中醫在安寧療護的角色－晚期攝護腺癌案例報告

現今安寧照護觀念已逐漸受到重視，目前仍以西醫照護為主，缺乏中西醫整合醫療團隊的研究與探討，本案例可提供以中醫觀點及治療，作為中醫介入癌末病人安寧療護的參考。本案例為高齡96歲的攝護腺癌症患者合併膀胱轉移，經歷多次經尿道前列腺切手術及尿道膀胱腫瘤切除術，並接受雙側睪丸切除術。病患本身年老體衰，加上長期臥床，造成氣血兩虛，有血尿、小便不利及出現疲倦、意識不清等問題，中醫證型屬脾腎兩虛，痰瘀阻滯下焦，合併手術傷及血絡，氣血衰微。在會診中醫後，以中醫藥治療近一年，期間以濟生腎氣丸及五苓散補腎利水治療，及用川七、白芨達到活血止血、減緩血尿，並加上黃耆及當歸益氣、補營血，提升病患體力，後期以生脈保元湯益氣生津，提升體力，加上猪苓湯改善腫瘤壓迫所造成的排尿困難及水腫症狀，病患在安寧病房出院後最後於花蓮榮民之家安詳辭世。中醫藥的介入，可適當的給予治療並緩解病人身體上的不適，提升在晚期安寧照護的品質，讓病患及家屬圓滿完成最後的旅程。

關鍵字

攝護腺癌；安寧療護；中醫

並列摘要

The concept of Hospice Palliative Care has gradually received attention now, but lack of research and discussion on the integrated medical team of Chinese and Western medicine. This article provides Chinese medicine viewpoint as a reference for Chinese medicine intervention in the treatment of hospice care for cancer patients. This case is a 96-year-old prostate cancer patient with bladder metastases undergoing multiple transurethral resections of the prostate and urethral bladder tumor resections, and bilateral splenectomy. The long term bedridden elderly patient has hematuria, dysuria, fatigue, and unconsciousness after multiple surgery, causing both qi and blood deficiency. After consultation with the Department of Chinese Medicine, the patient was treated with Chinese medicine to relieve edema and hematuria and improve his physical strength for nearly one year. The patient was discharged from the hospital in the hospice ward and died peacefully at the Hualien Veterans Home. This article shows that the intervention of Chinese medicine can alleviate the physical discomfort of patients in the late stages and improve the quality of Hospice Palliative Care.