當歸芍藥散臨床應用於婦科疾病之探討

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標題:	當歸芍藥散臨床應用於婦科疾病之探討 Study of Application for Gynecological Disorders by Dang-Gui-Shao-Yao-San
作者:	杜思範
貢獻者:	藥學系呂玉玲
關鍵字:	當歸芍藥散全民健康保險學術研究資料庫痛經症子宮內膜異位症 Endometriosis Dang-Gui-Shao-Yao-San(DGSYS) Dysmenorrhea National Health Insurance Research Database(NHIRD)
日期:	2016
上傳時間:	2016-12-21 15:35:41 (UTC+8)
摘要:	歷史悠久的中藥方劑「當歸芍藥散」(Dang-Gui-Shao-Yao-San) 即是出自東漢年間，醫聖張仲景所著《金匱要略》。由兩組藥物組成，一為血分藥：當歸、芍藥、川芎；一為氣分藥：茯苓、白?、澤瀉；諸藥相合，共奏養血疏肝，健脾利濕，通暢血脈，和血利水，為婦科良方。本研究的目的係藉由全民健康保險學術研究資料庫分析當歸芍藥散治療婦科疾病臨床上之相關應用。由西元2005年1月至2007年12月份之中醫門診處方及治療明細檔(CD檔)、中醫門診處方醫令明細檔(OO檔)等資料，將有使用當歸芍藥散治療之女性病患納入分析調查。資料分析以Statistical Product and Service Solutions（SPSS／12.0）統計軟體進行描述性統計分析。本研究結果顯示，這三年間使用當歸芍藥散的女性病患共有11860人。統計結果發現於中台灣的使用比率最高，診所則是開立當歸芍藥散最多的醫療院所。然而，中醫師最常使用當歸芍藥散治療11～50歲的女性患者，並且給予4～7日份的藥量。研究結果發現當歸芍藥散在臨床上，主要用於痛經症、月經異常、月經週期不規則、無月經、白帶等婦科疾病，如此也證實，當歸芍藥散對於女性一生經歷「經、帶、胎、產」，這四個時期有其重要性。研究結果也發現使用當歸芍藥散治療痛經的人，相對於無尋求中醫就診的人有較低的子宮內膜異位症罹病機率（5.30% vs. 8.57%）。現在醫學指出當歸芍藥散具有抗發炎，鎮痛，抑制子宮平滑肌收縮，雙向調節下視丘－卵巢之功能。正與中醫師以活血化瘀的方法，調理「不通則痛」，「不榮則痛」之痛經症或是子宮內膜異位症之理論有不謀和合之處，因此使用當歸芍藥散來長期調理女性是可行的。本研究受限於資料庫所提供資訊，所以無法明確的知道當歸芍藥散治療婦科疾病的療效與安全性。因此，建議設計一個隨機、雙盲、與安慰劑對照的臨床試驗，來長期追蹤當歸芍藥散的藥效與安全性評估。 Dang-Gui-Shao-Yao-San（DGSYS）is a widely used formula of traditional Chinese medicine（TCM）, it derived from “Jingui Yaolue,” a medical classic written by Zhongjing Zhang during the Eastern Han Dynasty. DGSYS has been used in gynecological disorders for thousands of years. It contains two groups of drug, one is a blood-activating ( Angelica ,White peony, Chuanxiong ), the other is stasis-eliminating drug(Hoelen, Bighead atractylodes, Alisma). The aim of this study is to explore DGSYS of clinical indications for gynecological disorders by National Health Insurance Research Database (NHIRD). We analysis medical records from 2005 to 2007 of NHIRD which treat gynecological disorders for women by DGSYS. The statistical analysis used SPSS/12.0 statistical software. The results of analysis present 11860 females used DGSYS from 2005 to 2007,which have clinical effect. The results show the highest utilization rate of DGSYS for the clinic are central Taiwan, and the administration age is mainly in the 11～50 years old female patients and treatment duration is 4～7 days. It usually was used in clinical to treat female’s dysmenorrheal, menstrual abnormalities, irregular menstrual cycles, no menstruation, vaginal discharge and many other gynecological disorders. So, we predict that DGSYS is important in female’s physiological uncomfortable period. It could reduce gynecological disorders, such as menstruation, leucorrhea, pregnancy and childbirth. In fact, The patients using DGSYS to treat dysmenorrhea comparing than unused TCM patients has lower incidence of endometriosis (5.30% vs. 8.57%). The modern medicals indicate DGSYS have anti-inflammatory; analgesic; inhibit uterine smooth muscle contraction and regulate both the hypothalamus - ovarian function. Activating blood stasis method in Traditional Chinese Medicine（TCM） also has same treatment of dysmenorrhea or endometriosis.Therefore, the DGSYS was used to women for long-term Conditioning is feasible. However, DGSYS therapeutic effectiveness and safety evaluation analysis was not provided in this study. Further well-designed, randomized, double-blinded and placebo-controlled clinical trials are still needed to elucidate this problem in the future.
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