薄氏腹針治療對類固醇治療無效的病毒感染後的嗅覺異常─病例報告

The Application of Bo’s Abdominal Acupuncture on Post-Viral Olfactory Disorder After Steroid Treatment Failure: A Case Study

研究目的：上呼吸道病毒感染後發生的嗅覺異常（PVOD）是現代醫學所面臨的難題，使用類固醇治療僅29.6% 有明顯效果，又關於傳統及替代療法的文獻並不多，於是希望能藉由此病例報告闡述薄氏腹針對於治療PVOD 的療效。病例報告：這位52 歲女性無任何慢性病史，患者以嗅覺下降及嗅覺倒錯來求診，自述1 月底時感冒有膿痰、鼻塞、頭痛、鼻涕難擤、難呼吸，自當時便聞不到味道，而後發現嗅覺全無，1 個月後出現可聞到的氣味都似蒜頭味。西醫診斷為病毒性鼻竇炎，X 光顯示鼻竇通暢，服用類固醇已四週但未見改善。因上述症狀至針灸門診求診。我們使用薄氏腹針，穴位包括中脘、下脘、氣海、關元、滑肉門、氣穴、商曲、石關、陰都、大橫，及上風濕點等，經由一週兩次，共16 次的針灸治療後，患者的嗅覺下降、及嗅覺倒錯獲得改善及頭痛、鼻塞等伴隨症狀消失，並且能分辨數種花香及果香等香味。結論：薄氏腹針對於治療PVOD 有其效果，可以改善 嗅覺及其他伴隨症狀，亦可能縮短嗅覺復原所需要的時間，當患者使用類固醇無效時，薄氏腹針可做為一種替代或是輔助治療。然而，本病例仍無法排除有嗅覺自然恢復的可能性。我們需要更多臨床案例及設計良好的臨床試驗來證實其有效性。

 

Objective: Post-viral olfactory disorder (PVOD) is a troublesome disorder. Only 29.6% of patient gained significant improvement after corticosteroid treatment. There have been few studies on alternative way in treating post-viral olfactory disorder (PVOD). The purpose of this case study was to investigate the effect of Bo’s abdominal acupuncture in a patient with PVOD. Case presentation: A 52-year-old female presented with hyposmia and parosmia for over one month. At first, she noticed loss of the sense of smell after recovery from the cold, and about one week later, all her sense of smell became garlic odor. Initially she visited otolaryngologist for help. Viral sinusitis was diagnosed though image studies showed no structural abnormality that would cause conductive olfactory dysfunction. Daily steroids was prescribed for four weeks, but her sense of smell was not improved. Therefore, she came to our department of acupuncture for help. Methods and outcome: According to the theories of Bo’s abdominal acupuncture, CV12 (Zhongwan, 中脘), CV10 (Xiawan, 下脘), CV6 (Qihai, 氣海), and CV4 (Guanyuan, 關元) were applied for conducting Qi back to its origin. Both sides of ST24, KI13, KI17, KI18, and KI19 were prescribed for symptoms of upper-jiao, especially located at head, therefore we chose them for olfactory dysfunction. Ab1 were applied for nasal diseases. SP15 was prescribed for strengthening the spleen and eliminating dampness. All acupoints mentioned above are the treatment protocol for common cold and nasal diseases. Disposable stainless steel filiform needles (30 gauges, 40mm long) were inserted and retained for 15 minutes. Acupuncture was performed twice a week for two months. During the course of treatment, her garlic smell faded away and she could recognize flavor of fruits and flowers over time. Conclusion:Abdominal acupuncture can improve the sense of smell and nasal symptoms of PVOD patients, without disadvantages of somatic acupuncture including painful sense and poor compliance. It might be a choice of alternative or adjuvant therapy for PVOD when patients were refractory to corticosteroids. However, the possibility of natural recovery could not be ruled out. We need more clinical cases and well-designed clinical trials to confirm the effectiveness.