從血尿的治療探討中醫病因病機以及鑑別診斷

Discussion on Pathogenesis and Differential Diagnosis of Traditional Chinese Medicine from Hematuria Treatment

10.6516/TJTCM.201909_22(2).0020

陳曉瑱(Hsiao-Tien Chen)；廖厚勳(Hou-Hsun Liao)

血尿 ； 腎泌尿 ； 泌尿鑑別診斷 ； 病因病機 ； 中醫 ； Hematuria ； Urinary tract diseases ； Differential diagnosis ； Pathogenesis ； Traditional Chinese medicine

中醫藥研究論叢

22卷2期（2019 / 09 / 30）

203 - 213

繁體中文

血尿是泌尿系統損傷常見的病理症狀，成年人盛行率高達20%，病因複雜且檢查項目多樣化，約有10%~20%病患檢查後，確診血尿病因不明，需持續追蹤診察。本病患為82歲血尿婦女，西醫診斷為乙狀結腸第四期合併左側腎水腫，經皮穿腎造廔引流術後一週仍持續出現血尿症狀，因此會診中醫。西醫以止血劑為主但有造成血塊阻塞泌尿系統的副作用，且停藥後可能症狀即再復發，本例配合使用中藥治療一週後未見有副作用，且其療效合併西醫治療為佳，可見血尿病位非單純腎、膀胱，病患出現血尿伴隨心火、腹股溝腫痛、陰器澀痛問題，此特殊症狀可將病位設定在心、小腸、肝、膀胱上治療，得到良好的療效。未來在面對血尿，甚至是泌尿道疾患上，以中西醫生理病理為基礎，結合檢驗數據和中醫四診合參、臨床症狀觀察，以提升中醫對於血尿的全面治療。

Hematuria is a common pathological symptom of urinary system injury. The prevalence rate of adults is as high as 20%. The etiology is complicated and the examination items are diversified. About 10% to 20% of diagnosed patients are unknown the cause of hematuria. It is necessary to continue to follow up. In this case report, patient was a 82-year-old hematuria woman who diagnosed as the fourth stage of the sigmoid colon with left renal edema. Hematuria symptoms continued to appear one week after percutaneous nephrostomy and drainage, so the Chinese medicine was consulted. Western medicine mainly uses hemostatic agents, but it has the side effects of clots blocking the urinary system, and the symptoms may recur after stopping the drug. In this case, there is no side effect after one week of treatment with traditional Chinese medicine, and the curative effect is better with Western medicine treatment. The disease is not simple kidney or bladder. The patient has hematuria accompanied by heart fire, swelling of the groin, and pain of the genitals. This special symptom can be used to treat the disease in the heart, small intestine, liver and bladder, and get good curative effect. In the future, in the face of hematuria, and even urinary tract diseases, based on the pathology of Chinese and Western doctors, combined with test data and four diagnostics of Chinese medicine, clinical symptoms, to improve the comprehensive treatment of hematuria in Chinese medicine.

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