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中医药研究论丛
 222.12 鼻咽癌投与清咽利膈汤临床病例报告
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TJ TCM.22(2) : 115-124, 2019 115
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鼻咽癌投与清咽利膈汤临床病例报告
The Use of Qing Yang Li Ge Tang Decoction in Nasopharyngeal Carcinoma: Case Report
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杨清惠1,2* 洪义成3
1 高雄荣民总医院传统医学科，高雄，台湾
2 树人医护管理专科学校，屏东，台湾
3 高雄荣民总医院药学部药师，高雄，台湾
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【摘要】
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鼻咽癌主要发生在东南亚地区，以台湾、香港和中国大陆地区为主。根据卫生署在2008 年统计资料显示，鼻咽癌为台湾男性主要癌症死亡原因的第九名。鼻咽癌好发年龄主要在40 至50 岁之壮年期，对社会、经济、劳力及家庭造成重大冲击。男比女易患鼻咽癌，比例为3 比1。鼻咽癌发生之原因为多重因素所构成，危险因子为种族遗传因素、环境因素、抽菸和喝酒以及EB 病毒感染。中医认为，鼻咽癌发病主要是由脏腑机能失调，火毒、瘀血、痰浊内生，留结鼻咽而变生癌肿。鼻咽癌开始是肺热。肺开窍於鼻，肺气通於鼻，肺气不和则上焦热盛，迫血离经出现鼻衄。若气血凝滞，津液壅塞停结，则变生息肉而鼻塞。其次是肝郁气逆，肝与相表里，胆移热於脑则脑崩。肝气逆则头痛、耳聋。若风热毒气郁积脏腑，则出现口舌歪斜视一为二等症状。若肝肾精血亏损，虚火内动，或痰火升郁於耳中，则耳鸣、耳聋。治疗鼻咽癌注重蠲毒逐瘀化痰结。笔者於2015 至2018 年开立清咽利隔汤明显改善治疗35 位鼻咽癌及头颈癌病患放化疗後所导致的副作用。清咽利隔汤改善耳鸣，重听，耳漏，耳痛等不适症状，降低感染风险，同时再也不需要使用洗鼻器，大福改善病人生活品质。
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【关键词】头颈部肿瘤、鼻咽癌，放射治疗、中医、清咽利膈汤
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Ching-Huey Yang1,2*Yi-Chen Hung3
1Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
2Shu-Zen Junior college of Medicine and Management, Pingtung, Taiwan
3Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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【Summary】
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Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide, but it is endemic in a few areas including Southern China. Epstein-Barr virus (EBV) has been suggested as a cause of undifferentiated NPC, environmental risk factors, and/or genetic susceptibility, may interact with EBV to play a role in the carcinogenesis of NPC. R/T is the primary treatment because of NPCs deep anatomic location. High incidence of lymphatic metastase and poor pathological differentiation. Temporal bone is unavoidably included in the radiation filed, so various otologic complications, such as otitis externa, otitis media with effusion, chronic otitis media, osteoradio necrosis of the temporal bone, and sensorineural hearing loss (HL) are common occurrences after radiotherapy for NPC. Post irradiation otitis media with effusion (OME) is the most common and its morbidity is as high as 9% to 26%. This refers to Chinese Medicine as “phlegmdampness
constitution”. In this case of NPC, Qing Yan Li Ge Tang is used to clear up the thick mucus in which phlegm expelled, purulent nasal discharge reduced. Dysguesia was noted after CCRT was improved greatly after sputum expelled and otalgia susbsided. Regular oral intake of QYLGT reduced tinnitus, dizziness, otorrhea, and infection; thus, patient’s quality of life is improved greatly and no longer need to use nasal wash.
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【Keywords】Head and Neck Tumor, Nasopharyngeal carcinoma, Radiotherapy, Qing Yang Li Ge Tang
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