神門穴灸治放療後，味覺障礙療效觀察與現代化分析

Observation of Shenmen Acupoint Moxibusition Curative Effect on Post-Radiotherapy Taste Dysfunction

頭頸癌近幾年在國內長年是前十大死因之一，但放射線治療所產生的味覺障礙在西元1959年就被發現，近代醫學至今仍沒較有效的改善處治。從傳統中醫角度，放射線治療被視為是火邪傷陰而會造成陰分缺乏、削弱氣機的症狀，而以清熱解毒、益氣活血方法常可取得穩定的療效。但味覺細胞受損、味覺障礙，中醫辨證治療下療效也有侷限；本研究藉由臟腑學說「心主任物」的發揮，選用神門穴艾灸方式在臨床診療觀察中取得穩定療效。本文同時蒐集本院中醫內科門診頭頸部相關癌症患者，在以神門穴艾灸治療前後，藉由記錄主觀味覺評估、脈診儀與熱像儀等客觀數據綜合探討在「心主任物」理論中、可能的療效因素。在記錄觀察三位包含急性與慢性味覺障礙的鼻咽部惡性腫瘤案例連續三次的自我味覺評估與脈象、舌象結果，發現經過每周或者每2周一次、連續三次的治療後，患者的主觀味覺改善程度都有40%-60%的改善幅度，且觀察到急性期療效反映較快，第一次治療就有顯著改善，而慢性期患者則需兩周的治療期才能有顯著的變化；同時亦得到在患者的左關有頻譜能量下降並達統計上的顯著差異（p<0.05），以及在艾灸前後的舌象溫度下降變化，然溫度變化幅度並未達顯著差異。綜觀結果，本研究藉現代診斷儀器輔助下，推論神門灸可能與調和相火而君火得充，則心主任物功能得以恢復。然而因為收案人數不足，未能得到更多的數據驗證理論，但希望在此前驅性研究驗證神門灸對於味覺障礙的治療經驗，並持續未來能有更多個案累積以有更強而有力的證據。

Head and neck cancer has remained one of the top ten causes of death in Taiwan in these years. There are yet a directly effective treatment for taste dysfunction, which is one of the side effects of radiotherapy. For Chinese medicine, radiotherapy for cancer is taken for exogenous heat that reducing the yin constitutions, leading to qi weakness. Therefore, clearing heat and detoxifying, nourishing qi and activating blood always taken to well alleviate the mucositis, dysphagia, and dry mouth symptoms form radiotherapy for head and neck cancer as qi-yin injuries. But for bud cells'damage, taste disorder even poor quality of life are still unsolved efficiently today. This study used moxibustion on Shenmen point in outpatient treatment on selected head and neck cancer cases from internal Chinese medicine clinic in KMUH, and recorded the differences by pulse analyzer, and thermal image camera to verify the presumed thesis. The results of sphygmography and tongue images from three acute and chronic dysgeusia cases of nasopharyngeal cancer revealed statistically reduce on spectral energy (p<0.05), and temperature alteration on thermal images of tongue while was not drastically change. The present study assumed that due to reconciling of premier fire, refilling of sovereign fire so recovering the function of Liver and Kidney, and main commanding ability of Heart. Due to limited cases, the evidence was not strong enough to support the curative effects. We hope to accumulating more strengthen and higher qualitative evidences in the future.