以台灣草藥加強龍膽瀉肝湯治療黃疸型慢性肝炎療效之醫案報告

34歲男性病患，自述過去病史爲B型肝炎帶原者。91年起病人固定在台中某教學醫院肝膽腸胃科追蹤治療，其肝功能指數GOT/GPT約在350-900(U/L)，總黃疸指數Bil-T約在1.1-2.0(mg/dl)之間。期間肝功能指標在94年曾偏高至900U/L，此外並合併有長期易疲倦、口乾口渴等症狀。95年9月因主訴爲目黃，口乾渴，口苦，食慾不振，容易疲倦，小便深黃等症狀，前來台中榮總中醫科就診，當時肝功能指數G阿約700(U/L)，經辨證後證屬中醫的濕熱型黃疸。然而在治療上，我們認爲不論是採中醫的辨證論治以清熱利濕爲治療方法，或者現代醫學的辨病論治，針對組織發炎腫脹產生膽汁淤留而採取清熱利膽法，皆無法完全反應疾病治療的全貌。因此採取「傳統辯證論治整合現代組織病理微觀診斷學」的方式，兼採中西醫對疾病的切入點，並以此作爲處方用藥的指導基礎。現代醫學的病毒性肝炎與傳統中醫的肝熱並不相同，在治療上需消除病毒感染後所引起的肝細胞發炎腫脹與肝內膽汁滯留。在整體治療策略上，本病態、在經過傳統辨證論治與現代組織病理微觀變化的辨病論治後，診斷及治療大法如下：一、肝細胞的發炎腫脹歸屬組織病理性「肝熱火鬱」。二、因肝組織急性發炎呈現出的膽汁滯留，其微觀辨證歸屬陽黃，因此引導出「瀉肝利疸」的治療法則，臨床的論治運用「龍膽瀉肝湯」加味合併台灣本土草藥「小本七層塔」、「黃花蜜菜」及「桶交藤」、「魚腥草」等肝病經驗用藥。病人在接受近十個月的治療後，其肝功能指數GOT/GPT與黃疸指數Bil-T逐漸恢復到正常範圍，口乾口苦以及疲倦等症狀亦獲得明顯改善。治療期間發現當龍膽瀉肝湯的科藥治療效果呈現鈍化時，加入本土草藥可獲得較明顯療效終至恢復至正常值。本病例約經過10個月後的中醫治療後，因肝指數回到正常範圍及臨床症狀改善而停止服用中藥，目前病患仍回台中榮總中醫科門診追蹤，西醫每三個月外院定期追蹤包括常規腹部超音波及肝功能檢查，至今二年多雖然仍爲B型肝炎帶原，但其肝功能指數依舊維持於正常範圍，生活品質也獲得改善。本文認爲台灣草藥與傳統中藥之合用對慢性活動性肝炎之治療上提供新的治療方向，斯土、斯藥，個人提供淺顯的臨床經驗，供作向儕在治療病毒性肝炎的臨床參考。

關鍵字

組織病理微觀診治學；黃疸型慢性肝炎；肝細胞組織膽滯火鬱；龍膽瀉肝湯；台灣草藥

並列摘要

A male, 34 years old patient had a chronic hepatitis B with serum ALT levels of 350-900 (U/L) and total bilirubin (Bil-T) between 1.1-2.0 mg/dl. He was following up in a teaching hospital, Taichung since 2002. His serum ALT level reached a high level of 900 U/L in 2005. He visited our clinic on September 2006 due to yellowish eyes, thirsty, bitter taste, loss of appetite, fatigue and dark urine with a serum ALT level of 700 U/L. Syndrome differentiation diagnosed the case as the damp-heat type of jaundice. However, either 'Therapy of Clearing Heat and Draining Dampness', or 'Clearing Heat and Promoting Bile' derived from traditional or modern pathological diagnosis had their limitations. Therefore, we combined both strategies for the case treatment. Since the viral hepatitis by modern pathological diagnosis is different from liver heat of traditional medicine, the treatment is mainly to eliminate the inflammation of hepatocytes and stagnation of bile. Our diagnosis was the following: 1) The inflammation of hepatocytes belonged to 'Liver Heat and Fire Stagnation' and 2) The stagnation of bile from hepatitis belonged to 'Yang yellow' by micro-diagnosis. Therefore it led to the therapy of 'Dissipating Liver and Promoting Bile'. The treatment was consisting 'Longdan Xiegan Tang' and local herbs including Salvia plebeia, Wedelia chinesis, Mallotus repandus, Houttuynia cordata. After 2 months of treatment, the patient's serum ALT/AST were returned to normal levels. His thirsty, bitter taste and fatigue syndromes were all improved after our treatment. When this patient had fatigue and rebound in ALT, local herbs was put back to 'Lungdan Xiegan Tang' until these factors were subsided down. After a normal ALT level was maintained, he stopped the herbal treatment and remained symptom free for two years. However, his serum HBeAg and HBsAg were still persistent in the follow up exal1ls. This study reports a new treatment for chronic hepatitis by combining local herbs with traditional formula based on 'Cytopathology micro-diagnosis' and 'Syndrome differentiation'.

並列關鍵字

Cytopathology micro-diagnosis ； Jaundice type of chronic hepatitis ； Hepatocytes stagnation of bile ； Longdan Xiegan Tang ； Local Herbs

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以台灣草藥加強龍膽瀉肝湯治療黃疸型慢性肝炎療效之醫案報告

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