中西結合治療缺血性腦中風：病例報告

Treating ischemic stroke with Chinese MedicineTherapy following conservative treatment using Western Medicine:A Case Report

10.6528/CAMS.201912_7(1).0009

何秀琴(Ho Hsiu-Chin)

中西醫結合治療 ； 缺血性腦中風 ； 辨證論治 ； ischemic stroke ； Chinese Medicine therapeutics ； Ru-Mo Si-Wu Tang ； Bu-Yang Huan-Wu Decoction ； Shi-Quan Da Bu Decoction ； You-Gui Yin

中國鍼灸學雜誌

7卷1期（2019 / 12 / 29）

131 - 146

繁體中文

報告病例為71歲女性，有高血壓病史，曾因雙膝退化性關節炎，曾於入院前兩週前，接受左關節置換術，使用助步器行走中。病患於2008/07/21晚上8點左右，主訴眩暈約數分鐘，無噁心嘔吐現象。家屬漸發現病人反應變慢，說話簡短，但沒有含糊不清或肢體軟弱情形。症狀約一小時後，即送至一家醫學中心（A醫院）急診，入院當時無神識混亂，但不久發現有複視、顏面麻痺與右側肢體無力等現象，電腦斷層（CT）檢查發現左皮質下區有缺血性區塊。經評估，由於病患之NIHSS scale 5，且於發病二周前曾接受左膝關節置換術，故未給與tPA治療，僅保守內科治療。病人逐漸出現聲音嘶啞，右側手足肌力衰退情行情形。病患家屬於醫院治療隔日（2008/07/22）下午至本診所求診，於下午8點開始口服中藥水煎治療。經中西醫合療兩週（2008/08/07），右腳可上抬約10公分、右手無力稍可握拳且手指可張開。約兩個月後，病患可使用筷子進食，不需家人攙扶，逐漸可自己站起來使用助步器行走。約四個月後，病患可到公園，使用單手四腳助步器行走約1公里。約八個月後，病患記憶、思考、語言與認知功能恢復，行走穩定。中醫文獻沒有缺血性腦中風的病名，依據臨床症狀，此類疾病應屬腦卒中的範疇。中醫治療，隨著疾病的進展，依據辨證論治原則，使用不同的治腦方劑，著重其個體化治療；急性期時，治療原則為活血化瘀、平肝潛陽、清熱化痰、通腑瀉下、淡滲利濕，病情穩定後則補氣補血補陽，促進組織修復，減少併發症的發生。中醫治療中風具有多方向的治療特色，能有效對抗缺血性傷害，提高神經細胞的存活力，中西醫結合治療更提供實際而有效的療法，因此值得進一步大規模研究。

Purpose: To evaluate the effects of combined Chinese Medicine therapy and Western medical therapeutics on the patient with ischemic stroke. Case Report: A 71 years-old female patient experienced acute attack of vertigo lasting for minutes, without nausea or vomiting at night on 07, 21, 2008. The patient had history of hypertension without medication, osteoarthritis of bilateral knee joints and right total knee replacement surgery two weeks ago. After vertigo attack, delay of response and speech impairment were gradually appeared. Within an hour, she was referred to emergency room of a medical center, where she presented limb weakness, diplopia or facial palsy but no consciousness disturbance. Brain CT scan exhibited hypodensity over left subcortical area. Two days later, MRI revealed cerebral infarction in the territory of left middle cerebral artery, which compatible with right hemiplegia. Conservative treatment of Western Medicine was applied instead of tPA therapy. The patient's family, therefore, contacted our clinic for Chinese medical treatment. Principally, different Decoctions were given depending on clinical presentations. Simply, Ru-Mo Si-Wu Tang (乳沒四物湯) and Bu-Yang Huan-Wu Decoction (補陽還五湯) were given in early stage. Shi-Quan Da Bu Decoction (十全大補湯) and You-Gui Yin (右歸飲) were applied later and in re-establish periods. Results: After taking the prescription for two weeks, the patient could elevate right foot up to 10 cm in height and streched her fingers. After five-weeks treatment, the patient could stand up with assistive devices. Two months later, she could walk more stably and up to 20 meters in distance without escort. After four months, she could walk for one kilometer with a crutch. Eight months later, she displayed clear verbal expression, recovered memory, clear thinking and cognition ability. Also, she felt more energetic and more stable gaits. Conclusions: We suggested that combinations of Chinese herb and Western medical therapeutics to ischemic stroke patient, which may improve the outcome obtained with single treatment philosophy. The combined therapeutics may play an important role on improving blood circulation and decrease ischemic damage of brain tissue. However, the relative mechanism of combined therapeutics is still unclear and worth to be further advanced studied.

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