神經源性大便失禁之中醫藥病例報告

Traditional Chinese Medicine Treatment for Neurogenic Fecal Incontinence: A Case Report

10.7102/JTCIM.202406_22(1).0004

程瀠萱(Ying-Hsuan Chen)；許銘仁(Ming-Jen Sheu)；許堯欽(Yao-Chin Hsu)

後縱韌帶骨鈣化症 ； 脊椎狹窄 ； 神經源性大便失禁 ； 大便滑泄 ； 督脈損傷 ； Ossification of the Posterior Longitudinal Ligament ； Neurogenic Fecal Incontinence ； spleen-kidney yang deficiency ； Du meridian damage ； Bu Zhong Yi Qi Tang

中醫內科醫學雜誌

22卷1期（2024 / 06 / 01）

35 - 50

繁體中文;英文

82歲男性，民國108年罹患C3-6頸椎後縱韌帶骨鈣化症（Ossification of the Posterior Longitudinal Ligament, OPLL），因椎管狹窄壓迫神經，開始出現手足四肢無力麻木、步行困難、排便困難等症狀。109年頸椎手術後，四肢無力仍無改善且大小便控制功能惡化，出現大便應力性失禁以及排尿障礙尿液滯留。因服用藥物皆無法有效改善大便失禁的問題，故至本院中醫尋求協助。來診時患者主述為大便失禁已經五個月，每天站立或手足用力時即發作，伴隨聲低氣短，食慾不佳，脈沉無力，且因脊椎壓迫出現下肢無力，需輪椅代步。中醫辨證為腎陽虛衰、中氣下陷，處方選擇補中益氣湯合八味地黃丸為主方，補氣助陽，並佐以澀腸止瀉。服藥三週後，大便失禁滲出量減少，頻率減少至兩日一次；服藥八週後，患者自主控制排便能力進步，失禁頻率下降至兩週一次；至第十週後大便失禁已明顯改善，僅剩一個月一次；第十六週開始便秘，故開始加入養血潤腸藥物，並將補腎陽改為滋腎陰，便秘獲得改善，排便再度獲得控制。此後均在治療過程中，隨患者體徵的轉變，調整助陽及滋陰藥物比例，調和陰陽，患者經治療後整體精神體力佳，食欲進步，排便狀況平穩，大便失禁幾乎未再發作。此案用中醫辨證論治處方順利改善神經源性大便失禁，提升患者精神體力，使整體功能及生活品質上升。

An 82-year-old male patient was diagnosed with Ossification of the Posterior Longitudinal Ligament (OPLL) at the C3-6 cervical vertebrae in 2019. The condition led to neural compression due to spinal canal stenosis, resulting in symptoms such as limb weakness, numbness, difficulty walking, and constipation. Despite undergoing cervical spine surgery in 2020, the patient experienced persistent limb weakness and deterioration of urinary and fecal control functions. This manifested as fecal urge incontinence and urinary retention. As conventional pharmacological interventions failed to address the fecal incontinence issue, the patient sought assistance from traditional Chinese medicine treatment. Upon consultation, the patient reported a five-month history of fecal incontinence, exacerbated during periods of physical exertion, accompanied by low voice, shortness of breath, poor appetite, and a pulse that was deep and weak. TCM diagnosis revealed damage to the Du meridian, with the identification of spleen-kidney yang deficiency and qi descent as the underlying patterns. The prescribed herbal formula consisted primarily of Bu Zhong Yi Qi Tang combined with Ba Wei Di Huang Wan to supplement qi, and warm and tonify the spleen and kidney. Additionally, an astringent formula was included to address bowel stagnation. After three weeks of treatment, there was a reduction in the frequency and volume of fecal incontinence. By the eighth week, the patient exhibited improved voluntary bowel control, with incontinence occurring only once every two weeks during physical exertion. Remarkable improvement in fecal incontinence was noted by the tenth week, with incidents reduced to once a month. However, constipation emerged by the sixteenth week, prompting a modification of the treatment plan to include blood-nourishing and bowel-moistening herbs. Further adjustments were made, transitioning from tonifying kidney yang to nourishing kidney yin, promoting blood circulation, and moistening the intestines, resulting in alleviation of constipation and regaining control over bowel movements. Subsequent treatment adjustments were guided by the patient's evolving symptoms, involving the modulation of yang-invigorating and yin-nourishing herbal proportions to harmonize the yin-yang balance. The patient experienced overall improvement in mental and physical well-being, enhanced appetite, and stabilized bowel habits. Fecal incontinence rarely recurred, showcasing the successful application of TCM pattern differentiation and treatment principles in ameliorating neurogenic fecal incontinence and enhancing the patient's quality of life.