中醫治療子宮肌瘤暨崩漏之病例報告

Uterine Leiomyoma with Metrorrhagia and Metrostaxis Treated with Traditional Chinese Medicine: A Case Report

子宮肌瘤是婦女生殖系統最常見的良性腫瘤，生育年齡的婦女患有子宮肌瘤的機會約達50%，因其造成的不正常的子宮出血是子宮切除常見的原因。子宮不正常出血在中醫證屬崩漏之範疇，《諸病源候論》：「忽然暴下，謂之崩中。」「非時而下，淋漓不斷，謂之漏下。」本病例於2008年6月診斷有子宮肌瘤（肌瘤大小：9.0×7.2×8.4cm）。同年10月症見腹脹明顯，下腹部可觸及一腫塊；經婦科超音波追蹤，肌瘤體積變大（2008年10月27日肌瘤大小：10.8×11.5×8.6cm）。患者於同年11月至中醫門診，主訴月經量多，經來十二日未止。中醫診斷崩漏，證屬衝任損傷，血海失固，氣隨血脫，肝腎陰虛。給予芎歸膠艾湯、一貫煎加減，以急則補氣養血，升提止血；緩以滋養肝腎為法。並於月經來時佐以生化湯加減，經治療後陰道排出肉塊，肌瘤體積縮小（2008年12月1日肌瘤大小：6.5×7.6×6.2cm）。患者持續治療，崩漏症狀緩解，且肌瘤體積持續縮小（2008年12月19日肌瘤大小：5.5×6.0×5.9cm），為一中醫治療子宮肌瘤暨崩漏的有效臨床案例。

Uterine leiomyoma is by far the most common benign uterine tumor. Asymptomatic uterine leiomyoma clinically apparent in approximately 40 to 50 percent of women older than 35 years of age. The most frequent indications for hysterectomy was abnormal uterine bleeding caused by leiomyoma. The symptoms of abnormal uterine bleeding in Traditional Chinese Medicine pattern is metrorrhagia and metrostaxis. A patient diagnosed as uterine leiomyoma measuring 9.0×8.4×7.2 cm in size on June 30, 2008 presented abdominal distention. In October, a palpable mass at the ultrasonography revealed enlarged size of uterine leiomyoma measuring 11.5×10.8×8.6 cm in size. This patient looked for TCM care in Nov. 2008 and complained of massive uterine bleeding that lasting for twelve days. The diagnosis of TCM was metrorrhagia and the pattern was damage to the thoroughfare and conception vessels, sea of blood losing control, qi collapse following bleeding and liver-kidney yin deficiency. The TCM doctors treated with xiong gui jiao ai tang and modified formula of yi guan jian. This treatment for the acute condition could tonify qi and blood to upraise the qi and arrest bleeding while for the chronic condition could nourish and tonify the liver and the kidney and also treated the patient with modified formula of Sheng Mai San during menstruation. After this treatment, myomatous tissue fragments were delivered via vagina and the size of myoma decreased (the myoma size was 6.5×7.6×6.2 cm on Dec. 1, 2008). The patient continues to be treated by TCM care and the metrorrhagia and metrostaxis condition is in remission and the myoma size also continues becoming smaller (the myoma size was 5.5×6.0×5.9 cm on Dec. 19, 2008). This is an effective clinical medicine case of TCM treatment for uterine leiomyoma with metrorrhagia and metrostaxis.