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221.17 以治疗胆管癌患者吞咽困难合并食欲不振案例体现金匮要略之肝脾病理关系－吞咽困难合并食欲不振治疗概念之探讨

TJ TCM.22(1) : 177-186, 2019

DOI : 10.6516/TJTCM.201903_22(1).0017

以治疗胆管癌患者吞咽困难合并食欲不振案例体现金匮要略之肝脾病理关系

－吞咽困难合并食欲不振治疗概念之探讨

A Case Report of Interpret Liver-Spleen Pathologic Relationship in Synopsis of Prescriptions of the Golden Chamber by Treating Dysphagia of a Patient with Cholangiocarcinoma

李欣桦1　陈晓瑱1　廖厚勋1*

1 佛教慈济医疗财团法人大林慈济医院中医部，嘉义，台湾

【摘要】

本病例报告之患者於诊断出胆管癌後逐渐出现吞咽困难及食欲下降的情形，并於此次接受中医治疗前三个月因前述问题而住院。经中医四诊及分析後，归咎其发於肿瘤压迫及情治不畅等因素。《千金衍义》曰：「噎之与膈，本同一气，膈证之始，靡不由噎而成。」，因此将患者主诉归类在噎膈。《金匮要略·脏腑经络先後病脉证》：「问曰：上工治未病，何也？师曰：夫治未病者，见肝之病，知肝传脾，当先实脾，四季脾王不受邪，即勿补之。中工不晓相传，见肝之病，不解实脾，惟治肝也。」本例虽为胆管癌，但以中医理论而言，可从肝立论，患者的病程发展和典籍中的肝脾病相吻合，因此从预防医学的观点讨论肝胆疾病患者的给药方针。本病患者在中医的药物治疗之下，吞咽困难和食欲不振的问题都有大幅改善，其他脾胃相关症状，例如打嗝、排便等，也都有获得帮助。

【关键词】吞咽困难、噎膈、胆管癌、金匮要略

Hsin-Hua Li1　Hsiao-Tien Chen1　Hou-Hsun Liao1*

1Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical

Foundation, Chia-Yi, Taiwan

【Summary】

The case of the report had difficulty to swallow and gradually lost appetite after the diagnosis of cholangiocarcinoma, and admission because of these reasons three months before the Chinese medication. After analyzing and diagnosing by the theory of traditional Chinese medicine, we found out that the causes of the discomforts were compression of the tumor and depression. Dysphagia is recorded as yē gé in Chinese medication. Synopsis of prescriptions of the golden chamber mentioned that The supreme healer cures the illness that is still obscure, so when liver got sick, treating spleen should be the first order. Although the case was cholangiocarcinoma, according to Chinese medication theory, we make a point on liver’s pathogenesis. The progression of this case was quite match with the liverspleen relationship just mentioned, so we decided how to treat this kind of patient in the view of preventive medicine. Under the Chinese medication, the patient got improved in the dysphagia and appetite, and other digestive system problem such as hiccup and defecation.

Keywords：dysphagia, cholangiocarcinoma, Synopsis of prescriptions of the golden chamber

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