“肝主情志”与妊娠恶阻之关系浅析  

Analysis of the Relationship betw een"Liver Master Sentiment"and Hyperemesis Gravidarum

作　　者：关木馨 杨新鸣[2] 王宇(审校)[2] 卢凤娟 石百超 魏士焱 陈香楠 吴效科[2] GUAN Mu-xin;YANG Xin-ming;WANG Yu;LU Feng-juan;SHI Bai-chao;WEI Shi-yan;CHEN Xiang-nan;WU Xiao-ke(Graduate School,Heilongjiang University of Chinese Medicine,Harbin 150040,China;Department of GynecologyⅠ,The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学研究生院,哈尔滨150040 [2]黑龙江中医药大学附属第一医院妇一科

出　　处：《国际生殖健康/计划生育杂志》2025年第2期166-170,共5页Journal of International Reproductive Health/Family Planning

基　　金：2023年中医药循证能力提升项目([2023]24号);国家中医药传承创新中心项目([2022]366号);黑龙江省“头雁”团队——中西医结合妇科特色技术创新团队([2019]5号);黑龙江省中医药管理局2022年度中医药科研课题项目(ZHY2022-124)。

摘　　要：妊娠恶阻即妊娠恶心呕吐或妊娠剧吐,高达80%的孕妇受其影响,严重者甚至会导致胎儿生长发育异常。心理因素是其重要病因,情绪心理障碍与之双向作用,长期心理生理应激状态会增加患病风险,精神分析理论认为妊娠剧吐患者有潜在的精神问题,可转化为躯体症状。中医认为情志为肝所主,肝的生理特性及功能可调节心理应激反应,情志不畅、肝气郁逆则易引发妊娠恶阻。现代研究也证实抑郁、焦虑等心理因素与妊娠恶阻有关,可能因精神社会压力致胃肠功能紊乱诱发症状。中医治疗妊娠恶阻有清肝和胃、降逆止呕,润木达郁、平冲降逆、疏肝解郁、调和气血等方法,常用药物有黄连、苏叶、竹茹、姜半夏、陈皮、黄芩等,制方如加味温胆汤、橘皮竹茹汤、桂枝汤加味等。西医治疗中,良好伴侣支持可减轻妊娠恶心呕吐的严重程度,英国皇家妇产科医师学会指南强调评估妊娠期及产后心理健康状况,倡导多学科团队参与,正念解压法等心理干预可提高患者生活质量。The hyperemesis gravidarum refers to the nausea and vomiting of pregnancy or the hyperemesis related to pregnancy,affecting up to 80%of pregnant women,which even lead to the abnormal fetal growth and development in severe cases.Psychological factor are an important cause,and the emotional and psychological disorder has a bidirectional effect on the pernicious vomiting.The long term of psychological and physiological stress can increase the risk of illness.Psychoanalytic theory suggests that patients with pernicious vomiting have potential mental problems,and that these mental problems can be transformed into physical symptoms.Traditional Chinese medicine believes that emotions are governed by the liver,and the physiological characteristics and functions of the liver can regulate psychological stress responses.If emotions are not smooth and liver qi is depressed,it can easily lead to the pernicious vomiting.Modern research has also confirmed that psychological factors such as depression and anxiety are related to pregnancy disorders,which may be triggered by the gastrointestinal dysfunction due to psychological and social stress.Traditional Chinese medicine treatment for the hyperemesis gravidarum includes methods such as clearing the liver and stomach,reducing nausea and vomiting,moistening the wood,promoting diuresis,regulating the liver,relieving depression,and harmonizing qi and blood.The commonly used drugs include Huanglian,Suye,Zhuru,Jiangbanxia,Chenpi,Huangqin,etc.The formula includes the modified Wendan Tang,Jupi Zhuru Tang,Guizhi Tang,etc.In Western medicine treatment,good partner support can alleviate the severity of nausea and vomiting of pregnancy.The guidelines of the Royal College of Obstetricians and Gynecologists in the UK emphasize the assessment of mental health status during pregnancy and postpartum period,advocate multidisciplinary team participation,and use the mindfulness based stress relief methods and other psychological interventions to improve patients′quality of life.

关 键 词：妊娠恶阻 情志辨证 情绪调节 心理因素 从肝论治 

分 类 号：R271.4[医药卫生—中医妇科学]