中藥結合西醫治療改善原田氏病──病例報告

Combination of Chinese Herbal Medicine and Western Medicine Could Improve Harada's Disease - A Case Report

原田氏病（Vogt-Koyanagi-Harada Disease ,VKHD）為一多系統性自體免疫疾病，主要發生於有色人種，其特徵為葡萄膜虹彩炎合併漿液性視網膜脫離，並常伴隨神經學（肩頸僵硬、腦脊液增多症、腦膜炎）與皮膚相關（白癜風、脫髮）的症狀。其臨床表現多元，取決於疾病階段而有所不同，中醫臨床證型亦隨之改變：急性期以肝經濕熱為主，恢復期則為肝腎陰虛。本病例為一位57歲男性患者，於2011年4月時因雙眼視物模糊而前來本院傳統醫學部就診，因患者於2010年6月30日出現Vogt-Koyanagi-Harada diesase（原田氏葡萄膜虹彩炎），臨床表現為雙眼撕裂感、視物模糊、畏光等，雙眼眼底顯示漿液性視網膜剝離，網膜斷層攝影（OCT）顯示雙眼視網膜下液體，螢光眼底血管攝影檢查（FAG）顯示點狀螢光。急性期西醫給予常規藥物皮質類固醇（Mednin、Prednisolone）與免疫抑制劑（Sandimmun neoral），緩解期則為症狀治療。中醫治療方面為期9個月（2011/4/18－2012/1/19），治則以益氣養陰、疏肝清熱為主，藥方採用：小柴胡湯合竹葉石膏湯加減，結果病患矯正視力尚可維持右眼1.2、左眼0.9，顯示中藥結合西醫眼科治療可提升原田氏病病患的生活品質。 Vogt-Koyanagi-Harada Disease (VKHD) is a multisystem autoimmune disease that occurs mainly in people of color. It's characterized by uveitis with serous retinal detachment, and is often accompanied by neurology (neck stiffness, cerebrospinal fluid increase, meningitis) and skin (vitiligo, alopecia) related symptoms. Depending on the stage of disease, the clinical manifestations perform diverse, and the clinical symptom of Chinese medicine also change: the acute phase perform damp-heat in liver channel, and the recovery period perform deficiency of liver-yin and kidney-yin. This case report showed a 57-year-old male came to the hospital's traditional medicine department in April 2011 due to blurred vision of both eyes. On June 30,2010, this patient suffered from Vogt-Koyanagi-Harada disease, the clinical manifestations perform tearing eyes, blurred vision, photophobia, etc. The fundus of eyes showed serous retinal detachment, and optical coherence tomography (OCT) showed subretinal fluid OU, and fluorescein angiography showed fluorescent point. Prednisolone and Sandimmun neural was given in the period of acute phase, and symptomatic treatment done in recovery period. Chinese medicine treatment for a period of 9 months (2011/4/18-2012/1/19), the principles of treatment was supplementing qi and nourishing yin, dispersing liver qi and heat-clearing. We used xiao chai hu tang combined with zhu ye shi gao tang. The results showed that the patient's corrected visual could maintain OD 1.2 amd OS 0.9, indicating that Chinese herbal medicine combined with western medicine ophthalmology treatment could improve the quality of life of patients with Harada's disease.