針刺治療三叉神經痛之病例報告

Acupuncture Treatment for Critical Trigeminal Neuralgia: a Case Report

張益銓(Yi-Chuan Chang)；許致善(Chih-Shan Hsu)；徐堅銘(Chien-Ming Hsu)

三叉神經痛 ； 攝護腺惡性腫瘤 ； 帶狀皰疹 ； trigeminal neuralgia ； prostate cancer ； herpes zoster

中華針灸醫學會雜誌

19卷1期（2016 / 03 / 01）

19 - 29

繁體中文

本個案為一76歲男性，病史複雜，於102年出現續斷性右臉麻痛，初以下頷區域為主，後逐漸拓展至右半面；起先患者以拔牙處理，但病兆仍未緩解；至103年中，患者表示疼痛指數(VAS scale)已達8-9分，嚴重影響到患者語言、吞嚥咀嚼、飲水等生活功能，後於104年4月28日於針灸科進行介入。於就診追蹤半年期間，患者三叉神經疼痛緩解明顯，現可如常飲食、言語表達，止痛藥服用量減低；由於患者介入前後改善明顯，且三叉神經痛對患者的日常生活功能有重大影響，臨床治療有諸多值得思考剖析之處，故透過本病例報告以供臨床研究者參考與討論。

Critical trigeminal neuralgia is difficult to deal with both in modern medicine and traditional Chinese medicine. Acupuncture is not uncommon for treating this order in Taiwan. This 76 year-old man who suffered from trigeminal neuralgia about 2 years with VAS score 8 to 9 points, suffering from speaking, chewing, swallowing and coughing in oral motivation, which dominantly affect the life quality. After the acupuncture intervention for half year, the patient's symptom for right face parenthesis and severe pain around trigeminal nerve distribution area relieved obviously. Hence, we introduce this case and the acupuncture treatment program for critical trigeminal neuralgia intervention.

1. 吳侃陽中醫師專欄 - 三叉神經痛的中醫診治 http://www.ancientac.com/wp-content/uploads/2007/02/b_treatingtrigeminalneuralgia.pdf
2. Childs, AM,Meaney, JF,Ferrie, CD,Holland, PC(2000).Neurovascular compression of the trigeminal and glossophary ngeal nerve: three case reports.Arch Dis Child,82,311.
3. Cruccu, G(2006).Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia.Neurology,66(1),139-141.
4. Gronseth, G,Cruccu, G,Alksne, J(2008).Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies.Neurology,71,1183.
5. Guardiani, E,Sadoughi, B,Blitzer, A,Sirois, D(2014).A new treatment paradigm for trigeminal neuralgia using Botulinum toxin type A.Laryngoscope,124,413.
6. Hamlyn, PJ(1997).Neurovascular relationships in the posterior cranial fossa, with special reference to trigeminal neuralgia. 2. Neurovascular compression of the trigeminal nerve in cadaveric controls and patients with trigeminal neuralgia: quantification and influence of method.Clin Anat,10,380-388.
7. Headache Classification Committee of the International Headache Society (IHS)(2013).The International Classification of Headache Disorders, 3rd edition (beta version).Cephalalgia,33,629.
8. Katusic, S,Beard, CM,Bergstralh, E,Kurland, LT(1990).Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984.Ann Neurol,27,89.
9. Katusic, S,Williams, DB,Beard, CM(1991).Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984.Neuroepidemiology,10,276.
10. Love, S,Coakham, HB(2001).Trigeminal neuralgia: pathology and pathogenesis.Brain,124,2347.
11. Love, S,Hilton, DA,Coakham, HB(1998).Central demyelination of the Vth nerve root in trigeminal neuralgia associated with vascular compression.Brain Pathol,8,1.
12. Pan, SL,Yen, MF,Chiu, YH(2011).Increased risk of trigeminal neuralgia after hypertension: a population-based study.Neurology,77,1605.
13. Rosen, BD,Saad, MF,Shea, S(2006).Hypertension and smoking are associated with reduced regional left ventricular function in asymptomatic: individuals the Multi-Ethnic Study of Atherosclerosis.J Am Coll Cardiol,47,1150.
14. Young, RF,Vermeulen, SS,Grimm, P(1997).Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related.Neurology,48,608.
15. 吳永剛(2008)。重劑引火湯治療原發性三叉神經痛臨床體會。中國中醫急症，17(12)
16. 李新吾(2011)。針刺蝶腭神經節 - 治鼻 3 穴位治療鼻部疾病的機制分析及有關針刺方法的介紹。臨床耳鼻咽喉頭頸外科雜誌，25(5)
17. 胡琳娜,邵水金,劉延祥(2010)。電針治療周圍神經損傷的修復機制。中國組織工程研究與臨床康復，14(46)
18. 馬建中(1980).中醫診斷學.正中書局出版.
19. 黃衛(2008)。針刺治療三叉神經痛探微。實用中醫內科雜誌，22(2)

1. 葉家豪,楊鯉源,卓雨青(2018)。針灸併用治長年帶狀疱疹後侵及其他神經系統醫案報告。中西整合醫學雜誌，20(1)，31-39。