痛經病例討論──四君子湯臨床運用之經驗

Herbal product (Sijunzi Tang and its derivatives)as an alternative treatment for dysmenorrhea—a case report

四君子湯出自於宋朝《和劑局方》一書，是治療氣虛的總方，主要功用為健脾益氣，可以治療氣虛所引起之各種症狀；另一方面，從中醫的角度來看痛經的形成原因有許多種，其證型大致可分為：氣滯血瘀型、寒濕凝滯型以及氣血兩虛型等三大類型。氣虛型痛經可表現在原發型痛經及繼發型痛經。我們發現，在臨床上用四君子湯或是其變方（如：六君子湯）來治療氣血兩虛型或是氣虛有痰的痛經症有極佳的療效。一般臨床經驗原發型痛經較繼發型痛經易治快好，雖然四君子湯能改善氣血兩虛型的病症，對於臨床中醫師或許並不意外，但實際研讀婦科古籍後發現，歷代鮮少提及用四君子湯加減治療痛經的論述。另外，由本醫案可知，雖由刺激排卵製劑導致術後子宮腺肌症復發之痛經，若辨證仍屬氣血兩虛型，則用四君子湯加減方的六君子湯亦可達到不錯的療效。故無論其為原發型痛經或繼發型痛經，由本文兩個醫案顯示，異病同治是中醫治療學上非常獨到的一面。

Sijunzi tang (Tai Ping Hui Min He Ji Ju Fang ) is an assembled formula for qi vacuity. In generally, Sijunzi tang has function not only in strengthening the spleen and replenishing qi but also in treating various kinds of symptoms from the qi vacuity. “Zheng” is the unique theory of diagnosis and treatment in traditional Chinese medicine (TCM). Based on TCM ancient theory, dysmenorrhea was divided into three types such as qi-stagnation-blood-stasis, cold-damp-stagnation and qi-blood-bothdepletion. No matter what primary or secondary dysmenorrhea could cause by qi-depletion type. From our clinical observation, there were good effects on treating both qi-blood-both depletion and qi-depletion with phlegm by applying Sijunzi tang or its derivations (such as Liujunzi tang). According the previous experience, the effect of herbal remedies in treating primary dysmenorrhea is superior in treating secondary dysmenorrhea. It’s hardly surprising that Sijunzi tang can relieve the painful menstruation caused by primary dysmenorrhea. A matter worthy of note from a case of postoperative adenomyosis treated with ovulation induction treatment, her recurrence of severe dysmenorrhea had successfully relieved by applying 4-week Liujunzi tang. Aside from the classification of dysmenorrheal in conventional medicine, these two cases shown that pattern identification of TCM might be a considerable guide in treating painful menstruation which was either caused by primary or secondary dysamenorrhea.