下咽癌病患空腸造口術術後腹脹之病例淺談小柴胡湯合小建中湯之用藥思考策略

本病例報告之患者因下咽部表皮鱗狀上皮細胞癌接受全喉切除手術，因營養需求接受空腸造口術，其後因管路滑脫而再次接受空腸造口術，並於術後出現明顯腹脹情形，經中醫四診及分析後，歸納為飲食、情志及與癌症相關之處置等因素所致。腹脹相關症狀首見於《素問．刺熱篇》與《六元正紀大論》，《素問．大奇論、玉機真藏論》中的「少腹滿」，《陰陽應象大論》中的「中滿」，及《靈樞．邪氣臟腑病形》中提及的「腹氣滿」均屬於腹滿的範疇。腹脹之病因多與寒濕、虛寒、濕熱、實熱困阻或食滯⋯等有關，依其症狀又有虛實之分。本病例之患者因長期飲食不節，再加上疾病因素進食困難等，導致脾胃虛弱，受納及運化功能不佳，又因情緒憂慮抑鬱而肝氣鬱結，氣機升降受阻，進而氣機橫逆，肝脾不和，而致腹脹，雖經西醫診斷依其症狀給予藥物治療及灌腸處置，但腹脹情況仍未有明顯改善，故於104年08月11日會診中醫，經中醫診察並給予藥物治療後其腹脹症狀遂得緩解。

關鍵字

腹脹；小柴胡湯；小建中湯；空腸造口術；下咽癌

並列摘要

This is a report of a 47-year-old man suffering from abdominal distention after re-do jejunostomy. The patient was a case of Squamous cell carcinoma of right hypophyaryngeal cancer cT4aN0M0 c-stage IVA, pT3N2bM0 p-stage IVA, who had a pass history of depressive disorder and received jejunostomy for nutrition support. This time, because of the jejunostomy dislodge, he was admitted to the hospital for re-do jejunostomy. After the surgery, abdominal distention was noted and Metoclopramide and Lactulose was prescribed continually. Due to the limited improvement of the symptom, the patient asked for the consultation of the department of Chinese medicine. Evaluating by the four methods of diagnosis, improper diet, emotional maladjustment and associated cancer treatment were attributed to the symptom. The combination of Xiao-Jian-Zhong-Tang and Xiao- Cai-Hu-Tang was used, and then the outcome was satisfying. The symptom of abdominal distention was relieved remarkably after one day and disappeared entirely on the next day. The thinking process of combining Xiao-Jian-Zhong-Tang and Xiao-Cai-Hu-Tang for the treatment would be described in the discussion.