中醫理論在臨床危重症之運用－以海外義診一案為例

The Clinical Application of the Conclusions from Traditional Chinese Medical Theory on Emergent and Critical Patient Conditions-A Case from the Volunteering International Medical Services in Napel

林伯欣(Po-Hsin Lin)

《中西整合醫學雜誌》 16卷2期 (2014/06) Pp. 45-53

摘要

醫學經典的理論記載隱含臨床診治的指導原則，醫史的發展脈絡與相關文獻記錄則提供了臨床醫療人員解讀分析經典的最佳工具。對臨床中醫師來說，醫經醫史的研究不僅是學術殿堂上的專業論述，更是可以實證與推廣的思維與重要方法。本醫案中之中年男性持續15天神智不清、無法口語溝通、大腹膨脹、全身浮腫、臥床無法自行活動、肢體關節痛甚，雖經當地西醫診治，但毫無起色，因而被送至義診場地。經診察後認為病患呈現「心腎陽虛，中焦脾胃虛實寒熱夾雜，營衛化生不良，肺氣虛，三焦腠理不暢通」的綜合病機，給予針刺太溪、合谷、陷谷、中渚、陰陵泉等穴位，同時合併服用真武湯、防己黃耆湯及半夏瀉心湯。在留針觀察四小時內服藥三次、並不定時動針，過程中多數症狀逐漸改善，最後病患能口述四肢身體疼痛完全消失，喜極而泣，在旁人攙扶下走路回家。本病案診治過程除了使病患直接受惠之外，也間接提供了「醫經醫史研究並非落伍的紙上談兵、而是中醫學術提升與臨床發展最重要根本」的證明。在中醫學發展仍方興未艾的當代，經典理論、歷史紀錄與臨床診治間的聯繫與對話實有其必要性與迫切性。

關鍵字

醫經醫史 ； 危重症病患 ； 古典中醫學

並列摘要

More than often, the guidance for clinical diagnosis and treatment had been implicitly embeded in the medical classics. The structure of medical history development and related documents provides the most ideal research tools for the clinical practitioners to interpret and analyze the medical classics. For the practicing Chinese medicine doctors, the theory of medical classics and the medical history serve not only as the academic deliberations but as the approaches that can be tested and promoted in clinical application. The present case of middle-aged man was persistent 15 days of mental confusion, unable communication with language, abdominal distension, systemic edema, only bed side and couldn't automatic activity, extremities and joints pain severity. Despite LMD treatment, but there is no improvement, and thus sent to the medical service site. The patient's condition was observed and according Chinese medical theory, the diagnosis was Heart and Kidney yang vacuity, vacuityrepletion and cold-heat complexes in middle burner of spleen and stomach, dysfunction of Construction and Defense transformation, qi vacuity of lung, and the interstices of triple burner obstruction. After acupuncture (KI3, LI4, ST43, SJ3, and SP9) and herb medicine therapy (Xhenwu Tang, Farng-jii Hwang-chyi Tang, and Ban-xia Xiexin Tang) , patient stay at medical service site and under observed for four hours, the majority of patient's symptoms gradually improved. Finally, the patient was so happy as to weep to express by himself that the pain of body and limbs disappeared completely, and walking home in the assistance of others. This thesis documents the Volunteering International Medical Services team's encounter with a Napel patient who was in the critical state. This case is an example that the patient significantly benefited from the treating approach referred from the medical classics. In addition, this case is a proof that the medical classics and history is the most important foundation of both the academic advances and the clinical evolution for the Chinese Medicine. While we attempt progress in the development of the Chinese Medicine, it is very necessary that we continue to make connections among the medical classics, the medical history and the clinical practice.

並列關鍵字

Medical Classics and History ； Emergent and Critical Patient ； Classical Chinese Medicine