中西医治疗妊娠恶心呕吐的进展

doi:10.12280/gjszjk.20250045

摘要/Abstract

摘要：

妊娠恶心呕吐（nausea and vomiting of pregnancy，NVP）是妊娠期女性最常见的并发症，西医认为其发病与遗传、激素、幽门螺杆菌以及社会心理等因素有关，治疗常用多西拉敏/吡哆醇、异丙嗪、甲氧氯普胺、昂丹司琼、加巴喷丁和糖皮质激素等药物。尽管药物能显著改善NVP症状，但其可能对母体和胎儿健康产生影响，这也引发了孕妇对妊娠早期用药的担忧。中医认为冲气上逆、胃失和降是其主要病因病机，以调气和中、降逆止呕为治疗原则，既可通过辨证论治开具中药口服汤剂，又可灵活运用针刺、穴位注射、穴位贴敷、穴位按摩、耳穴压豆、艾灸以及中药直肠滴入等中医外治方法，疗效确切。然而，目前关于中医疗法的临床研究样本量相对较少，这限制了对中医特色疗法的深入探索。未来应进一步深化中西医协同研究，为NVP患者提供更科学、个体化的诊疗选择。

关键词: 妊娠, 恶心, 孕吐, 妊娠剧吐, 治疗, 中西医结合疗法

Abstract:

Nausea and vomiting of pregnancy (NVP) is the most common complication among pregnant women. The pathogenesis is related with genetics, hormones, Helicobacter pylori, and social psychological factors in the theory of Western medicine. Doxylamine/pyridoxine and other oral drugs are commonly used for treatment, including promethazine, metoclopramide, ondansetron, gabapentin, and glucocorticoids. Although these drugs can significantly alleviate NVP symptoms, the potential impact on the health of both mother and fetus has raised the concern among pregnant women, especially regarding the use of these medications in the first trimester. It is considered by Traditional Chinese Medicine (TCM) that the main etiology and pathogenesis of NVP is adverse rising of Chongqi, and disharmong of stomach qi. Based on the principle of regulating qi and harmonizing the middle, lowering counterflow and stopping vomiting in TCM treatment which not only prescribe oral decoction of TCM "varies from person to person" through syndrome differentiation but also flexibly use external treatment methods, such as acupuncture, acupoint injection, acupoint application, acupressure, auricular point pressing with bean, moxibustion and rectal instillation, have showed the remarkable efficacy. However, the relatively small sample sizes of clinical studies on TCM therapies have limited the in-depth exploration of these distinctive treatment approaches. In the future, it is imperative to further deepen the collaborative research between Western medicine and TCM to provide more scientific and personalized options for the diagnosis and treatment of NVP.

Key words: Pregnancy, Nausea, Morning sickness, Hyperemesis gravidarum, Therapy, Integrated Chinese traditional and Western medicine therapy

石百超, 王宇, 高敬书, 卢凤娟, 关木馨, 吴效科. 中西医治疗妊娠恶心呕吐的进展[J]. 国际生殖健康/计划生育杂志, 2025, 44(5): 416-423.

SHI Bai-chao, WANG Yu, GAO Jing-shu, LU Feng-juan, GUAN Mu-xin, WU Xiao-ke. Research Progress of Treating Nausea and Vomiting of Pregnancy with Traditional Chinese Medicine and Modern Medicine[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(5): 416-423.

参考文献 60

[1]	Zhu S, Zhao A, Lan H, et al. Nausea and Vomiting during Early Pregnancy among Chinese Women and Its Association with Nutritional Intakes[J]. Nutrients, 2023, 15(4):933. doi: 10.3390/nu15040933.
[2]	Maslin K, Dean C. Nutritional consequences and management of hyperemesis gravidarum: a narrative review[J]. Nutr Res Rev, 2022, 35(2):308-318. doi: 10.1017/S0954422421000305.
[3]	Lowe SA, Steinweg KE. Review article: Management of hyperemesis gravidarum and nausea and vomiting in pregnancy[J]. Emerg Med Australas, 2022, 34(1):9-15. doi: 10.1111/1742-6723.13909.
[4]	周燕, 卫爱武. 卫爱武从抑肝和胃论治妊娠恶阻经验[J]. 中医学报, 2022, 37(8):1671-1675. doi: 10.16368/j.issn.1674-8999.2022.08.304.
[5]	孙雪, 刘红, 张跃辉. 王秀霞教授治疗妊娠恶阻经验浅谈[J]. 光明中医, 2023, 38(2):241-243. doi: 10.3969/j.issn.1003-8914.2023.02.011.
[6]	赵威, 田凡, 张翠, 等. 张大伟教授治疗热证妊娠恶阻经验采撷[J]. 河北中医, 2024, 46(10):1596-1598,1603. doi: 10.3969/j.issn.1002-2619.2024.10.003.
[7]	Fejzo MS, MacGibbon KW, First O, et al. Whole-exome sequencing uncovers new variants in GDF15 associated with hyperemesis gravidarum[J]. BJOG, 2022, 129(11):1845-1852. doi: 10.1111/1471-0528.17129.
[8]	Fejzo M, Rocha N, Cimino I, et al. GDF15 linked to maternal risk of nausea and vomiting during pregnancy[J]. Nature, 2024, 625(7996):760-767. doi: 10.1038/s41586-023-06921-9.
[9]	Dekkers G, Broeren M, Truijens S, et al. Hormonal and psychological factors in nausea and vomiting during pregnancy[J]. Psychol Med, 2020, 50(2):229-236. doi: 10.1017/S0033291718004105. pmid: 30696502
[10]	Yldz G, Mat E, Kurt D, et al. Hyperemesis Gravidarum and Its Relationship with Placental Thickness, PAPP-A, and Free Beta-HCG: A Case-Control Study[J]. South Clin Istanb Eurasia, 2022,33:4. doi: 10.14744/scie.2021.93546.
[11]	Liu C, Zhao G, Qiao D, et al. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities[J]. Front Med(Lausanne), 2021,8:809270. doi: 10.3389/fmed.2021.809270.
[12]	Ng QX, Venkatanarayanan N, De Deyn MLZQ, et al. A meta-analysis of the association between Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum[J]. Helicobacter, 2018, 23(1). doi: 10.1111/hel.12455.
[13]	Rasin BH, Aboud RS. Association between Hyperemesis Gravidarum in Iraqi Women with Helicobacter pylori Infection[J]. Egyptian J Hosp Med, 2022, 89(1):5653-5659. doi: 10.21608/ejhm.2022.266022.
[14]	Shaban MM, Kandil HO, Elshafei AH. Helicobacter pylori seropositivity in patients with hyperemesis gravidarum[J]. Am J Med Sci, 2014, 347(2):101-105. doi: 10.1097/MAJ.0b013e31827bef91. pmid: 23459164
[15]	郭彩霞, 孙薇丽, 毛宇楠, 等. 刘宏奇教授治疗妊娠恶阻临证经验浅析[J]. 山西中医药大学学报, 2021, 22(1):55-56. doi: 10.19763/j.cnki.2096-7403.2021.01.15.
[16]	郭逸男, 李金燕, 陈小凤, 等. 邓高丕辨治妊娠恶阻经验[J]. 广州中医药大学学报, 2021, 38(11):2502-2505. doi: 10.13359/j.cnki.gzxbtcm.2021.11.035.
[17]	Wang M, Liu W, Ge J, et al. The immunomodulatory mechanisms for acupuncture practice[J]. Front Immunol, 2023,14:1147718. doi: 10.3389/fimmu.2023.1147718.
[18]	邓玲. 揿针疗法治疗脾胃虚弱型妊娠恶阻的临床效果[J]. 中国当代医药, 2022, 29(4):134-137. doi: 10.3969/j.issn.1674-4721.2022.04.036.
[19]	Lu H, Zheng C, Zhong Y, et al. Effectiveness of Acupuncture in the Treatment of Hyperemesis Gravidarum: A Systematic Review and Meta-Analysis[J]. Evid Based Complement Alternat Med, 2021,2021:2731446. doi: 10.1155/2021/2731446.
[20]	周瑞, 殷红梅, 刘春丽. 穴位注射治疗妊娠剧吐疗效观察[J]. 山西中医, 2024, 40(3):34-35. doi: 10.20002/j.issn.1000-7156.2024.03.012.
[21]	孙杨, 刘亚楠, 李丛珊. 间苯三酚联合内关穴位注射维生素B6治疗妊娠剧吐的效果分析[J]. 河北中医, 2024, 46(10):1708-1711. doi: 10.3969/j.issn.1002-2619.2024.10.026.
[22]	李子曦, 周荣生, 曹振平. 穴位贴敷联合铝碳酸镁及补液治疗妊娠剧吐疗效观察[J]. 安徽中医药大学学报, 2023, 42(1):59-63. doi: 10.3969/j.issn.2095-7246.2023.01.015.
[23]	左海红, 程文君, 郜丽晓, 等. 中药穴位贴敷联合西药治疗痰湿阻滞型妊娠恶阻临床研究[J]. 新中医, 2023, 55(16):164-168. doi: 10.13457/j.cnki.jncm.2023.16.032.
[24]	倪娇芳, 李吉英. 中药穴位贴敷疗法联合静脉补液治疗肝胃不和型妊娠恶阻[J]. 深圳中西医结合杂志, 2022, 32(8):30-33. doi:10.16458/j.cnki.1007-0893.2022.08.009.
[25]	Garcia GT, Ribeiro RF, Faria Santos IB, et al. Electrical Stimulation of PC 6 to Control Chemotherapy-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review and Meta-Analysis[J]. Med Acupunct, 2021, 33(1):22-44. doi: 10.1089/acu.2020.1431. pmid: 33613810
[26]	Tara F, Bahrami-Taghanaki H, Amini Ghalandarabad M, et al. The Effect of Acupressure on the Severity of Nausea, Vomiting, and Retching in Pregnant Women: A Randomized Controlled Trial[J]. Complement Med Res, 2020, 27(4):252-259. doi: 10.1159/000505637. pmid: 32018274
[27]	王新月, 霍森烨, 高妍, 等. 穴位按摩联合维生素B1、维生素B6治疗妊娠剧吐的临床效果观察[J]. 中国妇幼健康研究, 2025, 36(1):32-37. doi: 10.3969/j.issn.1673-5293.2025.01.006.
[28]	殷洁. 穴位按摩联合补液治疗妊娠剧吐的疗效观察[J]. 名医, 2021,(7):72-73.
[29]	Negarandeh R, Eghbali M, Janani L, et al. Auriculotherapy as a means of managing nausea and vomiting in pregnancy: A double-blind randomized controlled clinical trial[J]. Complement Ther Clin Pract, 2020,40:101177. doi: 10.1016/j.ctcp.2020.101177.
[30]	李思其. 耳穴压豆疗法治疗肝胃不和证妊娠恶阻的临床研究[D]. 沈阳: 辽宁中医药大学, 2022.
[31]	刘炜, 徐晓红. 艾灸辅助治疗重度妊娠呕吐的效果观察[J]. 基层医学论坛, 2019, 23(8):1136-1137. doi: 10.19435/j.1672-1721.2019.08.069.
[32]	汪婷婷, 柯雪爱. 温和灸联合基础补液治疗妊娠剧吐临床研究[J]. 新中医, 2021, 53(1):124-128. doi: 10.13457/j.cnki.jncm.2021.01.033.
[33]	陈妍, 胡珊, 宁艳, 等. 火龙罐治疗脾胃虚弱型妊娠剧吐30例[J]. 中国针灸, 2021, 41(4):449-450. doi: 10.13703/j.0255-2930.20200311-k0004.
[34]	马丽娜, 王宇, 秦莹, 等. 中医药治疗妊娠恶阻的现状和展望[J]. 现代中西医结合杂志, 2023, 32(17):2478-2482. doi: 10.3969/j.issn.1008-8849.2023.17.029.
[35]	冯华, 陈梅, 刘娜. 中药直肠滴入联合西药治疗气阴两虚型妊娠恶阻40例[J]. 陕西中医, 2016, 37(4):401-402. doi: 10.3969/j.issn.1000-7369.2016.04.008.
[36]	史杨, 王娜, 张小环, 等. 苏叶黄连汤直肠滴入治疗重症妊娠剧吐32例[J]. 安徽医药, 2023, 27(2):401-404. doi: 10.3969/j.issn.1009-6469.2023.02.044.
[37]	温乐萍. 麦粒灸结合耳穴压豆辅治脾胃虚弱型妊娠恶阻临床观察[J]. 实用中医药杂志, 2023, 39(7):1336-1337.
[38]	陈湘宜, 张里援, 陈苗苗, 等. 和胃固妊汤联合和胃安胎膏外敷神阙穴对肝胃不和型妊娠剧吐临床分析[J]. 中华中医药学刊, 2024, 42(8):73-76. doi: 10.13193/j.issn.1673-7717.2024.08.015.
[39]	赵素珍, 郑秋霞, 郑海霞, 等. 耳穴压豆联合穴位揿针治疗脾胃虚弱型妊娠呕吐30例疗效观察[J]. 浙江中医杂志, 2024, 59(6):538-540. doi: 10.3969/j.issn.0411-8421.2024.06.032.
[40]	陈露露, 漆洪波. 美国妇产科医师学会“妊娠期恶心呕吐指南2018版”要点解读[J]. 实用妇产科杂志, 2018, 34(6):421-426.
[41]	Yavari Kia P, Safajou F, Shahnazi M, et al. The effect of lemon inhalation aromatherapy on nausea and vomiting of pregnancy: a double-blinded, randomized, controlled clinical trial[J]. Iran Red Crescent Med J, 2014, 16(3):e14360. doi: 10.5812/ircmj.14360.
[42]	Faramarzi M, Yazdani S, Barat S. A RCT of psychotherapy in women with nausea and vomiting of pregnancy[J]. Hum Reprod, 2015, 30(12):2764-2773. doi: 10.1093/humrep/dev248.
[43]	Li Z, Wu J, Song J, et al. Ginger for treating nausea and vomiting: an overview of systematic reviews and meta-analyses[J]. Int J Food Sci Nutr, 2024, 75(2):122-133. doi: 10.1080/09637486.2023.2284647.
[44]	Hu Y, Amoah AN, Zhang H, et al. Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis[J]. J Matern Fetal Neonatal Med, 2022, 35(1):187-196. doi: 10.1080/14767058.2020.1712714.
[45]	Tan MY, Shu SH, Liu RL, et al. The efficacy and safety of complementary and alternative medicine in the treatment of nausea and vomiting during pregnancy: A systematic review and meta-analysis[J]. Front Public Health, 2023,11:1108756. doi: 10.3389/fpubh.2023.1108756.
[46]	Wu XK, Gao JS, Ma HL, et al. Acupuncture and Doxylamine-Pyridoxine for Nausea and Vomiting in Pregnancy : A Randomized, Controlled, 2×2 Factorial Trial[J]. Ann Intern Med, 2023, 176(7):922-933. doi: 10.7326/M22-2974.
[47]	Schleuβner E, Jäkel S, Keck C, et al. Nausea and Vomiting of Pregnancy and its Management with the Dual-Release Formulation of Doxylamine and Pyridoxine[J]. Geburtshilfe Frauenheilkd, 2024, 84(2):144-152. doi: 10.1055/a-2225-5883.
[48]	Madjunkova S, Maltepe C, Koren G. The delayed-release combination of doxylamine and pyridoxine (Diclegis^®/Diclectin^®) for the treatment of nausea and vomiting of pregnancy[J]. Paediatr Drugs, 2014, 16(3):199-211. doi: 10.1007/s40272-014-0065-5. pmid: 24574047
[49]	Schrager NL, Parker SE, Werler MM. The association of nausea and vomiting of pregnancy, its treatments, and select birth defects: Findings from the National Birth Defect Prevention Study[J]. Birth Defects Res, 2023, 115(3):275-289. doi: 10.1002/bdr2.2096.
[50]	Braude D, Crandall C. Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: a randomized, double-blind, noninferiority trial[J]. Acad Emerg Med, 2008, 15(3):209-215. doi: 10.1111/j.1553-2712.2008.00060.x.
[51]	Sun L, Xi Y, Wen X, et al. Use of metoclopramide in the first trimester and risk of major congenital malformations: A systematic review and meta-analysis[J]. PLoS One, 2021, 16(9):e0257584. doi: 10.1371/journal.pone.0257584.
[52]	Nelson-Piercy C, Dean C, Shehmar M, et al. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69)[J]. BJOG, 2024, 131(7):e1-e30.doi: 10.1111/1471-0528.17739.
[53]	Mares R, Morrow A, Shumway H, et al. Assessment of management approaches for hyperemesis gravidarum and nausea and vomiting of pregnancy: a retrospective questionnaire analysis[J]. BMC Pregnancy Childbirth, 2022, 22(1):609. doi: 10.1186/s12884-022-04922-6.
[54]	Cao X, Sun M, Yang Q, et al. Risk of abnormal pregnancy outcomes after using ondansetron during pregnancy: A systematic review and meta-analysis[J]. Front Pharmacol, 2022,13:951072. doi:10.3389/fphar.2022.951072.
[55]	Albazee E, Almahmoud L, Al-Rshoud F, et al. Ondansetron versus metoclopramide for managing hyperemesis gravidarum: A systematic review and meta-analysis of randomized controlled trials[J]. Turk J Obstet Gynecol, 2022, 19(2):162-169. doi: 10.4274/tjod.galenos.2022.14367. pmid: 35770443
[56]	Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum[J]. Obstet Gynecol, 2024, 143(6):745-758. doi: 10.1097/AOG.0000000000005518. pmid: 38301258
[57]	Guttuso T Jr, Messing S, Tu X, et al. Effect of gabapentin on hyperemesis gravidarum: a double-blind, randomized controlled trial[J]. Am J Obstet Gynecol MFM, 2021, 3(1):100273. doi: 10.1016/j.ajogmf.2020.100273.
[58]	Fujii H, Goel A, Bernard N, et al. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study[J]. Neurology, 2013, 80(17):1565-1570. doi: 10.1212/WNL.0b013e31828f18c1. pmid: 23553472
[59]	Sridharan K, Sivaramakrishnan G. Interventions for treating nausea and vomiting in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials[J]. Expert Rev Clin Pharmacol, 2018, 11(11):1143-1150. doi: 10.1080/17512433.2018.1530108.
[60]	Yost NP, McIntire DD, Wians FH Jr, et al. A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy[J]. Obstet Gynecol, 2003, 102(6):1250-1254. doi:10.1016/j.obstetgynecol.2003.08.013. pmid: 14662211