慢性骨盆腔疼痛症候群之針刺及中藥治療病例報告

Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome with Traditional Chinese Medicine (TCM) and Acupuncture

梁曦(Hsi Liang) ； 張凱惟(Kei-Wei Chang) ； 陳方佩(Fang-Pey Chen) ； 龔彥穎(Yen-Ying Kung)

《北台灣中醫醫學雜誌》 14卷1期 (2022/03) Pp. 13-30

摘要

本病例是一位六十五歲男性，於2016年起左側骨盆腔刺痛（VAS=5-9），痛連尿道及肛門，走路時加重；伴隨解尿困難，夜尿一夜二次。2018/04至台北榮總泌尿外科就診，診斷為攝護腺輕微腫大，2018/06/09北榮脊椎外科排除疼痛是由於腰椎神經壓迫，遂於2018/10/08行經尿道前列腺切除術（TURP），刮除2.5g攝護腺組織，手術後疼痛和解尿困難未明顯改善。泌尿外科曾開立Doxaben, Senokot, Betmiga, Rowapraxin，患者下腹疼痛和解尿困難無明顯改善，故停用西藥治療，遂於2019/02開始至北榮傳統醫學部，希望改善下腹疼痛（VAS=5-9）、解尿困難、夜尿頻繁（2-3次／1夜），用力、天冷、運動疼痛加劇，尋求中藥及針灸治療。針刺治療以清熱利濕，活血化濁概念為主，經過18個月針刺治療，患者解尿費力和斷斷續續的情形已穩定改善，且下腹刺痛情形已大幅減緩。

關鍵字

慢性骨盆腔疼痛症候群 ； 針刺 ； 中醫

並列摘要

A 65-year-old Taiwanese male with diabetes mellitus, presented to Taipei Veterans General Hospital's urology department with sudden onset of left side pelvic pain, frequent nocturia and urine incontinent in April 2016. Urological examination resulted in diagnosis of enlarged prostate. The patient received transurethral resection of the prostate (TURP) and Doxaben, Senokot, Betmiga, Rowapraxin for symptomatic relief. Since the patient's left side pelvic pain did not improve with the treatment, he presented to our integrative medicine program inquiring about acupuncture and traditional Chinese medicine treatment for pain relief. The principle of treatment for this case is ＂clearing heat and promoting diuresis, promoting blood circulation for removing turbid pathogen＂. The patient's pelvic pain, frequent nocturia and urine incontinent got improvement after receiving the acupuncture accompanied by tradition Chinese medicine over 18 months. This case is suggestive that acupuncture in company with traditional Chinese medicine may be helpful treatment of patients with chronic prostatitis/chronic pelvic pain syndrome.

並列關鍵字

Cchronic prostatitis/chronic pelvic pain syndrome ； acupuncture ； tradition Chinese medicine

參考文獻

Kwon, J. K., & Chang, I. H. (2013). Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome. International neurourology journal, 17(2), 48–58. https://doi.org/10.5213/inj.2013.17.2.48

Koo, H. J., Song, Y. S., Kim, H. J., Lee, Y. H., Hong, S. M., Kim, S. J., ... & Park, E. H. (2004). Antiinflammatory effects of genipin, an active principle of gardenia. European journal of pharmacology, 495(2-3), 201-208.

Park, E., Kum, S., Wang, C., Park, S. Y., Kim, B. S., & Schuller-Levis, G. (2005). Anti-inflammatory activity of herbal medicines: inhibition of nitric oxide production and tumor necrosis factor-α secretion in an activated macrophage-like cell line. The American Journal of Chinese Medicine, 33(03), 415-424.

Jin Y. (2004). A combined use of acupuncture, moxibustion and long dan xie gan tang for treatment of 36 cases of chronic pelvic inflammation. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan, 24(4), 256–258.

Li, C., Li, Q., Mei, Q., & Lu, T. (2015). Pharmacological effects and pharmacokinetic properties of icariin, the major bioactive component in Herba Epimedii. Life sciences, 126, 57–68.