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
 
Yi-Jie Wu1Chiung-Hui Hsieh2Ting Chiu3*
1Chyuan An Tarng Chinese Medicine Clinics, New Taipei, Taiwan
2,3Department of Chinese Medicine, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
【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