化學治療導致周邊神經病變之中醫藥治療：病例報告

Traditional Chinese medicine in a patient with chemotherapy-induced peripheral neuropathy: a case report

柳硯文(Yan-Wen Liu) ； 蔡明諺(Ming-Yen Tsai)

《中西整合醫學雜誌》 21卷2期 (2019/12) Pp. 38-48

摘要

一名51歲女性，無任何過去病史，在2016年經歷了大腸癌病灶切除手術，及完成FOLFOX（FOLinic acid, Fluorouracil, OXaliplatin）標準化學藥物療程後，遺留四肢末梢麻木之症狀持續三年，終在中醫藥介入一個月後症狀得到緩解。經辨證以黃耆五物湯和當歸四逆湯兩方加減下，進行益氣養血、溫經通脈之法。病患除了四末麻木等神經症狀外，生活品質也得到改善，並經由客觀症狀量表證實了中醫藥之療效。於此分享本院治療此患者經驗，藉由實證醫學討論化學藥物治療導致周邊神經病變，以及探討中醫在此病症的治療思路－需在健運脾胃的基礎上，評估病症的屬性。盼望可以藉由中醫的早期介入，改善這類患者的症狀，為他們提供更好的生活品質。

關鍵字

中醫藥 ； 癌症 ； 化學治療副作用 ； 神經病變

並列摘要

A 51-year-old Taiwanese woman with history of stage III colon cancer. She has suffered from numbness and tingling in the limbs, whcih was caused by Oxaliplatin-base regimens since 2016. Western medications have been tried to treat her symptoms associated with chemotherapy-induced peripheral neuropathy (CIPN), few are consistently effective or tolerable. Therefore, she went to our traditional Chinese medicine (TCM) clinic for discomfort management in May 2019. Deficiency of qi-blood and cold inducing stagnation of meridian was identified by TCM syndrome differentiation. Her symptoms of neuropathy improved after 1-monthly intervention of Huang Qi Gui Zhi Wu Wu Tang and Dang Gui Si Ni Tang. The quality of life was also improved after TCM treatment through objective questionnaire assessments. In this case, we report this clinical experience and evidence-based treatment for CIPN. We also explore TCM viewpoint for CIPN. The essential therapeutic principle of this nerve damage is to strengthen the spleen and stomach and distinguish the nature of the disease. We highlight the benefit of alternative TCM treatment to achieve a better health care for the patients with CIPN.

並列關鍵字

Traditional Chinese medicine ； cancer ； chemotherapy-induced adverse event ； peripheralneuropathy

參考文獻

J. S. de Moor, A. B. Mariotto, C. Parry, C. M. Alfano, L. Padgett, E. E. Kent, et al., "Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care," Cancer Epidemiol Biomarkers Prev, vol. 22, pp. 561-70, Apr 2013.

M. D. Stubblefield, H. J. Burstein, A. W. Burton, C. M. Custodio, G. E. Deng, M. Ho, et al., "NCCN task force report: management of neuropathy in cancer," J Natl Compr Canc Netw, vol. 7 Suppl 5, pp. S1-S26; quiz S27-8, Sep 2009.

J. A. Boyette-Davis, E. T. Walters, and P. M. Dougherty, "Mechanisms involved in the development of chemotherapy-induced neuropathy," Pain Manag, vol. 5, pp. 285-96, 2015.

T. Bao, C. Basal, C. Seluzicki, S. Q. Li, A. D. Seidman, and J. J. Mao, "Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk," Breast Cancer Res Treat, vol. 159, pp. 327-33, Sep 2016.

D. L. Hershman, C. Lacchetti, and C. L. Loprinzi, "Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Summary," J Oncol Pract, vol. 10, pp. e421-e424, Nov 2014.