慢性阻塞性肺病反覆咳嗽以六君子湯等複方治療驗案

Successful Treatment of Cough in Chronic Obstructive Pulmonary Disease By Liujunzi-tang And Other Chinese Medicine Compound-A Case Report

黃書澐(Shu-Yun Huang) ； 許堯欽(Yao-Chin Hsu)

《臺灣中醫醫學雜誌》 13卷1期 (2015/03) Pp. 59-72

摘要

本病例為66歲男性病患，咳嗽不癒已10餘年，3年前於成大診斷為慢性阻塞性肺病，3個月前因肺炎併左倒膿胸住院，經引流與胸腔內視鏡手術後胸悶痛已無，但咳嗽仍較住院前為甚，因而於102年5月至本院中醫部就診。來診時咳嗽、黃白痰，痰量較多，疾行時短氣而喘；X光檢查左下肺處有肋膜積液、左右鼻竇積液；望診面黃白無華，白晴黃，舌紅暗，苔厚膩，脈濡滑數無力。中醫辨證為脾氣虛衰，痰濕不運，肺失宣肅；故以健牌除濕，宣肺化痰為主要治則，開立六君子湯、麻杏甘石湯加減方。本案例兩周後回診，咳嗽、痰量明顯減少，氣促減輕，鼻竇炎改善不需手術治療；服藥七個月後X光顯示肺部狀況良好，已無積液及發炎。可知中醫的培土生金法能有效改善西醫使用抗生素等抗菌清熱治療後遺留的痰、虛問題，緩解咳嗽與提升生活品質。

關鍵字

咳嗽 ； 慢性阻塞性肺病 ； 肺炎 ； 膿胸 ； 培土生金法 ； 六君子湯

並列摘要

This is a 66 years old male with history of chronic obstructive pulmonary disease (COPD), which diagnosed 3 years ago in NCKU hospital. He had been suffered from chronic cough more than 10 years. The cough got worsen after an acute attack of pneumonia complicated with empyema on 2013 Feb. Hens, he came to Chinese medicine department for help on 2013 May. Chief complain were cough with yellowish sputum and short of breath. Chest X-ray showed: blunting of left CP angle with pleura effusion, and skull water view showed: cloudy of bilateral paranasal sinus. He looks tired with sallow face and yellow sclera. The tone is in dark-red color, and the coating on the tongue was thick and greasy. Slippery and soft pulse was also noted. The therapeutic principle is tonifying spleen to dehumidify, and dispersing lung qi to dissipate phlegm. The prescription is based on Liujunzi-tang and Maxingganshi-tang. In our case, the cough and sputum decreased, short of breath and sinusitis improved in two weeks. Further more, after 7 months treatment, the chest X-ray showed his lungs are free of infiltration. This case told us that the method of ＂bank up earth and engender metal＂ could help on solve phlegm and qi vacuity problem after antibiotics treatment.

並列關鍵字

cough ； chronic obstructive pulmonary disease ； COPD ； pneumonia ； empyema ； bank up earth and engender metal method ； Liujunzi-tang.

參考文獻

台灣胸腔暨重症加護醫學會 2012年COPD診治指引 , http://www.tspccm.org.tw/files/guide/COPD指引2012.pdf

張伯臾、董建華、周仲瑛: 中醫內科學，知音出版社，台灣，1998; 83-84。

劉建博，楊梅娟: 健脾清肺化痰法對慢性阻塞性肺疾病合併全身炎症反應綜合徵療效及核因子─κB表達的影響，廣州中醫藥大學學報，2009 ; 2(6) : 3-4。

韓雲，謝東平，林嬿釗，李芳，翁燕娜: 培土生金法對COPD機械通氣患者營養狀態及免疫功能的影響，遼寧中醫雜誌，2007 ; 34(10) : 1359-1361。

Alfageme I, Munoz F, Pena N, Umbria S : Empyema of the thorax in adults Etiology, Microbiological findings and management. Chest 1993 ; 103 :839-843.