龍膽瀉肝湯治療帶狀皰疹之病例報告

A Medical Case Report of Herpes Zoster with Longdan Xiegan Decoction

林家琳(Chia-Lin Lin) ； 曾子澄(Tzu-Cheng Tseng) ； 陳朝宗(Chao-Tsung Chen)

《中醫內科醫學雜誌》 16卷2期 (2018/12) Pp. 71-81

https://doi.org/10.7102/JTCIM.201812_16(2).0006

摘要

帶狀皰疹為中醫外科門診常見案例，表現為病灶處嚴重疼痛並有灼熱感，但常因發病原因不同，於臨床辨證上，中醫證型難以捉摸，雖然病患大多可在數周後自行痊癒，但仍有患者在水泡結痂後遺留痛感且持續數月，因此如何提高止痛、加速傷口癒合、以及預防復發，就成了中醫治療上的重要課題。本病例為一81歲男性，突發右側頭面部沿三叉神經眼分支之帶狀皰疹，並伴隨嚴重疼痛感、局部起水泡、與病灶範圍紅腫熱等情況，經西醫治療一周後，疼痛不適感依舊，遂至中醫門診求助；經過針灸與中藥治療，不但在三天後，水泡即結痂，兩周後，疼痛感完全消失，且在一個月後沒有復發。本病例起初以龍膽瀉肝湯為主方清利肝膽濕熱，中後期搭配補陽還五湯補氣活血兼化瘀；另外加上針灸以圍刺的方式，在病灶周圍施針，加上在神經節末端、以及遠端配穴增強療效，為一中醫治療帶狀皰疹之成功且速效案例，提供給臨床中醫師選方用藥以及針灸思路上的參考。

關鍵字

帶狀皰疹 ； 龍膽瀉肝湯 ； 補陽還五湯 ； 圍刺

並列摘要

Herpes zoster is commonly seen in Chinese Medicine dermatology, which caused by the Varicella-zoster virus (VZV). The main symptoms of Herpes zoster include a cluster of blisters distributed band-like on the skin and accompanied by severe burning pain. Presently, the antiviral therapies are effective, but do not meet patients' expectations of symptomatic relief. Therefore, reduction of pain intensity and improvement of rash healing become an aim at Chinese medical treatment. This case report showed a 81-year-old man who suffered from Herpes zoster on the part of his right Ophthalmic branch of Trigeminal nerve dermatome skin with serious burning pain, local swelling and fever. After Chinese Medicine treatments, the crust formed gradually after three days, and the burning pain was relieved after two weeks, furthermore, the Herpes zoster didn’t relapse after a month. During the treatment, Longdan Xiegan Decoction was given at first, then added Buyanghuanwu decoction. In addition, we also combined acupuncture around the lesion. The patient had an excellent outcome after several times of treatment, which can provide clinical Chinese Medicine doctor a viable and acceptable treatment option for patients who suffer from Herpes zoster.

並列關鍵字

Herpes zoster ； Longdan Xiegan decoction ； Buyanghuanwu decoction ； surrounding acupuncture

參考文獻

Schmader, K.(2016).Herpes Zoster.Clin Geriatr Med.32(3),539-53.

Dworkin, R.H.(2007).Recommendations for the management of herpes zoster.Clin Infect Dis.44(Suppl 1),S1-26.

Jumaan, A.O.(2005).Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002.J Infect Dis.191(12),2002-7.

Haanpaa, M.,Laippala, P.,Nurmikko, T.(1999).Pain and somatosensory dysfunction in acute herpes zoster.Clin J Pain.15(2),78-84.

Drolet, M.(2010).The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study.Cmaj.182(16),1731-6.