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中医药研究论丛
 222.13 中西医治疗高泌乳素血症引起月经失调之病案报告
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TJ TCM.22(2) : 125-138, 2019
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中西医治疗高泌乳素血症引起月经失调之病案报告
A Case Report in the Treatment of Hyperprolactinemia Induced Menstrual Disorder with Traditional Chinese and Western Medicine
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林佳瑜1 黄中瑀1*
1 台北市立万芳医院传统医学科，台北，台湾
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【摘要】
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在现代的社会，临床上越来越多见女性於非怀孕期因泌乳素(prolactin;PRL) 分泌过度导致高泌乳素血症(hyperprolactinemia; HPRL)，并出现月经失调、溢乳(galactorrhea) 甚或不孕的疾病。引起HPRL 主要的病因有垂体泌乳素瘤(prolactinoma)、药物引发、甲状腺功能低下或多囊性卵巢症候群(polycystic ovary syndrome; PCOS) 等。虽然目前西医主以内服治疗药物－多巴胺受体激动剂(dopamine agonists; DA agonists) 作为首选治疗方式，但其会有服药後噁心、头晕、便秘或姿势性低血压等副作用及停药後复发率较高的问题。本文以传统中医理论及病案分析来阐述高泌乳素血症发生的病因病机，认为肝、脾、肾三脏的功能失调是导致气血失和，气机逆乱以致此病的基本病因病机，而肝气郁结则是贯穿整个病程的关键病机。在中药治疗上则多以补虚泻实、标本同治为主，故以“补肾疏肝、健脾养血、理气活血”为基本治疗原则，且可根据各兼夹证酌予中药加减组合来调治，以达到抑乳调经的目的，并希望藉由中药的治疗，能减低西药使用剂量及副作用，且改善停服西药後复发率偏高的问题。
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【关键词】高泌乳素血症、泌乳素、溢乳、月经失调、中药治疗
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Chia-Yu Lin1Chung-Yu Huang1*
1Department of Traditional Chinese Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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【Summary】
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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.
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【Keywords】Hyperprolactinemia (HPRL), Prolactin (PRL), Galactorrhea, Menstrual disorders, Traditional Chinese Medicine (TCM)
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