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中医药研究论丛
 221.18 中药结合西医治疗改善原田氏病－病例报告
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TJ TCM.22(1) : 187-196, 2019
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中药结合西医治疗改善原田氏病－病例报告
Combination of Chinese Herbal Medicine and Western Medicine Could Improve
Harada’s Disease - A Case Report
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苏郁婷1,2 张凯惟1 陈方佩1,3 龚彦颖1,4*
1 台北荣民总医院传统医学部，台北，台湾
2 中国医药大学中医学系，台北，台湾
3 国立阳明大学传统医药研究所，台北，台湾
4 国立阳明大学医学院医学系，台北，台湾
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【摘要】
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原田氏病(Vogt-Koyanagi-Harada Disease ,VKHD) 为一多系统性自体免疫疾病，主要发生於有色人种，其特徵为葡萄膜虹彩炎合并浆液性视网膜脱离，并常伴随神经学（肩颈僵硬、脑脊液增多症、脑膜炎）与皮肤相关（白癜风、脱发）的症状。其临床表现多元，取决於疾病阶段而有所不同，中医临床证型亦随之改变：急性期以肝经湿热为主，恢复期则为肝肾阴虚。本病例为一位57 岁男性患者，於2011 年4 月时因双眼视物模糊而前来本院传统医学部就诊，因患者於2010 年6 月30 日出现Vogt-Koyanagi-Harada diesase（原田氏葡萄膜虹彩炎），临床表现为双眼撕裂感、视物模糊、畏光等，双眼眼底显示浆液性视网膜剥离，网膜断层摄影(OCT) 显示双眼视网膜下液体，萤光眼底血管摄影检查(FAG）显示点状萤光。急性期西医给予常规药物皮质类固醇(Mednin、Prednisolone) 与免疫抑制剂(Sandimmunneoral)， 缓解期则为症状治疗。中医治疗方面为期9 个月(2011/4/18-2012/1/19)，治则以益气养阴、疏肝清热为主，药方采用：小柴胡汤合竹叶石膏汤加减，结果病患矫正视力尚可维持右眼1.2、左眼0.9，显示中药结合西医眼科治疗可提升原田氏病病患的生活品质。
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【关键词】原田氏病、葡萄膜虹彩炎、科学中药、小柴胡汤合竹叶石膏汤
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Yu-Ting Su1,2 Kai-Wei Chang1 Fang-Pei Chen1,3 Yen-Ying Kung1,4*
1Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2College of Chinese Medicine, China Medical University, Taipei, Taiwan
3Insitiute of Traditional Medicine, National Yang-Ming Univerdity, Taipei, Taiwan
4School of Medicine, National Yang-Ming Univerdity, Taipei, Taiwan
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【Summary】
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Vogt-Koyanagi-Harada Disease (VKHD) is a multisystem autoimmune disease that occurs mainly in people of color. It’s characterized by uveitis with serous retinal detachment, and is often accompanied by neurology (neck stiffness, cerebrospinal fluid increase, meningitis) and skin(vitiligo, alopecia) related symptoms. Depending on the stage of disease, the clinical manifestations perform diverse, and the clinical symptom of Chinese medicine also change: the acute phase perform damp-heat in liver channel, and the recovery period perform deficiency of liver-yin and kidney-yin.
This case report showed a 57-year-old male came to the hospital’s traditional medicine department in April 2011 due to blurred vision of both eyes. On June 30,2010, this patient suffered from Vogt-Koyanagi-Harada disease, the clinical manifestations perform tearing eyes, blurred vision, photophobia, etc. The fundus of eyes showed serous retinal detachment, and optical coherence tomography (OCT) showed subretinal fluid OU, and fluorescein angiography showed fluorescent point. Prednisolone and Sandimmun neural was given in the period of acute phase, and symptomatic treatment done in recovery period. Chinese medicine treatment for a period of 9 months (2011/4/18-2012/1/19), the principles of treatment was supplementing qi and nourishing yin, dispersing liver qi and heat-clearing. We used xiao chai hu tang combined with zhu ye shi gao tang. The results showed that the patient’s corrected visual could maintain OD 1.2 amd OS 0.9, indicating that Chinese herbal medicine combined with western medicine ophthalmology treatment could improve the quality of life of patients with Harada’s disease.
Keywords：Vogt-Koyanagi-Harada Disease, uveitis, scientifically processed Chinese herbal medication, xiao chai hu tang combined with zhu ye shi gao tang
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