中醫治療腹瀉型大腸激躁症之病例報告

Traditional Chinese Medicine Treatment of Diarrhea Predominant Irritable Bowel Syndrome (IBS)-A Case Report

大腸激躁症是一種常見的疾病，常見症狀包含腹痛、腹部不適、腹脹及排便失調。屬於功能性異常的腸胃疾病，通常會反覆發作、慢性且持續，目前尚未完全清楚大腸激躁症的致病機轉，雖病患腸道結構正常但卻表現出異常的蠕動功能及腸道臟器過度敏感。一般認為情緒和壓力是誘發及惡化因素，病患的症狀可能受到基因、環境和心理因素影響。腸躁症在中醫被歸類於「泄瀉」、「腹痛」、「便秘」等範疇，和肝、脾、腎相關，病位在大腸。本案例是泄瀉為主要症狀的大腸激躁症病患，每天腹脹痛、水便3-4行約40年，經中醫辨證為肝鬱脾虛，故以疏肝解鬱，益氣健脾為基本治療原則，使用參苓白朮散及加味逍遙散加減，經過中藥調理後緩解症狀，並改善病患生活品質，大腸激躁症生活品質評量表（IBS-QoL）從一開始就診的10分提升至57分。

Irritable bowel syndrome (IBS) is a common disease. Abdominal pain, abdominal discomfort, abdominal distension and defecation disorder are the most common symptoms. It is a functional gastrointestinal disease that usually occurs repeatedly, chronically and persistently. The pathophysiology of IBS is not clear. Although the patient's intestinal structure is normal, but it shows abnormal peristaltic function and oversensitization of intestinal organs. It is generally believed that emotions and stress are inducing and deteriorating factors, and patients' symptoms may be affected by genetic, environmental, and psychological factors. Intestinal irritability is classified in the categories of ''diarrhoea'', ''abdominal pain'', and ''constipation'' in Chinese medicine. It is related to liver, spleen, and kidney, and the disease location is in the large intestine. This case is a patient with irritable bowel syndrome with as the main symptom. He had abdominal pain and 3-4 times of diarrhea for about 40 years. The clinical syndrome is liver stagnation and spleen deficiency. Therefore, the basic treatment principle is to relieve the liver and relieve depression, and benefit qi and spleen. Suffering from quality of life. We used Shen-ling-bai-zhu-san and Jia-wei-xiaoyao- san to treat this patient and successfully relieve symptoms and improve patients' quality of life. IBS-QoL increased from 10 at the beginning to 57.