中醫治療頑固性胸痛之病例報告

「胸痛」為現今患者就診常見的主訴之ㄧ。臨床以胸部憋悶、疼痛，甚則胸痛徹背，短氣，喘息不得臥等為主要表現。藉由詳細的病史詢問、症狀及理學檢查，先排除可能致命的疾病，包括急性心肌梗塞、主動脈剝離、肺動脈栓塞、張力性氣胸及肺炎。現代醫學一般將胸痛分為「心因性」及「非心因性」，心因性疾病常見狹心症、心肌梗塞、主動脈剝離、心肌炎、心包膜炎、肺栓塞等；非心因性疾病常見有氣胸、肺炎、胃食道逆流、食道破裂、帶狀皰疹、中膈腔膿瘍、肌肉骨骼神經病變等。其中約60%的胸痛診斷為非器質性疼痛，以肌肉骨骼系統疾病為最常見的原因，約30%，其中肋軟骨炎佔13%。本篇病例報告一位胸痛持續長達十五年時間的43歲男性，經西醫檢查排除內臟器質性病變，診斷為肋軟骨炎，給予具輕微止痛效果的抗憂鬱藥Tofranil，建議觀察追蹤。2013年10月底開始至中醫診治，臨床診斷為胸痹，證屬肝鬱氣滯兼夾血瘀痰凝，治則以疏肝行氣，活血袪瘀，化痰止痛。經科學中藥複方柴胡加龍骨牡蠣湯為主方加減治療，二週後症狀減緩，服西藥次數、劑量減少，約二個月後，可完全停服西藥。藉此個案說明中醫藥治療頑固性胸痛有確實之療效，值得合理推廣。

關鍵字

胸痹；柴胡加龍骨牡蠣湯；中醫藥治療

並列摘要

＂Chest pain＂ is one of patients' common chief complaints. The clinical manifestations include chest tightness, chest pain, short breath, and hard to take a breather when lying. With detailed history, symptoms and physical examination, patient can be rule out potentially fatal diseases, including acute myocardial infarction, aortic dissection, pulmonary embolism, tension pneumothorax, and pneumonia. In modern medicine, chest pain generally be classified as psychogenic and non-psychogenic types. Psychogenic type includes angina pectoris, myocardial infarction, aortic dissection, myocarditis, pericarditis, pulmonary embolism, and so on. Non-psychogenic type common includes pneumothorax, pneumonia, gastroesophageal reflux, esophageal rupture, herpes zoster, mediastinal abscess, musculoskeletal neuropathy. The diagnosis of 60 percent of chest pain is regarded as non-organic pain. This patient is about a 43-year-old man with chest pain lasting more than 15 years. After western medicine examination, excluded for nonorganic disease, he was diagnosed as costochondritis, and treated with Tofranil. In addition, OPD followed up. By the end of October 2013, he began to accept TCM treatment, diagnosed of ＂chest impediment＂. The patterns of TCM was liver depression and qi stagnation, blood stasis and phlegm congealing. The treatment goals were to relieve pain by sooth the liver and move qi, activat blood and eliminate stasis and resolve phlegm. After the treatment of finished herbal product of CHAI HU JIA LONG GU MU LI TANG, his uncomfortable symptoms were gradually relieved during two months and finally stop taking medicine. This case report displays the efficacy of the TCM treatment of intractable chest pain. So it is indeed worthy for spreading.