痛經因子宮內膜異位（巧克力囊腫）中醫治療病例報告

A Case Report of Treating Dysmenorrhea Caused by Endometriosis with Chinese Therapies: Essence of TCM Evidence-Based Medicine

子宮內膜異位症不但會造成痛經，且為造成不孕的頭號殺手；卵巢巧克力囊腫則破壞卵巢機能，並具潛在破裂的風險，困擾著女性日常的生活品質。本案例為一位35歲患有子宮內膜異位症及卵巢巧克力囊腫的婦女，因數年來每次生理期時皆有嚴重腹痛的症狀，在結合中醫辨證、西醫辨病的方法後，診斷本個案為血瘀證合併心、肝火旺體質的痛經，訂出瀉心肝火、潤肺益陰的治則，在治療調理3個月的期間，以科學中藥粉搭配每週1次局部針刺（子宮、氣海、關元）及藥草薰蒸（氣海、關元及八髎穴），最後終以龍膽瀉肝湯、清心蓮子飲、清燥救肺湯及十味敗毒散為主要治方加減，解除多年來重度痛經不適的症狀。

Endometriosis is one of the prevalent diseases severely affect women's quality of life during childbearing ages. The symptoms of endometriosis include chronic pelvic pain, painful intercourses, abnormal uterine bleeding, painful menstruation, and decreased fertility. Plus, endometriosis combined with ovarian chocolate cyst can make illness condition worse. One of the most common clinical manifestations of endometriosis is painful menstruation or as it is called, dysmenorrhea which can negatively affect women's ability to work and reduce their self-confidence. This case reports a 35-year-old woman that had suffered from severe pain every period for many years. Physical examination and ultrasound examination confirmed an elastic hard mobile chocolate cysts measuring 7 x 7 cm in the right adnexa. Diagnosis of blood stasis and effulgent heart-liver fire were made based on the traditional Chinese medicine theory. Treatment according to syndrome differentiation, ”Long-Dan-Xie-Gan Tang”, ”Qing-Xin-Lian-Zi Yin”, ”Qing-Zao-Jiu-Fei Tang”, ”Shi-Wei-Bai-Du San” were prescribed in combination with acupuncture to purge heart-liver fire, moisten the lung, and replenish yin. Acupuncture and herbs fumigation were used to stimulate acupuncture points such as ”Zi Gong” (EX-CA 1), ”Qi Hai” (CV6), and ”Guan Yuan” (CV4) once a week. To her surprise, monthly severe pain in the pelvis area was disappeared after three-month treatment. We infer that Chinese herbal medicine in combination with acupuncture might be as an alternative therapy for relieving painful endometriosis.