痛經的病因病機及中醫辨證分型治療文獻探討

Dysmenorrhea: A Study on Its Etiology, Pathomechanism, and Literature of Traditional Chinese Medicine (TCM) Pattern Identification and Treatment Administration

本文主要目的是在探討痛經的病因病機及中醫的辨證分型及臨床治療。痛經是婦科常見病之一，常可持續多年或多日。發生下腹部不適疼痛嚴重影響日常生活和勞動的，叫「痛經」。常伴有頭暈、噁心、嘔吐、腰酸痛、全身無力等。現代醫學認為，子宮合成和釋放前列腺素的增加是原發性痛經的重要原因，尤其是前列腺素F2α（PGF2α）增高，前列腺素E2（PGE2）下降時疼痛加劇。研究發現PGF2α可刺激子宮收縮，而PGE2可使子宮平滑肌鬆弛當PGF2α異常升高時，子宮過度收縮，引起子宮血流不足，子宮肌肉組織缺血，刺激子宮自主神經疼痛纖維而發生痛經，這也符合中醫「不榮則痛」的理論。中醫治療痛經辨證分型主要可分為以下幾種證型，痛經病因有氣滯血瘀、寒凝胞中，濕熱下注、氣血虛弱、肝腎虛損等；根據文獻研究顯示，痛經以肝鬱氣滯型和寒凝血瘀型最為多見。痛經病機可歸為血瘀二字，治宜活血化瘀為主，根據不同的病因，適當配伍補益藥、理氣藥、溫裡藥或清熱藥等。

The focus of this study was on the etiology, pathomechanism, as well as traditional Chinese medicine (TCM) pattern identification and administration of clinical treatment for dysmenorrhea. Dysmenorrhea is one of the most common clinically presenting conditions in gynecology, and one that can persist for days and years. It presents with discomfort or excessive pain in the lower abdomen around the time of menstrual periods that can seriously disrupt daily life and work, often accompanying with symptoms including dizziness, nausea, vomiting, backache, and general weakness. The modern medical perspective is that an increase in the synthesis and release of prostaglandins by the uterus is a main factor in primary dysmenorrhea. Specifically, the severity of pain is intensified as a result of an increase in prostaglandin F2α (PGF2α) and a decrease in prostaglandin E2(PGE2). Research has revealed that PGF2α can stimulate uterine contraction and PGE2 can cause uterine smooth muscle dilation. Thus, an abnormal increase in PGF2α leads to excessive uterine contractions that induces inadequate blood flow to the uterus and uterine muscle ischemia, which in turn stimulates the autonomic nervous system pain fibers in the uterus causing dysmenorrhea. This pathomechanism is also congruous with the TCM theory of 'insufficient blood flow causes pain.' TCM treatment of dysmenorrhea pattern identification can mainly be divided into the following pattern types: the etiology of dysmenorrrhea consists of qi stagnation and blood stasis, cold congealing in the uterus, damp-heat pouring downward, qi and blood vacuity, and liver and kidney vacuity detriment. Research studies indicate that dysmenorrhea most commonly presents as 'liver depression, qi stagnation' pattern and 'cold congealing, blood stasis' pattern. However, blood stasis is the most important factor involved in the pathomechanism of dysmenorrhea with the administration of medicinals that promote blood and resolve stasis the primary treatment. Other medicinals, such as those that supplement, rectify qi, warm the interior, and clear heat can be added based on the individual patient's condition.