以木防己湯及真武湯治療水腫患者之病案報告

A Case Report of Mu Fang Ji Tang and Zhen Wu Tang Used in the Patient with Edema

水腫在臨床照護上是很常見的相關症狀，可涉及各種內外因以及五臟虛損，甚至是三焦之氣化功能。此病例為一名有胸腺瘤病史之水腫患者，施行過左下肺葉切除及腹主動脈支架置放手術，入院時影像學檢查有左側肋膜積水情形，初以《金匱要略》中所述及之膈間支飲方法調治，方以木防己湯加減，用藥後病人呼吸喘促較減緩，然腹脹仍持續，且夜間因胃嘈雜不適欲催吐，四肢水腫未獲得改善甚而逐漸加重，慮及脾腎運化水濕，改以真武湯溫腎陽、利水氣，治療後諸症漸減。故透過此病例，討論痰、飲、水、濕的中醫初步論治，並分析木防己湯與真武湯的相關臨床見證與治療的關係。 Edema is a very common symptom in clinical diseases and it often involved in a variety of internal and external causes as well as the vacuity of five viscera, and even the qi transformation of triple burner in Traditional Chinese medicine (TCM). This case is an edematous patient with the history of thymoma, who had undergone the left lower lobe lung resection and angioplasty with stent placement. This time he was admitted due to the left pleural effusion and shortness of breath and edema. And patient asked for Chinese medicine treatment. Due to the pleural effusion, we use mu fang ji tang which is referred to as the therapy of propping rheum in the diaphragm in the Essential Prescriptions of the Golden Coffer. After the treatment, the patient’s dyspnea improved. However, the abdominal fullness sustained and edema gradually got worse, and the patient had nausea and vomit at night. Therefore we use zhen wu tang to warm kidney yang and disinhibit water. After all the treatment, the patient’s symptoms got relived and discharged from hospital. Therefore, through this case, we could realize the initial identification of phlegm, rheum, water and damp of the treatment in traditional Chinese medicine, and analyze the relationship between the clinical evidence and the therapeutic effects of mu fang ji tang and zhen wu tang.

Edema is a very common symptom in clinical diseases and it often involved in a variety of internal and external causes as well as the vacuity of five viscera, and even the qi transformation of triple burner in Traditional Chinese medicine (TCM). This case is an edematous patient with the history of thymoma, who had undergone the left lower lobe lung resection and angioplasty with stent placement. This time he was admitted due to the left pleural effusion and shortness of breath and edema. And patient asked for Chinese medicine treatment. Due to the pleural effusion, we use mu fang ji tang which is referred to as the therapy of propping rheum in the diaphragm in the Essential Prescriptions of the Golden Coffer. After the treatment, the patient’s dyspnea improved. However, the abdominal fullness sustained and edema gradually got worse, and the patient had nausea and vomit at night. Therefore we use zhen wu tang to warm kidney yang and disinhibit water. After all the treatment, the patient’s symptoms got relived and discharged from hospital. Therefore, through this case, we could realize the initial identification of phlegm, rheum, water and damp of the treatment in traditional Chinese medicine, and analyze the relationship between the clinical evidence and the therapeutic effects of mu fang ji tang and zhen wu tang.