龍膽瀉肝湯加減治療急性副畢丸炎醫案一例報告

A Medical Case Report of Modified Long-Dan-Xie-Gan-Tang Decoction and External Therapies of Chinese Medinice on Acute Epididymitis

黃浩瑞(Hao-Ruei Huang) ； 蔡成輝(Cheng-Huei Tsai) ； 賴榮年(Lai-Jung Nien)

《臺灣中醫醫學雜誌》 9卷3期 (2010/09) Pp. 39-45

https://doi.org/10.30032/TJCM.201009.0005

摘要

急性副睪炎為常見之睪丸發炎疾患，目前抗生素已可有效控制，但可能會因餘留纖維硬塊而造成輸精管阻塞，進而導致不孕症。有研究顯示，減低發炎程度及時間可減少輸精管阻塞率，但仍缺乏有效之輔助治療。本案為一名已接受過抗生素治療的20歲急性副睪炎，惠者。於西醫治療後症狀減輕，但睪丸及副睪處仍持續腫痛，並可觸摸到硬塊，以及目赤、自鼻癢、咽痛、易怒等症狀。中醫診斷為肝經濕熱兼有血瘀，隨即以龍膽瀉肝湯方口減，以清濕熱兼通瘀血，再配合針刺以清熱濕養除，藥草薰蒸以暢通血脈。患者於4天後其睪丸回歸正常大小，且疼痛腫脹感完全消失。
龍膽瀉肝湯本為治療肝膽濕熱所制，多用於實證之瘡痬腫毒。本案中藉龍膽瀉肝湯並配合外治法來作為急性副睪炎之輔助療法，以縮短疾病病程。盼此醫案報告可作為將來供參考的中西醫整合治療模式。

關鍵字

急性副睪炎 ； 肝經濕熱 ； 龍膽瀉肝湯

並列摘要

Acute epididymitis, the most common inflammatory disease on male genitals, currently, can be efficaciously controlled by antibiotics. Fibrous degeneration appearing posterior to inf1ammation, however, may further incur the obstructions on spermatic ducts causing infertility. Though the reduced rate of obstructions has manifested in some researches by relieving the level and shortening the time of inflammation, western medicine hitherto lacks an efficient auxiliary treatment.
In this case, a 20-year-old patient, whose situation had been alleviated after accepting antibiotics medication in western medicine, still felt painful and swelling on his testes and epididymis. In addition to fibrous degeneration discovered by palpation, redness of eyes, itch on eyes and nose, sore throat and irritable temper also happened on him. After being diagnosed as dampness-heat with blood stasis syndrome in liver meridian, the patient then accepted modified Long-Dan-Xie-Gan-Tang (LDXGT) decoction to clean the dampness-heat and make the blood stasis syndrome unobstructed, which was cooperated with acupuncture for c1eaning the dampness-heat and supporting yin, as well as herbs steam for smoothing the blood circulation. In 4 days, the size of his testes returned to normal and he felt no more painful.
LDXGT, originally designed for treating dampness-heat in liver meridian, is commonly applied on sthenia inflammation, In this case, LDXGT and external therapies of Chinese medinice were adopted as auxiliary treatments to shorten the disease process. We, by the virtue of this case, anticipated offering a reference for western-chinese integrated treatment pattern.

並列關鍵字

Acute epididymitis ； Dampness-beat in liver meridian ； Long-Dan-Xie-Gan-Tang