- 期刊
帶狀皰疹合併神經痛的中醫診療病例報告
Herpes zoster with neuralgia treated with Chinese medicine: A case report
摘要
帶狀皰疹（Herpes zoster；HZ）是造成國民健康負擔的常見疾病，本病的發病源自於水痘病毒（Varicella-zoster virus）的再活化，病毒的再活化又與年齡、壓力及人體免疫功能缺失密切相關。本病發病初期的特點是沿著神經皮節分布的皮膚紅疹、水皰與膿皰，之後在二至三週左右緩解結痂。在皮膚病灶緩解之後，還有將近20％的病人可能被持續超過三個月的神經痛所困擾。劇烈的皰疹後神經痛經常導致睡眠障礙、憂鬱、慢性疲勞，讓病人無法正常生活。本案例是一位48歲男性，罹患急性帶狀皰疹，經住院治療後病情控制穩定而出院。未料在出院後三日病情復發。右前額顏面連鼻樑皮膚水皰與膿皰新生，每日嚴重神經抽痛多次，持續四日後因疼痛難忍，求助於中醫。本案診斷屬帶狀皰疹合併神經痛，中醫辨證主證為肝火夾濕熱上亢頭面、次證為腎陰虧虛併有痰瘀阻絡，處方以龍膽瀉肝湯合知柏地黃丸加減。服藥後，劇烈的神經抽痛在第四日停止發作，水皰膿皰在一周內開始消退結痂，結痂皮疹在第二周退轉淡褐色色素沉澱。在急性期症狀獲得控制後，處方續轉以健脾疏肝的加味逍遙散，加減滋養肝腎的杞菊地黃丸鞏固療效。四個月後電話隨訪，皮膚與神經症狀均未再發作，也無副作用。在本案例，我們運用中醫辨證論治有效且迅速的控制這個帶狀皰疹合併神經痛的案例，符合臨床「治癒」的療效標準。
並列摘要
Herpes zoster is a common disease bring about the health-care burden. It is caused by a reactivation of varicella zoster virus reactivation. Age, stress, and immunocompromized status are known factors for virus reactivation. The characteristic skin lesions of active phase include the rash, papules, vesicles and pustules spread along the affected nerve dermatomes. And the lesions eventually resolved to crust in 14-21days. 20% of patients with herpes zoster suffer from post-herpetic neuralgia in the following 3 more months. The severe post-herpetic neuralgia often lead to sleep disturbance, depression, chronic fatigue and inability to perform daily activity. A 48 years old male had admitted under the diagnosis of Herpes zoster. After treatment the illness was subsided, so he discharged. But the disease relapsed rapidly just three days after discharge. Vesicles and pustules over the right forehead recurred accompanied with yellowish exudate and the severe throbbing pain. As the neuralgia was unendurable, the patient came to our Chinese medical ward for help. According to the Chinese Pattern Identification, the major syndrome was Hyperactivity of Liver fire and Damp Heat upward the head and face, the minor syndrome is Deficiency of the Kidney Ying, Phlegm stasis blocking the meridians. So, Long Dan Xie Gan Tang and Zhi Bo Di Huang Wan were prescribed combined with drugs promote blood circulation and transform stasis. The unbearable throbbing pain was remitted and stopped in the 4^(th) day, blisters and pustules began to fade into crust, the conjunctivitis subsided in the 7^(th) day. The crusting eliminated into pigmentation within the 2^(nd) weeks. As the acute illness was controlled, the prescription changed under the aim to consolidate the curative effect : Jia Wei Xiao Yao San to strengthen the spleen and sooth the Liver, and Qi Ju Di Huang Wan to nourishes liver and kidney. Telephone interview after the 4^(th) months ensured the illness be control stability, no more skin lesion and neuralgia again, neither the complications. According to the principle of syndrome differentiation and treatment, we control the Herpes zoster combined severe neuralgia effectively and rapidly, and meet the efficacy criteria of「Cure」.
參考文獻
延伸閱讀
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