本病例为60岁女性患者，两年前曾患右脸贝尔氏麻痹，初期颜面神经麻痹 分级为House-Brackmann Facial Paralysis Scale Grade V，经神经科及物理治疗 6月馀後进展为Grade III，後续接受针灸治疗2个多月後，颜面神经麻痹续改 善至Grade I~II之间。然而在结束治疗後两年间患者仍有右侧面部後遗症状存 在，若睡眠较差或身体状况不佳时即出现右脸无力僵硬状况，口鼻处尤为明显 。因频繁发作的右脸不适感，患者至本院中医部求诊。此患者在中医疗法上， 采用以脉象为主轴的诊疗方式，以制定患者针药治疗方针。针药无二致，此患 者的治疗重点为稳定气血、安神扶正、通畅经络兼除内热，故使用印堂、肾关 、足三里、外关、蠡沟、下巨虚等穴交替治疗；而主方则使用小柴胡汤合温清 饮，及清心莲子饮合甘麦大枣汤加减作为治疗。治疗後患者脸部後遗症状况及 头晕、眠差等兼症皆改善且病况稳定。临床上贝尔氏麻痹後遗症之中医治疗讨 论相对较少，希望以此案例分析，提供同道作为面瘫後遗症治疗的叁考面向之 一。 【关键词】颜面神经麻痹、贝尔氏麻痹後遗症、面瘫後遗症、针灸、中医治疗 |
We present a case received acupuncture and Chinese medicine for sequelae of Bell’s palsy. The 60-year-old female had right Bell’s palsy about two years ago. Initially, her facial paralysis was classified as House-Brackmann Grade V. After treatments of neurology department, physical therapy and acupuncture, her facial paralysis improved to House-Brackmann Grade I to II. However, the patient still suffered from residual symptoms of sequelae of Bell’s palsy including intermittent facial weakness and stiffness. Furthermore, poor sleep and dizziness were also noticed often. The symptoms of facial sequelae worsened when the patient had poor sleep or was in unwell physical condition. Due to the frequent episodes of facial discomforts, the patient sought consultation at Traditional Chinese Medicine Department. In this case, the diagnosis and treatments for the patient’s sequelae of Bell’s palsy depended mainly on pulse diagnosis of Chinese medicine. Acupuncture and herbal medicine were collaborative in this patient’s treatment plan. The goals of Chinese medicine treatments were stabilizing qi, blood and mind, strengthening healthy qi, dredging meridians, and clearing heat. Therefore, acupoints including Yintang(EX-HN3), Shenguan(T77.18), Zusanli(ST36), Waiguan(SJ5), Ligou(LR5), and Xiajuxu(ST39) were treated, and Xiao-Chai-Hu-Tang combined with Wen-Qing-Yin and Qing-Xin-Lian-Zi-Yin combined with Gan-Mai-Da-Zao-Tang with modifications were prescribed. After acupuncture and herbal treatments based on pulse examination, the patient’s facial sequelae and accompanying symptoms including dizziness and poor sleep improved and remained in a stable condition in two months. 【Keywords】Facial nerve paralysis； Sequelae of Bell’s palsy； Acupuncture； Traditional Chinese Medicine treatment |
282.6中医针药并用治疗贝尔氏颜面神经麻痹 後遗症之病例报告
