針藥並用輔助治療乳癌末期蕈狀傷口潰爛膿血之病例報告

The Therapeutic Experience of Malignant Fungating Wounds in End-Stage Breast Cancer with Traditional Chinese Medicine and Acupuncture-A Case Report

10.6516/TJTCM.202303_26(1).0003

陳豪君(Hao-Chun Chen)

乳癌末期 ； 蕈狀傷口 ； 腫瘤 ； 化療副作用 ； 中醫 ； 針灸 ； 癌症輔助治療 ； Breast cancer ； Malignant Fungating Wounds ； Tumor ； Side effects of chemotherapy ； Complementary and alternative medicine ； Traditional Chinese medicine (TCM) ； Acupuncture

中醫藥研究論叢

26卷1期（2023 / 03 / 30）

29 - 41

繁體中文;英文

48歲女性左側乳房腫塊兩年但不願就醫，前年1月乳房腫塊開始變大變硬，而後開始觸摸到左側腋下腫塊，但此時患者仍不願就醫，自行以網路偏方治療，直到去年四月乳房腫塊上皮膚開始滲出膿液，再半年後因乳房腫塊疼痛、虛弱、眠差、納差、體重減輕才於2021/09/28才第一次至西醫就診，就診時乳房腫塊已8公分，腫瘤皮膚蕈狀傷口潰瘍流膿血、肉芽組織範圍已達10cmx10cm，診斷為左側侵襲性乳管癌（T4bN2M1, Stage IV）合併淋巴結轉移，影像學上並已有肺部轉移，無法開刀。2021/10/18裝置port-A開始化療，第一次Docetaxel、第二次Docetaxel化療+Trastuzumab、Pertuzumab標靶完成後，因腫塊仍持續流膿血及化療副作用水瀉頻急而於2021/11/20至中醫門診就診，伴隨疲倦、納差、夜間眠差難入睡易醒、情緒緊張、胸悶心悸，兩耳耳鳴悶塞感、口乾口苦、雙手十指紅疹癢、小便頻而黃…等症狀，經中醫辨證為肝鬱氣滯化熱痰凝乳絡、化療後脾胃氣虛濕聚，經治以益氣健脾、疏肝清熱，用藥二個多月後患者左側乳房腫塊皮膚潰破收口，範圍縮小至6.5cmx5.5cm，且已無膿血滲出。

Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. Care usually aims to slow down disease progression, and improve quality of life by relieving the physical symptoms caused by the wounds (leakage, bad smell, pain and the risk of haemorrhage). This case is about a 48-year-old woman who has locally advanced invasive ductal carcinoma with lung metastasis and lymph nodes metastasis with a fungating malignant wound on her left breast. After 2^(nd) chemotherapy, the skin ulceration was still oozing and painful and the chemotherapy-related diarrhea, fatigue, poor-appetite, hair loss, insomnia, anemia and palpitation were also noticed. With sink pulsation and the above symptoms, the major diagnosis in traditional Chinese medicine is "liver qi stagnation and dampness-heat congestion" and "spleen and kidney deficiency". After benefiting spleen qi, dispersing stagnated liver qi and reducing the damp and heat, the fungating malignant wound has shrunk from 10 cm to 6.5 cm in diameter and no longer oozing within two months treating with acupuncture and traditional Chinese medicine. Also, the chemotherapy-related diarrhea in the 3^(rd) chemotherapy was reduced.

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