中藥介入疑因COVID-19染疫之女童乳房提早發育加劇之病例報告

Traditional Chinese medicine intervenes in the girl with the aggravation of early breast development suspected to be infected with COVID-19: A Case Report

8歲女童因患有中樞性性早熟，規則地接受中醫治療。自112年2月COVID-19疫情流行期間染疫開始，乳房發育加劇，由Tanner stage2轉為Tanner stage3，服用以龍膽瀉肝湯及知柏地黃丸為主方之中藥卻未見改善。初診時，病患同時罹患腸胃炎，因此，中醫辨證為外感寒邪、邪入肺胃，痰熱互結、相火旺盛，因此，以散寒解表、和中化溼、辛溫通竅之治則處理新加外感，另外，滋陰降火之治則治療性早熟，初步治療以荊防敗毒散、藿香正氣散、辛夷清肺湯和知柏地黃丸加減做為主方；中、後段時期則以健脾和胃、宣肺解表、散寒化飲之治則改善脾虛泄瀉和寒飲伏肺之證，知柏地黃丸加減方貫穿性早熟療程。經3週中藥治療，乳房增大及乳暈隆起回復至發育前狀態，整體乳房發育回到Tanner stage2（breast bud development），肺脾氣虛之消化功能欠佳及過敏性鼻炎症狀經持續治療後亦趨於穩定。本病例報告發表中藥治療感染COVID-19而加重性早熟病況之經驗，可望提供替代醫療之參考。

The 8-year-old girl investigated in this study who suffered from central precocious puberty and has since received traditional Chinese medicine(TCM) treatment regularly. After infection with COVID-19 in February 2023, she experienced intensified breast development (i.e., from Tanner stage 2 to Tanner stage 3), and taking traditional Chinese medicine based on Long Dan Xie Gan Tang and Zhi Bai Di Huang Wan did not show any improvement. At the first visit, the patient also suffered from gastroenteritis at the same time, the syndrome differentiation of TCM is that the exogenous cold pathogen invading lung and stomach, combination of phlegm and heat, and hyperactivity of ministerial fire. Therefore, the treatment principles in deal with the exogenous pathogen is dispelling cold and removing dampness for regulating stomach and resuscitation with pungent and warm-natured drug, and in addition, the rule of treatment in precocious puberty is nourishing yin to reduce pathogenic fire. The initial treatment consisted of jing fang bai du san, huo xiang zheng qi san, xin yi qing fei tang, and modified zhi bai di huang wan as the main formula, while in the middle and later periods, the therapeutic principle of strengthening the spleen and stomach, dispersing lung qi for resolving exterior, dispelling cold and removing dampness was used to improve the syndrome of diarrhea with spleen qi deficiency and cold fluid retention in lung. Among them, modified zhi bai di huang wan was prescribed throughout the treatment course of precocious puberty. After three weeks of traditional Chinese medicine treatment, the bulging of the patient’s breasts disappeared completely, the breast development returned to Tanner stage 2. It has also stabilized with poor digestion due to lung and spleen deficiency with qi weakness and alleviate allergic rhinitis symptoms. Through the TCM therapy in treating with this case, we could provide the experience on alternative medicine to the treatment of precocious puberty that aggravated by COVID-19.