中西醫結合治療酒精性肝硬化病例教案

Treatment of Alcoholic Liver Cirrhosis by Chinese Medicine Integrated Western Medicine

陳明和(Ming-Ho Chen) ； 朱文銘(Wen-Ming Chu) ； 林威全(Wei-Chuan Lin) ； 邱瑞發(Jui-Fa Chiu) ； 林臻瑋(Chen-Wei Lin)

《中西整合醫學雜誌》 11卷2期 (2009/12) Pp. 29-38

https://doi.org/10.29613/JICWM.200912.0004

摘要

這位64歲酒精性肝硬化的病人，因爲長期酗酒造成肝硬化及肝昏迷而尋求中西醫合併治療。此患者的總膽紅素(Total Bilirubin)在2.2~2.5mg/dl，因此出現面色萎黃，白睛黃，小便略黃，大便秘結等症狀，證屬肝膽濕熱之黃疸證。其雙手紅掌，胸前蜘蛛痣，下肢瘀血，男性女乳症等皆很明顯，證屬肝膽經氣血瘀滯。另外其吞嚥不適，亦與其食道靜脈結紮有直接關連性，就中醫病機而言，屬肝氣鬱結、痰凝氣血瘀滯於咽喉及胸膈中。在處方用藥的部分，以行氣化痰散結來處理食道靜脈結紮術後的吞嚥梗阻，並以通瀉腸腑來預防肝昏迷的復發。就中醫理論而言，本病屬於中醫“酒疸、黃疸、積聚”的範疇，其病因是酒積濕熱結聚肝膽經而致病。診療重點包括肝硬化的病因分類、病程分期、演變及癒後、三大併發症、中西醫的論點及合併治療、中醫藥的病機病勢分析、理法方藥、治療計畫及衛教醫囑。

關鍵字

酒精性肝硬化 ； 肝昏迷 ； 黃疸 ； 中醫藥治療

並列摘要

This 64 year-old male patient is a case of liver cirrhosis with a long term alcoholic habit. He had been hospitalized due to the hepatic encephalopathy and discharged from our hospital several times. On the date of our visit, this patient showed jaundice on skin and sciera, serious constipation and few amount of yellow-brown urine. His laboratory data showed total bilirubin 2.5 mg/dl and prothrombin time is 13.7 seconds. Otherwise the symptoms of palm erythema, spider navi, the ecchymosis of lower limb and gynecomastia were obvious.
This patient complained of dysphagia, it's a result of esophagus vance ligation. According to Chinese Medical theories, revealed a case of jaundice with phlegm turbidity, dampness and heat in the liver and gallbladder meridian. The pathogenesis of his sickness included alcoholic dampness and heat, phlegm turbidity blocking in the throat and esophageal. Our prescription contained large amount of Yinchen-how decoction (茵陳蒿湯) to clear liver-gallbladder damp-heat and to get ride of gastrointestinal waste and accumulation, plus Yinchen-five-ftiling powder (茵陳五苓散) to eliminate damp-heat, as well as Banxia-houpo decoction (半夏厚樸湯) to transit the obstruction of phlegm. After a period of hospital care integrated with Chinese Medicine, the evil heat and phlegm seemed to be cleared from his liver and gallbladder meridian. The patient currently receives regular follow-up in our OPD with Chinese Medicine. For the Chinese Medical theories, this disease is belonging to the accumulation of phlegm, jaundice and abdomen distention. The emphasis points of diagnosis are including of the cause and classification of liver cirrhosis, the three complications, the rule of prescription, the integration of Chinese and Western medicine.

並列關鍵字

alcoholic liver cirrhosis ； hepatic encephalopathy ； jaundice ； Chinese medicine