鼻咽癌投與清咽利膈湯臨床病例報告

The Use of Qing Yang Li Ge Tang Decoction in Nasopharyngeal Carcinoma: Case Report

10.6516/TJTCM.201909_22(2).0012

楊清惠(Ching-Huey Yang)；洪義成(Yi-Chen Hung)

頭頸部腫瘤 ； 鼻咽癌 ； 放射治療 ； 中醫 ； 清咽利膈湯 ； Head and Neck Tumor ； Nasopharyngeal carcinoma ； Radiotherapy ； Qing Yang Li Ge Tang

中醫藥研究論叢

22卷2期（2019 / 09 / 30）

115 - 123

繁體中文

鼻咽癌主要發生在東南亞地區，以台灣、香港和中國大陸地區為主。根據衛生署在2008年統計資料顯示，鼻咽癌為台灣男性主要癌症死亡原因的第九名。鼻咽癌好發年齡主要在40至50歲之壯年期，對社會、經濟、勞力及家庭造成重大衝擊。男比女易患鼻咽癌，比例為3比1。鼻咽癌發生之原因為多重因素所構成，危險因子為種族遺傳因素、環境因素、抽菸和喝酒以及EB病毒感染。中醫認為，鼻咽癌發病主要是由臟腑機能失調，火毒、瘀血、痰濁內生，留結鼻咽而變生癌腫。鼻咽癌開始是肺熱。肺開竅於鼻，肺氣通於鼻，肺氣不和則上焦熱盛，迫血離經出現鼻衄。若氣血凝滯，津液壅塞停結，則變生息肉而鼻塞。其次是肝鬱氣逆，肝與相表裡，膽移熱於腦則腦崩。肝氣逆則頭痛、耳聾。若風熱毒氣鬱積臟腑，則出現口舌歪斜視一為二等症狀。若肝腎精血虧損，虛火內動，或痰火升鬱於耳中，則耳鳴、耳聾。治療鼻咽癌注重蠲毒逐瘀化痰結。筆者於2015至2018年開立清咽利隔湯明顯改善治療35位鼻咽癌及頭頸癌病患放化療後所導致的副作用。清咽利隔湯改善耳鳴，重聽，耳漏，耳痛等不適症狀，降低感染風險，同時再也不需要使用洗鼻器，大福改善病人生活品質。

Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide, but it is endemic in a few areas including Southern China. Epstein-Barr virus (EBV) has been suggested as a cause of undifferentiated NPC, environmental risk factors, and/or genetic susceptibility, may interact with EBV to play a role in the carcinogenesis of NPC. R/T is the primary treatment because of NPCs deep anatomic location. High incidence of lymphatic metastase and poor pathological differentiation. Temporal bone is unavoidably included in the radiation filed, so various otologic complications, such as otitis externa, otitis media with effusion, chronic otitis media, osteoradio necrosis of the temporal bone, and sensorineural hearing loss (HL) are common occurrences after radiotherapy for NPC. Post irradiation otitis media with effusion (OME) is the most common and its morbidity is as high as 9% to 26%. This refers to Chinese Medicine as ＂phlegm-dampness constitution＂. In this case of NPC, Qing Yan Li Ge Tang is used to clear up the thick mucus in which phlegm expelled, purulent nasal discharge reduced. Dysguesia was noted after CCRT was improved greatly after sputum expelled and otalgia susbsided. Regular oral intake of QYLGT reduced tinnitus, dizziness, otorrhea, and infection; thus, patient's quality of life is improved greatly and no longer need to use nasal wash.

1. Chen, CY.,Young, YH,Hsu, WC,Hsu, MM(2001).Failure of grommet inserion in post-irradiation otitis media with effusion.Ann Otol Rhinol Laryngol,110,746-754.
2. Mayadagl, Alpaslan,Yaprak, Gokhan,Tezcan, Yilmaz(2014).Evaluation of late radiation side effects in nasopharyngeal cancer patients.International Journal of Hematology and Oncology,261-266.
3. Xu, Yao-dong,Ou, Yong-kang,Zheng, Yi-qing(2008).The treatment for postirradiation otitis media with media with effusion: a study of three methods, china.The Laryngoscope,2040-2043.
4. 行政院國民健康署：104 年癌症登記年報。https://www.hpa.gov.tw/Pages/List.aspx?nodeid=269
5. 李雲芳,胡元,郜飛宇(2011)。周維順治療喉癌經驗。河南中醫，08，848。
6. 周小君,田道法(2001)。鼻咽癌古文獻研究。中華醫史雜誌，31(02)，115-118。
7. 周淑英(2017)。香港蔣超偉博士對鼻咽癌的中醫論治經驗。香港中醫雜誌，01(12)，10-12。
8. 林宜信(2000)。中藥方劑「甘露飲」配合放射治療鼻咽癌引起口乾及黏膜發炎。中醫藥年報，127-146。
9. 林昭庚(2002)。中國醫學病症及病名分類之研究。中醫藥年報，247-502。
10. 香港衛生署衛生防護中心：鼻咽癌。https://www.chp.gov.hk/tc/healthtopics/content/25/54.html
11. 財團法人國家衛生研究院=NHRI(2000).鼻咽癌臨床診療指引.
12. 財團法人國家衛生研究院=NHRI(2000).鼻咽癌之診斷與治療共識.