中藥結合西醫治療可逆性腦血管收縮症候群

Treatment of Reversible Cerebral Vasoconstriction Syndrome with Traditional Chinese Medicine (TCM) and Western Medicine

曾瑋涵(Wei-Han Tseng) ； 張凱惟(Kei-Wei Chang) ； 陳方佩(Fang-Pey Chen) ； 龔彥穎(Yen-Ying Kung)

《台北市中醫醫學雜誌》 26卷2期 (2020/09) Pp. 23-33

https://doi.org/10.6718/TJCM.202009_26(2).0003

摘要

可逆性腦血管收縮症候群（RCVS）是一種尚未被充分認識的神經系統疾病，其中患者會遭受突然的嚴重頭痛（通常被稱為雷擊性頭痛），並表現出可逆性腦血管收縮。目前Nimodipine是最常用於治療該疾病的藥物。而中醫並無相對應之病名，頭痛的敘述卻早在《內經》可見，且可分為外傷頭痛與內傷頭痛，外傷頭痛以風邪為多，治法以祛邪為主；內傷頭痛則多與肝脾腎有關，治法多著重在扶正。本篇藉由分享一名45歲的RCVS患者，使用Nimodipine並同時配合中藥（以加味逍遙散、清上蠲痛湯為主，配合天麻、蔓荊子、丹參）調理，使病情趨於穩定，頭痛頻次、疲勞、嘔噁、心悸與胸悶等不適感均獲得改善，影像學追蹤也有明顯變化。

關鍵字

可逆性腦血管收縮症候群（RCVS） ； 加味逍遙散 ； 清上蠲痛湯

並列摘要

Reversible cerebral vasoconstriction syndrome (RCVS) is an under-recognized neurological disease in which patients suffer from sudden severe headache (often called thunderclap headache) and reversible cerebral vasoconstriction. Nimodipine is currently the most commonly used drug to treat the disease. Though there is no corresponding disease name in Chinese medicine, but the description of headache can be seen as early as in the ＂Huangdi Neijing ＂, and it can be divided into exogenous headache and introgenous headache. Exogenous headache is mostly caused by pathogenic wind, and the treatment is mainly to dispelling wind; introgenous headaches are mostly related to liver, spleen and kidney. And the treatment is mostly focused on strengthening the body. In this article, by sharing a 45-year-old RCVS patient, taking Nimodipine and at the same time combined with Chinese medicine (mainly with Jia Wei Xiao Yao San, Qing Shang Juan Tong Tang, combined with Tianma, Manjingzi, and Danshen) to stabilize the condition. Frequent headaches, fatigue, nausea, palpitations, chest tightness and other discomforts were all improved, and follow-up imaging also showed significant changes. This case can provide a reference for the effective clinical experience of treating RCVS with Chinese medicine and western medicine.

並列關鍵字

reversible cerebral vasoconstriction syndrome (RCVS) ； Jia Wei Xiao Yao San ； Qing Shang Juan Tong Tang

參考文獻

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Cappelen Smith, Cecilia et al.: Reversible Cerebral Vasoconstriction Syndrome: Recognition and Treatment. Current treatment options in neurology. 2017; 19(6): 21.