠過程中，孕婦生理上會自動調節為過度凝血體質，於姙娠末期至臨盆期間有造成靜脈栓塞的風險。因此，本方適用時機為第三姙娠期至產後初期之間，可藉以防止血栓生成，並有催生助產之功效。在藥理作用方面，文獻顯示方中的當歸、枳殼、貝母、生薑、甘草具有促進宮縮的效果；當歸、艾葉、菟絲子、甘草有抗孕激素活性；當歸、川芎、白芍、羌活、貝母、枳殼、生薑有促進子宮出血作用，因此本方不宜孕婦長期服用。若孕婦姙娠過程順利，實無服用此方安胎之必要。如有胎動腹痛、子宮出血等先兆性流產跡象，更不建議服用此方。

Baochan Wuyou decoction, a widespread herb formula applied to tocolysis and eutocia, is composed of 13 kinds of crude herbs and is a popular tocolytic agent prescribed by traditional herbal physician and herbs pharmacy. Unexpectedly, uterine hemorrhage, excessive fetal movement and even miscarriage often occurred in some cases treated with this herb formula. The objective of this review article is to investigate indications and pharmacological effects of Baochan Wuyou decoction on the basis of tocolytic mechanism, physiologic changes during normal pregnancy and herb pharmacology. About the indication, the overall drug efficacy of this decoction is qimoving and blood-activating, which can be applied to women with syndrome of qi stagnation or blood stasis, such as immune dysfunction and thrombophilia. Pregnant women are in a physiologically hypercoagulable state, probably at an increasing risk of venous thromboembolism during the period between the late stage of pregnancy and labor. Thus, the herb medication is adapted for preventing thrombus formation and expediting fetus delivery during the period between third trimester and early postpartum. There are several reports about the potential pharmacological effects of this decoction. To sum up, including Angelica sinensis, Citrus aurantium, Fritillaria cirrhosa, Zingiber officinale, Glycyrrhiza uralensis, these five herbs were found that could induce unexpected uterotonic activities. These four species, including Angelica sinensis, Artemisia argyi, Zingiber officinale, Glycyrrhiza uralensis, were recognized to have anti-progestogenic activities. And, these six herbs including Angelica sinensis, Ligusticum chuanxiong, Paeonia lactiflora, Notopterygium incisum, Fritillaria cirrhosa, Notopterygium incisum, Zingiber officinale, may increase the risk of hemorrhage. Thus, Baochan Wuyou decoction is not a proper prescription for long-term use during pregnancy. If there are symptoms of threatened miscarriage, such as abdominal cramps and vaginal bleeding, this herb formula would never be recommended.