中醫治療妊娠腹瀉之病例報告

Treatment of Diarrhea in Pregnancy：A Case Report

妊娠腹瀉的用藥對於懷孕婦女是一個難題，長期的腹瀉會導致孕婦體力的消耗，從而影響胎兒的營養狀況。我們報導這位34 歳的孕婦，過去有子宮內膜異位瘤及子宮肌瘤的病史，2011 年4 月因為胎兒無心跳而接受引產手術，2011 年12 月20 日中醫門診時已懷孕9 週，G2P0A1，這次懷孕前的最後一次月經是2011/10/12。病患主述最近一周出現持續每日4 次的水瀉，西醫給予Buscopan 和loperamide 治療效果雖有改善，然腹瀉症狀仍持續且有腹脹的症狀，因此前來中醫門診尋求治療，中醫辨證為脾腎虧虛，脾虛溼盛，氣血不足，治則為健脾益氣升陽除濕，補氣養血固腎安胎，處方以胃苓湯合保產無憂方為主，治療胎兼癥瘕之腹瀉，服藥一周後腹瀉即明顯改善。由此病例我們探討一位素有癥瘕之妊娠婦女造成腹瀉可能的機轉與中西醫治療妊娠腹瀉所應注意的事項。

The prescription of diarrhea during pregnancy is a difficult problem. Long term diarrhea will induce the malabsorption of the pregnant women and fetus. We reported a 9-week pregnant woman who had a previous history of endometriosis and myoma presenting of severe diarrhea. She had underwent termination of pregnancy for absence of fetal heart beat by ultrasound on 2011/4 (G2P0A1). This time she complained of severe diarrhea and abdominal bloating for a week and had been treated with Buscopan and loperamide. The symptom of diarrhea improved after the Western Medicine (WM) treatment however the abdominal bloating and diarrhea persisted so she visited the clinic of traditional Chinese Medicine (TCM) for further treatment. The syndrome differentiation by the TCM was pattern of spleen-kidney-qi-blood deficiency with dampness encumbrance. The principle of treatment were used the medicine that could dry dampness to fortify the spleen and kidney combined with regulate qi and nourish the blood to treat the diarrhea with aggregation accumulation. Symptoms of diarrhea and related gastrointestinal disorders relieved obviously after one week treatment as expected. From this case report, we elucidated the mechanism of the diarrhea during the pregnancy with endometriosis from the point of view of TCM and WM for the purpose to provide the clinical experience and evidence.