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中医药研究论丛
 233.3 神门穴灸治放疗後味觉障碍疗效观察与现代化分析
TJ TCM.23(3) : 35-54,2020
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神门穴灸治放疗後味觉障碍疗效观察与现代化分析
Observation of Shenmen Acupoint Moxibusition
Curative Effect on Post-Radiotherapy Taste Dysfunction
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李宗翰1 陈恩生1,2 陈忠渊1*
1 高雄医学大学附设中和纪念医院中医部，高雄，台湾
2 中国医药大学中医学院中医学系，台中，台湾
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【摘要】
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头颈癌近几年在国内长年是前十大死因之一，但放射线治疗所产生的味觉障碍在西元1959 年就被发现，近代医学至今仍没较有效的改善处治。从传统中医角度，放射线治疗被视为是火邪伤阴而会造成阴分缺乏、削弱气机的症状，而以清热解毒、益气活血方法常可取得稳定的疗效。但味觉细胞受损、味觉障碍，中医辨证治疗下疗效也有局限；本研究藉由脏腑学说「心主任物」的发挥，选用神门穴艾灸方式在临床诊疗观察中取得稳定疗效。本文同时蒐集本院中医内科门诊头颈部相关癌症患者，在以神门穴艾灸治疗前後，藉由记录主观味觉评估、脉诊仪与热像仪等客观数据综合探讨在「心主任物」理论中、可能的疗效因素。在记录观察三位包含急性与慢性味觉障碍的鼻咽部恶性肿瘤案例连续三次的自我味觉评估与脉象、舌象结果，发现经过每周或者每2 周一次、连续三次的治疗後，患者的主观味觉改善程度都有40%-60% 的改善幅度，且观察到急性期疗效反映较快，第一次治疗就有显着改善，而慢性期患者则需两周的治疗期才能有显着的变化；同时亦得到在患者的左关有频谱能量下降并达统计上的显着差异（p<0.05），以及在艾灸前後的舌象温度下降变化，然温度变化幅度并未达显着差异。综观结果，本研究藉现代诊断仪器辅助下，推论神门灸可能与调和相火而君火得充，则心主任物功能得以恢复。然而因为收案人数不足，未能得到更多的数据验证理论，但希望在此前驱性研究验证神门灸对於味觉障碍的治疗经验，并持续未来能有更多个案累积以有更强而有力的证据。
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【关键词】味觉受损、放疗副作用、艾灸、热象仪、脉诊仪
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Zong-Han Li1En-Sheng Chen1,2Jhong-Yuan Chen1*
1Department of Traditional Chinese Medicine, Kaohsiung Medical University Chung-Ho
Memorial Hospital, Kaohsiung, Taiwan
2Department of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan
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【Summary】
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Head and neck cancer has remained one of the top ten causes of death in Taiwan in these years. There are yet a directly effective treatment for taste dysfunction, which is one of the side effects of radiotherapy. For Chinese medicine, radiotherapy for cancer is taken for exogenous heat that reducing the yin constitutions, leading to qi weakness. Therefore, clearing heat and detoxifying, nourishing qi and activating blood always taken to well alleviate the mucositis, dysphagia, and dry mouth symptoms form radiotherapy for head and neck cancer as qi-yin injuries. But for bud cells’ damage, taste disorder even poor quality of life are still unsolved efficiently today. This study used moxibustion on Shenmen point in outpatient treatment on selected head and neck cancer cases from internal Chinese medicine clinic in KMUH, and recorded the differences by pulse analyzer, and thermal image camera to verify the presumed thesis. The results of sphygmography and tongue images from three acute and chronic dysgeusia cases of nasopharyngeal cancer revealed statistically reduce on spectral energy (p<0.05), and temperature alteration on thermal images of tongue while was not drastically change. The present study assumed that due to reconciling of premier fire, refilling of sovereign fire so recovering the function of Liver and Kidney, and main commanding ability of Heart. Due to limited cases, the evidence was not strong enough to support the curative effects. We hope to accumulating more strengthen and higher qualitative evidences in the future.
【Keywords】Taste Dysfunction; Radiotherapy Side Effect; Moxibustion;Sphygmography; Thermal Imager
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