從疾病辨證與體質辨證治療久咳不癒之病例報告

A Case Report of a Patient with Chronic Cough Treated by Constitution and Disease Pattern Identification

一名69歲的退休女性病患，過敏性鼻炎病史已多年，於2010年10月8日因反覆咳嗽已2年前來就 診。病患平日怕冷，口不乾渴，晨起或天寒時偶作噴嚏，且有鼻涕倒流感及目乾癢的現象，咳嗽時 伴隨涎沫狀水樣稀痰，偶因咽癢作咳，但現無咽癢。曾因反覆咳嗽日久不癒而就診西醫胸腔科，檢 查後無肺部異常之發現，並診斷為慢性咳嗽，服西藥治療仍持續咳嗽故前來就診。來診時面色淡 白、皮膚稍乾、目乾澀，舌淡紅黯苔薄白膩滑，脈軟滑不浮，證屬久咳氣虛，寒痰夾瘀蘊肺，病機為腎陽虛水津不化兼肺血虛夾肺絡瘀阻無以佈陽，治以苓甘薑味辛夏仁湯合當歸加味，以溫補腎陽和養血通瘀以蠲化寒痰兼益氣固表以防外邪復擾，服中藥後病人咳嗽頻率及稀痰均明顯減少。本病案可提供臨床醫師在治療慢性咳嗽時，除了需掌握標病辨證特徵外還需特別注意病患體質並提供當歸治療肺血虛咳嗽的用藥思路與經驗。

A 69-year-old retired female patient with history of allergic rhinitis for many years came to our outpatient department due to recurrent cough for two years. The patient couldn't take the cold and sneezed with post-nasal dripping and dry eyes with itching while getting up in the morning or in the cold whether. She also complained about coughing with saliva-like and watery sputum. Coughing with itching throat sensation sometimes occurred but there was no itching throat sensation now. She didn't feel thirst when cough happened. Therefore, she went to search for western medicine for help and was diagnosed as chronic cough but came to search for Chinese medicine because of poor response for western medicine and persisting cough. There were pale face, dry skin and eyes, dark-red tongue with slimy fur and much saliva, vacuous and slippery pulse under examination while chest X-ray showing perihilar infiltration. After pattern identification by symptoms and signs, the patterns were identificated as kidney yang vacuity, lung blood vacuity, cold phlegm and blood stasis in lung and exterior vacuity. After treating with modified Lin-Gan-Jiang-Wei-Xin-XiaZen-Tang in addition to Dang-gui, the frequency of cough and watery sputum decreased. This case report can provide suggestions not only in noticing constitution of the patient while treating with Chinese medicine but also in the thinking process of treating cough by Dang-gui.