加味越鞠丸治療月經後肛門疼痛之病例報告

A Case Report of a Patient with Proctalgia as the Dysmenorrhea Performance by Jiawei Yuejuwan Powder

痛經症是婦科常見疾患，但痛經症的表現不僅止於下腹疼痛，肛門不適感也是一特殊表現，包括肛門墜脹或脹痛感覺，此點不論在原發性痛經或繼發性痛經皆可能發生。本病案描述一位36歲女性2年多來於每次月經欲結束時即發生劇烈肛門痛，接受西醫婦產科檢查，從一開始被認為是原發性痛經，隨著病情逐漸加重最後被懷疑是子宮內膜異位症。後來經由中醫辨證論治發現患者屬氣滯體質合併肝氣鬱結，進而引起肝氣橫逆乘脾犯胃，並導致大腸氣滯。治療採取行氣為主，疏肝理氣並且兼調脾、胃、大腸氣機為輔。遂以越鞠丸統治六鬱並以治氣鬱為主；延胡索及香附加強行氣活血；左金丸並竹茹、枇杷葉、陳皮著重顧護中焦之功。患者在接受中藥治療約兩個月時間即明顯改善肛門痛現象，幾乎已無疼痛感，也不須再服用止痛藥。

Dysmenorrhea is a common gynecological disorders, but the symptom of dysmenorrhea is limited to not only abdominal pain, but also anal uncomfortable feeling, these are likely to occur both in primary dysmenorrhea or secondary dysmenorrhea. This case report is regarding a 36-year-old woman, 2 years ago, in the end of menstrual, having severe proctalgia. Using western obstetrics and gynecology examination technology, the patient was considered the beginning of primary dysmenorrhea, as patient's condition getting worsened, she was suspected to be getting endometriosis. Later, by Traditional Chinese Medicine Treatment diagnosis, this patient was classified into stagnancy of qi stasis, combined with depression of liver-energy and then abnormal rising of liver-energy, resulting in hepatic qi invades both spleen and stomach. Major treatment is to promote vital energy circulation, then disperse the depressed liver-energy and rectify it and recuperate qi movement in spleen, stomach and large intestine, Therefore, using Yuejuwan Powder to cure six kinds of stasis and depressed vital energy; Yan-hu-suo and Xiang-fu to promote vital energy and blood circulation; Zuojinwan Powder, Zhu-ru, Pi-pa-ye and Chen-pi to protect and look after middle warmer. The patient’s symptoms such as proctalgia has significantly improved after 2 months treatment and almost no longer feeling pain. She does not have to take painkillers.