登革熱中醫治療病例報告

本案例為36歲男性，日前因發燒急診，經登革熱快篩為陽性。服西藥後熱勢略退，但因仍全頭刺痛，畏寒發燒，故至中醫門診求診。來診時，症見頭不規則遊走刺痛、發熱37.4℃、疲倦、食欲不振、食後欲嘔、口臭、便溏不成形，血小板偏低95000/uL，舌苔黃乾厚不均、舌略紅暗，脈沉、左脈帶滑。中醫診斷為疫癘風熱外束肌表、濕熱直入陽明，治則採表裏雙解，開立柴葛解肌湯、桑菊飲加減治療。回診時，自述服藥一日後發燒退，二日頭痛減，畏寒疲倦改善，腸胃症狀改善，舌苔黃乾厚轉灰薄，舌紅，脈象轉細弦緩。但上臂與胸背皮膚出現出血點，血小板續下降至67000/uL，白血球偏低2600/uL，診斷為登革熱所致之血球病變，其病機為熱入營血、氣陰兩虛。遂依病機投以清營涼血、益氣養陰藥物處理。服藥後病患於二週內，精神體力迅速恢復，血球數量恢復正常，諸症改善。我們依中醫辨證論治原則，順利改善此登革熱病人的臨床病理症狀，可以提供醫界治療登革熱之參考。

關鍵字

登革熱；表裡雙解；清營涼血；益氣養陰

並列摘要

The 36-year-old man who suffered from colon cancer was accepting chemotherapy. He had high fever after bitten by mosquito when hiking on 18th September 2015 and went to ER. His Dengue Fever rapid screen was positive. He came to our OPD for paroxysmal irregular headache and whole body stabbing pain. The beastly headache affected the man and made him Chills；Fever37.4 ℃；Feeling tired；Poor appetite；Nausea after meal； Halitosis；Cold extremity. Low blood platelet count〈95000/uL〉 were noted；Yellow, dry, not even coated Fur；and the tongue was dark-red；Both were deep pulse, left pulse was slippery. The pattern of Chinese medicine differential diagnosis was Yi-li-re-du-waishu- ji-biao and Shire-zhiru-yang-ming.According to the therapeutic principle of biao-lishuang- jie,we prescribed chai-ge-jie-ji-tang and sang-ju-yin. At the 2nd visit, fever was gone within one day. Headache, Chills, Feeling tired, and GI sign has subsided lot in two days. The patient felt better generally. The coated fur turned gray and thin. The color of tongue was less dark-red. The pulse turned thin, string, and slow. However, He found some petechiae on his arm, chest, and back. Low blood platelet count and low leukocyte count appeared. Differential diagnosis that blood cell disease caused by Dengue Fever was reru- ying-xie, qi-yin-liang-xu. Then our therapeutic principle turned to qing-ying-liang-xie, yi-qi-yang-yin. He became vigor rapidly in two weeks. His white blood cell and platelet count became normal and all symptoms ameliorated. By Chinese differential diagnosis and treatment, we improved the Dengue Fever patient's clinical symptoms quickly and recorded in detail. We hope this case report become good reference to all doctors.