小腦萎縮症中西醫配合治療病例報告

Spinocerebellar ataxia treated with combination of traditional Chinese medicine and western medicine – a case report

這位患者為五十四歲男性，於2002 年時因突發下肢無力、走路不穩至醫院檢查，患者家族病史中有小腦萎縮症（Spinocerebellar ataxia），且MRI 亦顯示有小腦萎縮的情形，確診為小腦萎縮症後開始接受西方醫學及另類醫學治療。患者症狀隨著時間而逐漸變化，走路不穩情形加重至需使用柺杖或輪椅，同時也漸漸出現飲水易嗆咳、容易被口水嗆到，並且有手抖、持物不穩等情形。患者於2007 年於國外接受中藥及針灸治療，症狀雖然稍有改善，如飲水易嗆咳等症狀較穩定，但下肢無力及手抖等未見明顯改善，且肢體活動不協調，因此於2009 年六月至彰化基督教醫院中醫部就診，臨床診斷為痿證，證屬氣血虧虛，肝腎陰虛風動，夾有血瘀。治則以補養肝腎、補益氣血為主，佐以平肝息風活血祛瘀，中藥處方以一貫煎及補陽還五湯加減，臨床上再搭配針灸及穴位推拿等治療方式，增強補益肝腎、強筋壯骨功能。經過一個月密集治療，患者臨床症狀大有改善，手足麻症狀減輕，腰痠痛減輕、肢體協調度進步。因小腦萎縮症在中醫臨床上仍屬少見疾病，因此提供作為中西醫結合全人治療小腦萎縮症之有效案例。This 54-year-old male patient was sent to hospital due to sudden lower limb weakness in 2002. The MRI showed signs of cerebellar atrophy. The patient, with a family history of SCA, was subsequently diagnosed as spinocerebellar ataxia (SCA). The patient started to receive the treatments of both Western medicine and alternative medicine simultaneously. However, the symptoms gradually deteriorated over time to the state that crutches and wheelchair were needed. Also, coughing while drinking, choking accompanied by saliva-swallowing, hand-trembling and holding instability were observed. The patient received Traditional Chinese herbal medicine and acupuncture in 2007. Although coughing and chocking were improved slightly, there was no obvious progress on lower limb weakness and hand tremor. Starting from 2009, the patient began to receive the treatment from Department of Chinese Medicine, Changhua Christian hospital. The illnes was diagnosed as “Wilting disease” with insufficiency of qi and blood, liver-kidney yin deficiency with stirring wind and blood stasis. Based on the diagnosis, methods target on nourishing qi, replenishing blood, and enriching liver and kidney yin were prescribed. Yi-guan decoction（一貫煎）and bu-yang-huan-wu decoction（補陽還五湯）were used to treat the patient. Besides, acupuncture and manipulation on acu-point were also employed to revitalize liver and kidney. After intensive therapy for a month, significant improvements in hands and feet numbness, back pain and limbs coordination were observed. This promosing result demonstrates the feasibily and power of combining traditional Chinese Medicine and Western medicine in the treatment of SCA patients.