糖尿病合併肝膿瘍中西醫結合治療病例報告

Diabetes with Liver Abscess Treated with Combination of Traditional Chinese Medicine and Western Medicine: A Case Report

這是一位76 歲的男性患者，過去有糖尿病的病史，此次因呼吸喘促入院，住院期間因血糖控制不佳、合併右上腹疼痛，經電腦斷層檢查發現肝膿瘍，血液培養為肺炎克雷白氏桿菌（Klebsiella pneumoniae ssp. pneumoniae）感染，之後接受經皮穿肝抽吸和抗生素的治療。在住院過程中患者仍持續發燒三天、持續右上脅疼痛，中醫臨症觀察到有發熱惡寒、身熱汗出，舌象為舌質紅、舌苔白厚滿布，脈浮滑數，診斷為肝癰，治療以解表利濕清熱，理氣排膿，處方以藿朴夏苓湯加減。後二日身熱退，仍有右上脅疼痛，舌質稍紅，舌苔滿布白苔中根厚，脈按之滑數，續前方加入鬱金、敗醬草，以疏肝行氣止痛，清熱消癰排膿，祛瘀止痛。在治療過程中臨床症狀明顯地改善，而其舌象的變化發現舌苔亦有漸漸地減退，後續以超音波追蹤肝膿瘍液化程度，合併中醫芳香化濕、利濕排膿的治則下獲得有效的控制，提供作為中西醫結合治療糖尿病合併肝膿瘍的一有效臨床案例。

This 76-year-old male patient with the past history of diabetes mellitus, was admitted due to shortness of breathing. He was diagnosed as pyogenic liver abscess, Klebsiella pneumoniae ssp. pneumoniae related, companied with hyperglycemia and right upper abdominal pain in hospital course. Then he received transcutaneous needle aspiration and antibiotic therapy. As disease progressed, he had spiking fever for 3 days and persistent right upper abdominal pain with red tongue, white-thick fur, slippery, floating and rapid pulse. Therefore we prescribed Huo-pu-xia-ling decoction based on dampness-heat assailing the exterior, the fever subsided. Interestingly, the tongue appearance had obviously changed, like tongue fur reduced, as symptoms improved. We examined the quality and size of liver abscesses using abdominal sonography and found the liver abscesses reduced under treatment. Through this case report, we provide more evidence about diabetes with pyogenic liver abscess treated with combination of traditional Chinese medicine and western medicine.