| 中文摘要 |
"54歲女性病患，於96/8/28發生口齒不清、發燒及全身虛弱。96/8/31下午，家人發現病患口角歪斜、左上肢無力，故送至本院急診。96/9/1收入神經科加護病房治療，仍發燒至39℃，意識惡化，頸部僵硬，呼吸微喘（27次/分鐘），經檢查後診斷為單純疱疹病毒腦炎，治療期間持續高燒至96/9/21。96/10/03轉入一般病房，10/04會診中醫，希望能處理病患意識不佳、痰多的問題。診察發現：病患意識呈嗜睡狀態，痰白稠量多，偶咳嗽，咽中有痰音；體溫37.8℃，以鼻胃管灌食牛奶，餐前反抽有餘量；小便味臊色深黃；舌質嫩，舌色淡紅，舌苔白膩邊少苔；脈短滑，右寸左尺不足。病患不分晝夜，時時欲睡，呼之能醒，醒後神智尚清，不久又入睡，故病名診斷為神識昏蒙；且病患先有發燒、全身虛弱及說話不清楚的狀況，之後出現流涎、口角歪斜、肢體無力，迅速進展至神昏、呼吸困難的狀態，病程變化快速，再加上發病時間點，整體表現與溫病伏暑發病的特性相類似，故證型為伏暑後期、包絡痰熱未淨、清竅失寧、氣陰已傷。治法以豁痰開竅為主，佐宣肺運脾以化濕清熱，兼護氣陰。中醫介入是在伏暑後期所遺留之神志障礙，經過三個星期的治療，病人的痰量減少，清醒時間也漸漸延長。This patient was a 54-year-old woman. Her family found her with slurred speech, fever, and general weakness on 96/8/28. She was taken to our emergence department and was admitted to Stroke and Neurology Intensive Care Unit due to sudden onset deviated mouth and weakness of left upper limb on 96/8/31。High fever up to 39℃, progressing consciousness disturbance (GCS E1V1M1), neck stiffness, and shortness of breath were noticed on 96/9/1. After series of examinations, herpes simple virus(HSV) encephalitis was highly suspected. Although acyclovir was given, the fever persisted until 96/9/21. The patient was transferred to general ward on 96/10/03. Her family asked for consulting Chinese internal medicine doctor for disturbed consciousness with a large amount of sputum. At that time, the patient was drowsy, and she sometimes coughed up stick sputum with phlegm rale in throat. Her body temperature was 37.8℃. She was fed through nasogastric tube but digestive function was poor. The muscle of four limbs was soft (muscle power about 3-4 degree). Her urine was deep yellow in color with foul smell. Her tongue was pink and tender-soft with white slimy fur. Her pulse was short-slippery but weaker at right cun and left chi. The patient was drowsy in day and night. Her consciousness was clear after awaken but she fell asleep soon again. The diagnosis was disturbed consciousness. The initial symptoms were fever, weakness, and slurred speech. Then drawling, deviated mouth, and limb weakness occurred. Just four days later, the symptoms progressed to unconsciousness and dyspnea. Because of the rapid progress and the onset of the disease both corresponded to the characteristics of latent summerheat, the patterns were sequelae of latent summerheat, residual pericardial phlegm-heat affecting the clear orifices, and damage to qi and yin. Our major therapeutic methods were sweeping phlegm and opening orifices. Assistant treatments were diffusing the lung and invigorating the spleen to clear dampness-heat, and protecting qi and yin. While Chinese internal medicine doctor was consulted, the problem was focus on the neurologic sequelae of the latent summer-heat. After giving Chinese medication for three week, the amount of sputum decreased and the duration of awareness was prolonged. " |
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