頑固型便祕以非瀉下劑為主方治療三例

Three Cases of Non-classic Laxative Treatment of Chronic Refractory Constipation

10.6718/TJCM.202209_28(2).0004

侯耀華(Yao-Hua Hou)；鄒騰樟(Teng-Chang Tsou)

中藥 ； 臨床診療 ； 頑固型便祕 ； 腸躁症 ； Chinese medicine ； clinical management ； chronic refractory constipation ； irritable bowel syndrome

台北市中醫醫學雜誌

28卷2期（2022 / 09 / 30）

29 - 36

繁體中文

全球便祕的盛行率約有20%，治療常以瀉下潤腸劑作為短期通便的選擇，但久用效率降低且需要增劑，也不能處理便祕患者常連帶之腹脹、腹痛、呃逆等腸胃症狀。本篇蒐集三個不同年齡層頑固型便祕患者，以兼顧上下消化道排空能力及穩定神經系統作為考量，依照中醫整體辨證論治法調理，先調整脾胃異常症狀後，再改善便秘，結果可以減少長期使用瀉下劑患者的使用劑量，並改善便祕及連帶症狀。使用方藥包括瀉心湯類方：以半夏、生薑（乾薑）為主軸。行氣疏肝類方：以枳殼、厚朴、枳實、柴胡、香附等為主軸。溫陽健脾類方：以理中輩、四君子輩加減。可以做為治療便祕時的思考方向與辨證論治選擇。

The prevalence of constipation is about 20% around the world. The common medical therapies are laxative and secretagogues. However, it is only useful for short-term treatment and do not resolve comorbidities such as abdominal fullness, stomachache, hiccup, nor gastroesophageal reflux. Here are three cases of chronic refractory constipation patients in three age groups. By regulating the transit of upper and lower gastrointestinal system and sedating nerve system associating to the gastrointestinal system with the wholistic treatment principle of tradition Chinese medicine, cases reduce their dosage of laxative, and relive comorbidities. The use of Chinese medicine are: Xiexin tang, such as pinellia and ginger, drug for conduct Qi and dispersing liver, such as fructus aurantii, fructus aurantii immaturus, mangnolia officinalis, radix bupleuri and cyperus rotundus, etc., durg for warm yang and tonifying spleen, such as ginseng, atractylodes rhizome, poria cocos, liquorice, ginger etc.. This strategy could be an option for chronic constipation treatment.

1. 王興華,張惠惇,王光耀,葉儒佳,何承舉(2015)。功能性便祕的辨證與治療。臺灣中醫科學雜誌，8(2)，48-52。
   連結：
2. 江昆壕,彭啟豪(2018)。長期便祕之中醫治療病例。台北市中醫醫學雜誌，35-39。
   連結：
3. 林姿君,賴奇吟,何宗融(2020)。腸躁症的中醫治療病例報告。中醫藥研究論叢，23(2)，149-157。
   連結：
4. Bharucha, AE,Lacy, BE(2020).Mechanisms, Evaluation, and Management of Chronic Constipation.Gastroenterology,158(5),1232-1249.e3.
5. Jiang, Y,Tang, Y,Lin, L(2020).Clinical Characteristics of Different Primary Constipation Subtypes in a Chinese Population.J Clin Gastroenterol,54(7),626-632.
6. Jong, MS,Hwang, SJ,Chen, YC,Chen, TJ,Chen, FJ,Chen, FP(2010).Prescriptions of Chinese herbal medicine for constipation under the national health insurance in Taiwan.J Chin Med Assoc.,73(7),375-383.
7. Włodarczyk, Jakub,Wa'sniewska, Anna,Fichna, Jakub,Dziki, Adam,Dziki, Łukasz,Włodarczyk, Marcin(2021).Current Overview on Clinical Management of Chronic Constipation.Journal of clinical medicine,10(8),1738.
8. Zhong, LLD,Cheng, CW,Kun, W,Dai, L,Hu, DD,Ning, ZW,Xiao, HT,Lin, CY,Zhao, L,Huang, T,Tian, K,Chan, KH,Lam, TW,Chen, XR,Wong, CT,Li, M,Lu, AP,Wu, JCY,Bian, ZX(2019).Efficacy of MaZiRenWan, a Chinese Herbal Medicine, in Patients With Functional Constipation in a Randomized Controlled Trial.Clin Gastroenterol Hepatol,17(7),1303-1310.e18.
9. Zikos, Thomas A,Kamal, Afrin N,Neshatian, Leila,Triadafilopoulos, George,Clarke, John O,Nandwani, Monica,A Nguyen, Linda(2019).High Prevalence of Slow Transit Constipation inPatients With Gastroparesis.Journal of Neurogastroenterol and Motility,25(2),267-275.
10. 王曉翠,王新漢,張江偉(2011)。慢性腎衰患者服用大黃致繼發性便祕的治療體會。陜西中醫，32(05)，640-641。
11. 李麗,章浩軍,闕茂棋,王蘋(2019)。理中湯合枳術湯治療太陰陰結便祕型腸易激綜合征臨床觀察。廣州中醫藥大學學報，36(3)，332-336。
12. 周肸,錢海華,張丹,曾莉(2020)。加用柴胡疏肝散治療便祕患者心理障礙療效觀察。遼寧中醫雜誌，47(05)，99-102。
13. 劉薇,劉仍海(2018)。便祕證治四法。北京中醫藥，37(06)，539-543。
14. 儲琳,唐海軍(2019)。柴胡疏肝散加減治療便祕型腸易激綜合征療效觀察。實用中醫內科雜誌，33(11)，24-26。