中医药研究论丛

242.6 中药治疗第三期口腔癌淋巴转移肿块病例报告
TJ TCM.24(2) : 65-82, 2021
中药治疗第三期口腔癌淋巴转移肿块病例报告
Case Report: Traditional Chinese Medicine
Treatment in Advanced Oral Cancer
郑名惠1* 林焕钦1 黄廷芳2
1 卫生福利部丰原医院中医科,丰原,台湾
2 卫生福利部丰原医院牙科,丰原,台湾
【摘要】
本案例为一40 岁男性患者, 罹患口腔癌(squamous cell carcinoma,iT2N1M0),2019 年5 月病灶出现在舌头的右侧底部,肿痛不愈,不愿就诊,至2020 年2 月健检时发现白色斑块,口腔念珠球菌感染,舌出血溃疡,延伸至右下颔肿痛,经切片诊断为口腔癌。病人拒绝手术,2020 年3 月经同步化学放射治疗(concurrent chemoradi otherapy, CCRT)执行化疗cisplatin 3次、电疗35 次,效果不佳。初诊7 月17 日见右侧脸颊及下颔颈部肿胀硬块已直径5 cm,触之热烫,患者感觉头、耳内至颈部胀痛甚。耳鼻喉科诊断为第三期口腔癌,转诊血液肿瘤科,需2 小时服用吗啡一次止痛,肿块亦影响吞咽和语言,体重由未发病时(2019 年5 月)92 公斤,至初诊日(2020年7 月)下降为54.4 公斤,全身倦怠无力,面色萎黄,纳差,二便少,脉弦细滑,舌红苔薄。中医病机为长时间服食热毒之物(抽菸、饮酒、槟榔),热盛毒聚,积蕴於舌,损伤肌肉,经络阻滞,形成肿块。影响吞咽,病久身形消瘦,气阴两虚。证型气阴两虚夹热毒气郁。治则:清热解毒,除痰散结,通络怯瘀,兼补气阴。经中药处方25 次,肿块溃脓消失成1cm 以内,胀痛减(吗啡使用由2 小时一次,减为4 小时以上一次),较可吞咽。
【关键词】中药、真人活命饮、口腔癌、舌癌
 
Ming-Huei Cheng1*Huan-Chin Lin1Ting-Fang Huang2
1Department of Traditional Chinese Medicine, Feng Yuan Hospital of the Ministry of Health
and Welfare, Feng Yuan, Taiwan
2Department of Dentistry, Feng Yuan Hospital of the Ministry of Health and Welfare, Feng Yuan, Taiwan
【Summary】
A 40-year-old male presented with tongue ulcer, dysphagia, and hemoptysis for one year. He had a history of >20-year chewing betel quid, tobacco, and alcohol use. Advanced Oropharyngeal cancer (squamous cell carcinoma, C02.1 malignant neoplasm of border of tongue, iT2N1M0) was found, with metastatic lymphadenopathies. The tumor was treated by concurrent chemoradiation therapy (cisplatin*3). However, he has suffered from neck mass(a cluster of metastatic lymphadenopathies with central necrosis, in right upper neck and invades into the right parotid gland, 5cm), sore throat, dysphagia, otalgia, headache, odynophagia, change in voice, loss of appetite, weight loss(92Kg to 54.4Kg), sallow complexion, and fatigue after refusing the surgical excision since one month ago. The pulse diagnosis was string-like, fine, and slippery. Also, the tongue diagnosis was red tongue with thin fur. According to such many signs, a diagnostic conclusion according to Traditional Chinese Medicine Theory, pattern, suggested retained dampness heat toxin in tongue with dual deficiency of qi and yin constitutions. Therefore, we used the therapeutic principle--clearing heat, detoxify, dispelling phlegm, dispersing nodules, tonifying qi and enriching yin.After the Chinese Medicine based on the principle was given to the patient, he reduced the dose of morphine (one time 2 hours to 4 hours). Additionally, right
lymph node mass shrank from 5cm to 1cm, and otalgia, headache, odynophagia all were relieved..
 
【Keywords】Traditional Chinese Medicine; Oral squamous cell carcinoma; Tongue cancer; Retained dampness heat toxin; Dual deficiency of qiand yin; Xian Fang Huo Ming Yin