大腸癌術後解便不利之病例淺談麻子仁丸使用時機與思考策略

本病例報告之患者自大腸癌手術過後，出現明顯解便不利情形，經中醫四診及分析後，歸咎其飲食、壓力、情緒及手術等因素。便秘相關症狀早於《內經》即出現有「大便難」一詞，《素問．至真要大論》：「太陰司天，濕淫所勝⋯大便難」。便秘多與脾胃、腸中受寒熱有密切關係。如《素問．厥論》曰：「太陰之厥，則腹滿脹後不利」。《素問．舉痛論》：「熱氣留於小腸，腸中痛，癉熱焦渴，則堅乾不得出，故痛而閉不通矣」。脾胃之間冒受寒熱，加以內在原因包含飲食情緒，外來因素例如手術及數次化療，進而致使患者輸布失司，氣機不暢，升清降濁功能失常，而引發的解便不利，影響生活品質。雖然經過西醫症狀上的給藥治療，但仍力有未逮，故患者於104年5月13日開始尋求中醫治療，經過中藥治療，並且使用Bristol stool scale及CompleteSpontaneous Bowel Movement (CSBM)評估方式進行改善效果評估，患者便秘症狀獲得緩解，生活品質亦得到改善。

關鍵字

大腸癌；麻子仁丸；解便不利

並列摘要

The case of the report had suffered from Functional Constipation after Rectum Cancer`s surgery for several months. After analyzing and diagnosing by the theory of traditional Chinese medicine, we found out that the causes of her constipation were diet, stress, mood and surgery. Constipation and its accompanying symptoms have already recorded in Huangdi Neijing. According to the theory in Huangdi Neijing, constipation can be divided into internal and external patterns based on the underlying etiology . Besides mood, the former is characterized by the presence of heat or cold in stomach and spleen. The external factors are related to the chemical treatment and sugery which cause pathological accumulation of Qi (Qi stagnation). These reasons would not only result in her constipation, but also affect the quality of life. Due to suffering from constipation and the unsuccessful Western medicine treatment for months, the patient received Chinese medicine. After treating by Chinese herb, her constipation was released. Furthermore, we also evaluated the treatment outcomes by Bristol stool scale and Complete Spontaneous Bowel Movement (CSBM). In the end, her life quality was raised according with the relief of constipation symptoms.

並列關鍵字

Constipation ； Chinese Herb ； Ma-Zi-Ren-Wan

參考文獻

Cheng, C,Chan, AO,Hui, WM,Lam, SK(2003).Coping strategies, illness perception,anxiety and depression of patients with idiopathic constipation: apopulation-based study.Aliment Pharmacol Ther.18,319-326.

Google Scholar

Drossman, DA,Corazziari, E,Delvaux, M,Spiller, RC,Talley, NJ,Thompson, WG(2006).Rome III: The Functional Gastrointestinal Disorders.McLean, VA:Degnon Associates.