克隆氏病之中西醫會診病例報告

Crohn's disease: a admitted case report of Chinese and Western medicine consultations

克隆氏病是一種少見的發炎性腸道疾病，本病病因可能與免疫缺失、基因缺陷造成的症候群有關，不過尚無定論。本病的特點是慢性、全壁式、跳躍性的腸壁發炎。發炎潰瘍的部位大多在迴腸末端，部份會波及結腸。病人通常會出現腹痛及腹瀉，甚至血便。面對本病，西醫多以飲食控制、營養支持、類固醇或免疫抑制劑等藥物來控制病情。數年後，可能因為反復的腸道發炎潰瘍產生纖維化，導致腸阻塞或瘻管，需以手術治療。整體而言，現代醫學對於本病尚無特效的治療方法。 這是一位十六歲的年輕男性。約一年半前開始每隔3~6個月就會因腹痛至診所就醫，皆以急性腸胃炎診治。在101年9月因血便而住院檢查，內視鏡檢查發現食道遠端、迴腸未端、盲腸、升結腸、橫結腸有多處潰瘍，臨床€診斷為克隆氏病（Crohn's disease），病情經控制穩定後出院。至102年3月再因腹痛住院，診斷仍為克隆氏病，二週後症狀緩解出院。未料，三日後再度因為連續解血便而入院，西醫給予輸血，並投以消脹氣、止血藥、抗生素、類固醇..等藥物控制病情，但腹瀉與血便未見改善，遂於三天後（3月25日）會診中醫。 會診時依中醫四診所得，辨病為「血痢」。主要辨證為「腸道溼熱」。治則採清利濕熱為主。採用梔子冰片膏穴位貼敷，穴位採下脘、天樞、關元。每天貼2次，每次4小時。貼敷一天後血便消失，病人自覺腸蠕動變快，排氣增多，腹痛減輕。便轉黃糊，且有中藥味道。於是西醫類固醇開始減量，停用止血藥。再二日後黃色糊狀糞便漸轉黏稠，病人開始進食稀飯。再二日後，病人已開始吃固體食物，解出黃色糞便已成形。因病情控制穩定，病人於102年4月2日順利出院。我們認為：中藥穴位貼敷在本病例的治療過程中，發揮了積極有效的作用，其對於治療克隆氏病所造成的血便之作用機轉，值得進一步研究探討。

This 16 years old boy had suffered from recurrent abdominal pain and visited the clinic every 3-6 months, and was diagnosed with acute gastroenteritis. He was admitted with bloody stool in September 2012. Endoscopically, the multiple ulcerations were founded in the distal esophagus, terminal ileum, appendix, ascending colon, and transverse colon, The clinical diagnosis was Crohn's disease. After treatment, the condition improved and he discharged. Unfortunately, the patient admitted again for abdominal pain under the diagnosis of Crohn's disease in March 2003. The symptoms were subdued in 2 weeks, then he was dicharged. But the bloody stool recurred in 3 days, and he was hospitalized again. Flatulence medicines, hemostatics, antibiotics, and steroids were prescribed to controlled the condition, but the abdominal pain and bloody stool persisted, then the Chinese medicine was consulted. During the consultation, the disease differentiation by Chinese medicine-formulated diagnostic methods was bloody diarrhea. The prime differentiation was intestinal tract damp heat which was premier treatment-eliminated. The herbal paste compose of the jasmine- and borneol possessed 24 hour cycles daily for the acupoints─ ST7; ST25; CV4. After the therapy in 1 day, the bloody stool stopped, the bowel movements and passing gas increased, abdominal pain decreased, and yellow paste-like stool with Chinese medicine scent. Thence, the steroid dosages was decreased and the hemostatic medicine stopped. In 2 more days, the yellow paste-like stool piecemeal became thick sticky, In the next 2 days, he started solids food and had yellow formed stools. According to the improvement, he was discharged. This experience revealed: the herbal paste onto Acupoint therapy served as an active and effective treatment on the diarrhea and bloody stool by Crohn's disease, and the effective mechanism was worth further study.