以治療膽管癌患者吞嚥困難合併食慾不振案例體現金匱要略之肝脾病理關係──吞嚥困難合併食慾不振治療概念之探討

A Case Report of Interpret Liver-Spleen Pathologic Relationship in Synopsis of Prescriptions of the Golden Chamber by Treating Dysphagia of a Patient with Cholangiocarcinoma

本病例報告之患者於診斷出膽管癌後逐漸出現吞嚥困難及食慾下降的情形，並於此次接受中醫治療前三個月因前述問題而住院。經中醫四診及分析後，歸咎其發於腫瘤壓迫及情治不暢等因素。《千金衍義》曰：「噎之與膈，本同一氣，膈證之始，靡不由噎而成。」，因此將患者主訴歸類在噎膈。《金匱要略．臟腑經絡先後病脈證》：「問曰：上工治未病，何也？師曰：夫治未病者，見肝之病，知肝傳脾，當先實脾，四季脾王不受邪，即勿補之。中工不曉相傳，見肝之病，不解實脾，惟治肝也。」本例雖為膽管癌，但以中醫理論而言，可從肝立論，患者的病程發展和典籍中的肝脾病相吻合，因此從預防醫學的觀點討論肝膽疾病患者的給藥方針。本病患者在中醫的藥物治療之下，吞嚥困難和食慾不振的問題都有大幅改善，其他脾胃相關症狀，例如打嗝、排便等，也都有獲得幫助。 The case of the report had difficulty to swallow and gradually lost appetite after the diagnosis of cholangiocarcinoma, and admission because of these reasons three months before the Chinese medication. After analyzing and diagnosing by the theory of traditional Chinese medicine, we found out that the causes of the discomforts were compression of the tumor and depression. Dysphagia is recorded as y? g? in Chinese medication. Synopsis of prescriptions of the golden chamber mentioned that The supreme healer cures the illness that is still obscure, so when liver got sick, treating spleen should be the first order. Although the case was cholangiocarcinoma, according to Chinese medication theory, we make a point on liver's pathogenesis. The progression of this case was quite match with the liver-spleen relationship just mentioned, so we decided how to treat this kind of patient in the view of preventive medicine. Under the Chinese medication, the patient got improved in the dysphagia and appetite, and other digestive system problem such as hiccup and defecation.