中医药研究论丛

254.6 由子宫内膜异位症病案一例探讨龙胆泻肝汤对血清CA-125指数之影响

TJ TCM.25(4) : 59-70, 2022

DOI : 10.6516/TJTCM.202212_25(4).0006

由子宫内膜异位症病案一例探讨龙胆泻肝汤对血清CA-125指数之影响

Endometriosis with High Level of CA-125 Treated with Traditional Chinese Medicine and Influenced by its Dosage: A Case Report

吴宜洁1 谢琼慧2 邱亭3*

1泉安堂中医诊所,新北市,台湾

2,3 台北市立联合医院中兴院区中医科,台北市,台湾

【摘要】
子宫内膜异位症是妇科常见的疾病,可导致痛经和不孕。而血清CA-125广泛地作为子宫内膜异位症的肿瘤生物标记,可用作追踪子宫内膜异位症治疗成效及术後复发的叁考。本病例为31岁患有子宫内膜异位症(左侧巧克力囊肿)的女性,因长期有经痛及带下黄稠的症状,且CA-125指数偏高,经中医辨证论治,诊断为肝气郁结,湿热瘀阻,使用科学中药龙胆泻肝汤及桂枝茯苓丸合方加减治疗後症状改善且CA-125下降,但在桂枝茯苓丸剂量不变之下,随着龙胆泻肝汤使用剂量下降至3g╱天时,经痛等症状加重且CA-125指数又上升。此治疗经验显示3g╱天以下无法有效改善患者湿热下注的情形,故瘀热内阻症状又再起,反映在CA-125指数方面,则是数值再度升高,但仍需更多研究及病例追踪探讨之。
【关键词】子宫内膜异位症 ; 巧克力囊肿 ; CA-125; 龙胆泻肝汤 ; 剂量
【Summary】
Endometriosis, one of the common gynecologic diseases in women of reproductive age, may cause dysmenorrhea and infertility. Serum CA-125 is a valuable tumor biomarker in the evaluation of treatment and follow-up of recurrence in patients with endometriosis and initially elevated CA-125 level. This case is a 31 y/o female who was diagnosed as? endometriosis with dysmenorrhea, yellowish vaginal discharge, and elevated CA-125 level. According to TCM’s theory, the patient was diagnosed with Qi Stagnancy in Liver and the blockade of damp-heat and static blood. After the prescription of Longdan Xiegan Tang and Guizhi Fuling Wan, which was aimed to relieving Qi stagnancy in Liver, clearing damp-heat, and promoting blood circulation, the patient’s symptoms and CA-125 level has improved. However, when the dosage of Longdan Xiegan Tang decreased, the patient’s dysmenorrhea became severe, and CA-125 level elevated again. Therefore, we deduced that the symptoms of blockade of damp-heat and static blood could not be improved, so the CA-125 level elevated again when the dosage of Longdan Xiegan Tang being reduced to 3g/day. But it is still necessary to observe more cases and studies for actual conclusion.
【Keywords】
Endometriosis ; chocolate cyst; CA-125; Longdan Xiegan Tang; dosage