中西醫治療高泌乳素血症引起月經失調之病案報告

A Case Report in the Treatment of Hyperprolactinemia Induced Menstrual Disorder with Traditional Chinese and Western Medicine

在現代的社會，臨床上越來越多見女性於非懷孕期因泌乳素（prolactin；PRL）分泌過度導致高泌乳素血症（hyperprolactinemia；HPRL），並出現月經失調、溢乳（galactorrhea）甚或不孕的疾病。引起HPRL主要的病因有垂體泌乳素瘤（prolactinoma）、藥物引發、甲狀腺功能低下或多囊性卵巢症候群（polycystic ovary syndrome；PCOS）等。雖然目前西醫主以內服治療藥物－多巴胺受體激動劑（dopamine agonists；DA agonists）作為首選治療方式，但其會有服藥後噁心、頭暈、便秘或姿勢性低血壓等副作用及停藥後復發率較高的問題。本文以傳統中醫理論及病案分析來闡述高泌乳素血症發生的病因病機，認為肝、脾、腎三臟的功能失調是導致氣血失和，氣機逆亂以致此病的基本病因病機，而肝氣鬱結則是貫穿整個病程的關鍵病機。在中藥治療上則多以補虛瀉實、標本同治為主，故以“補腎疏肝、健脾養血、理氣活血”為基本治療原則，且可根據各兼夾證酌予中藥加減組合來調治，以達到抑乳調經的目的，並希望藉由中藥的治療，能減低西藥使用劑量及副作用，且改善停服西藥後復發率偏高的問題。

In modern society, more and more women who are not pregnant have HPRL with high level of PRL and express menstrual disturbance, galactorrhea or even infertility in clinical. The major pathological causes of HPRL include prolactinoma, induced by medication, hypothyroidism or PCOS, etc. In western medicine, the first choice medical therapy is using DA agonists, but they may have side effects including vomiting, dizziness, constipation or orthostatic hypotension, etc. and also have high incidence of recurrence after drug withdrawal. This paper explains that the basic pathogenesis of HPRL is liver, spleen and kidney disharmony which inducing Qi and blood dysfunction and liver-Qi stagnation is the key mechanism through the whole disease course by traditional Chinese medicine (TCM) theory and a case analysis. In TCM treatment, we should give priority to reinforce insufficiency and reducing excessiveness and also treating both manifestation and root cause of disease. ＂Tonifying kidney and relief liver, tonifying spleen and nourishing blood, smoothing Qi and invigorating the circulation of blood＂ are the basic treatment law of HPRL and according to the other characteristics of disease pattern, properly use the Chinese herbs in the prescription which in order to recover milk secretion and stimulate menstrual flow. We also hope that taking Chinese medicine can reduce the dosage of western medicine and incidence of recurrence after drug withdrawal.