小本七層塔合清熱解毒藥治嚴重肝昏迷會診醫案

Treatment of Salvia Plebeian with Clearing Heat and Resolving Toxin Herbs in Severe Hepatic Coma Case

王人澍(Jen-Shu Wang) ； 范娟娟(Chuan-Chuan Fan) ； 鄭啓清(Kee-Ching Jeng) ； 蔡真真(Jan-Jan Tsai) ； 蔡嘉一(Jah-Yi Tsai) ； 王琦嫻(Chi-Hsien Wang) ； 許雅雯(Ya-Wen Hsu)

《中西整合醫學雜誌》 10卷2期 (2008/12) Pp. 35-41

https://doi.org/10.29613/JICWM.200812.0004

摘要

這是一位58歲，台中榮總加護病房，肝癌經肝動脈腫瘤注射栓塞術引起嚴重肝昏迷之女性患者。96年1月時，腹部超音波發現肝臟有超過十公分以上的腫瘤，同年2/15及6/11前後接受兩次栓塞治療，8/21腹部斷層顯示肝內腫瘤增大約15公分，所以在9/7日再次接受第三次栓塞治療，此次併發嚴重肝昏迷，血中氨濃度升高至125μg/100ml，臨床呈現深度昏迷，病人由急診轉入重症病房住院治療，十日後因昏迷指數未獲得改善，家屬要求會診中醫進行中西醫結合治療。會診時病人意識呈深度障礙，偶有痛苦的呻吟，口氣焦臭，唇乾舌收，牙齦出血，全身膚色晦暗，中醫辨證診斷爲火毒熱盛，陰虛血熱，熱入營血，本病例之治則以清熱解毒法爲主，重用台灣本土民間被廣泛使用之肝病草藥小本七層塔，配合茵陳、梔子、板藍根、牛黃、魚腥草爲主要方藥，治療前後約一個月，病人血中氨濃度降低，神智恢復正常出院，顯示小本七層塔和清熱解毒藥治療肝昏迷有效果，值得進一步研究。

關鍵字

肝昏迷 ； 小本七層塔 ； 清熱解毒藥

並列摘要

A female, 58 years old patient with hepatoma s/p transeatheter arterial embolization (TAB), suffered from severe hepatic coma in intensive care unit of Taichung Veterans General Hospital. The hepatoma was diagnosed over 10 cm mass by sonography in January 2007. She received twice TAB at February and June in 2007, and unfortunately the hepatic tumor recurrence to 15 cm by CT scan at August in 2007. She received the third TAE at September 7 in 2007 and complicated hepatic coma. She was transferred to the intensive care ward with deep coma and elevated serum ammonia level of 125 μg/100 ml. The patient's coma scale was not improved after ten days treat; her family requested a consultation and combined with Chinese medicine treatment. The symptom and sign of the patient present in deep unconsciousness with occasional groaning, mouth and breath smelling odors, lips dried and lingual atrophy, gum bleeding, and black dark of whole body in skin color. The identify patterns diagnosis was fire-toxin exuberant heat, yin vacuity and blood heat, and heat penetrating construction-blood aspect patterns. Clearing heat and resolving toxin method was main principle of treatment in this case. Salvia plebeian in Taiwan folk medicine as a remedy for liver disease, Artemisia capillaris, Fructus Gardeniae jasminoidis, Isatidis Radix, Calculus Bovis, and Houttuynia cordata were used to treat the patient. The conscious recover and serum level ammonia decreased after treat for one month, the patient was discharged. This result suggests that Salvia plebeian combined clearing heat and resolving toxin herbs had a treat effect to hepatic coma and worth further investigation.

並列關鍵字

Hepatic coma ； Salvia plebeian ； Clearing Heat and Resolving Toxin Herbs