40 糖尿病性胃癱中西醫整合治療病例報告 [5,8,9] [10] 病例闡述 1. 基本資料 28 / 153 cm/58 kg 主訴現病史 Levemir 5 NovoRapid

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1 J Chin Med 28(2): 39-50, 2017 DOI: / 病例報告糖尿病性胃癱中西醫整合治療病例報告 1 1 2, , 4, * 臺中榮民總醫院傳統醫學科, 臺中, 臺灣臺中榮民總醫院高齡醫學中心, 臺中, 臺灣臺中榮民總醫院內科部內分泌新陳代謝科, 臺中, 臺灣 4 弘光科技大學護理系, 臺中, 臺灣本病例為一位 28 歲第一型糖尿病病史 13 年的女性患者曾多次因糖尿病酮酸中毒入院治療, 本次因噁心嘔吐入院, 嘔吐情形於急性血糖升高時 (>300 mg/ dl) 症狀加重, 胃排空試驗顯示胃排空時間延長, 診斷為糖尿病胃癱 (diabetic gastroparesis) 因反覆嘔吐住院五個月後會診中醫, 診斷為脾腎陽虛, 邪實在胃, 兼肝鬱, 經針灸內庭太衝豐隆與口服中藥附子理中湯加減治療後症狀獲得明顯緩解, 於會診後五周出院, 可提供中西醫結合治療糖尿病胃癱的參考關鍵字 : 糖尿病性胃癱嘔吐針灸中藥中西醫結合前言 Diabetic gastroparesis DGP 4.8% 1% 10 [1,2] [3] [1,4] [5,6,7] * 通訊作者 : citsai777@gmail.com 105 年 6 月 24 日受理,105 年 8 月 24 日接受刊載

2 40 糖尿病性胃癱中西醫整合治療病例報告 [5,8,9] [10] 病例闡述 1. 基本資料 28 / 153 cm/58 kg 主訴現病史 Levemir 5 NovoRapid Primperan Novamin Granisetron Kytril percutaneous endoscopic jejunostomy PEJ PEJ 6-7 PEJ 7 17 pms-mirtazapine 5/29-6/30 7/31-10/12 Gastric emptying study >300 mg/dl mg/ dl 5/9-5/14 7/15-7/18 8/10-9/11 Aprepitant 8/28 9/

3 馮瀞儀周書慧林時逸李奕德宋育民王俊興蔡嘉一過去病史 5. 個人史家族史 7. 檢查報告 7.1. 生命徵象與意識狀態 (9 月 11 日 ): / 20 / 158/108 mmhg GCS E4V5M 實驗室診斷數據 : WBC 10200/ CUMM, Hgb 9.5 g/dl, Platelet / CUMM, Creatinine 1.5 mg/dl, Na 125 meq/l, K 4.0 meq/l, CRP: 0.15 mg/ dl P 4.1 mg/dl, Mg 2.0 mg/dl, Ca 8.7 mg/dl albumin 3.1 g/dl 7.3. 影像學檢查報告 : Impression: Prolonged gastric emptying time Antral gastritis s/p biopsy, pathologic diagnosis: chronic gastritis Reflux esophagitis, La, Gr. B Small high signal at bilateral frontal subcortical white matter, r/o gliosis change Otherwise, no abnormal signal intensity change, enhanced lesion or mass effect in the brain parenchyma Two hyperechoic nodules are noted over liver Increased cortical echogenicity of bilateral kidneys may be due to chronic renal diseases A hyperechoic nodule over the cortex of left kidney. Hamartoma is first considered 8. 中醫四診 8.1. 望診 : 㿠聞診 : 8.3. 問診 :

42 糖尿病性胃癱中西醫整合治療病例報告 13 600 ml 12:00 4 1 10 PEJ lactulose 1000-1200 ml G0P0 LMP

4 42 糖尿病性胃癱中西醫整合治療病例報告 ml 12: PEJ lactulose ml G0P0 LMP 切診 : 9. 時序圖圖一病程時序圖 10. 診斷西醫診斷 : 中醫診斷 : 11. 病因病機分析與病因病機圖

5 馮瀞儀周書慧林時逸李奕德宋育民王俊興蔡嘉一 [9,11,12] [8] [5,8,9] 1 10 PEJ ml ml 㿠 [8,9] 12. 治則與針灸用藥思維治則 : 針灸選穴 :

44 糖尿病性胃癱中西醫整合治療病例報告圖二病因病機圖 2-3 12.3. 穴義分析 : 12.4. 方藥分析 : 2 2 2 2 6 1 0.2 1 cm 13.

6 44 糖尿病性胃癱中西醫整合治療病例報告圖二病因病機圖穴義分析 : 方藥分析 : cm 13. 追蹤診療紀錄 3 10 Novamin Primperan Novamin 9 27 PEJ 9/27 10/3 1-4 Novamin

7 馮瀞儀周書慧林時逸李奕德宋育民王俊興蔡嘉一 /4 10/9 PEJ 0-1 Novamin 10/9 10/ Novamin Novamin /9 10/ 表一中醫會診臨床紀錄表時間嘔吐次數脾胃症狀西藥變化中醫治療 9/11 9/16 9/17 9/23 9/24 9/30 10/1 10/7 4 9/14 9/15 10 Pimperan Novamin 9/17 9/ /21 A 3 9/18 Novamin 9/20 Primperan 0-2 PEJ ml A PEJ Novamin 10/1 10/ /4 B 10/4 10/7 0-4 Novamin 9/11 9/14 9/17 9/21 9/21 9/23 A * 2-3 9/24 9/28 9/24 9/27 A * 1-2 9/27 9/ /1 10/5 10/4 10/7 B # /1 10/7

8 46 糖尿病性胃癱中西醫整合治療病例報告時間嘔吐次數脾胃症狀西藥變化中醫治療 10/8 10/12 10/ / Novamin 10/12 10/8 10/12 10/10 1 ) 10/8 10/11 B # 5 10/8 10/10 * A # B 討論 (1) (2) 180mg/dL 15 (3) [1,3] [3] [ Metoclopramide Domperidone Erythromycin Prochlorperazine D2 antagonist Ondansetron 5-HT3 antagonist Promethazine H1 antagonist ] venting gastrostomy or jejunostomy [3,13,14] Granisetron Kytril selective 5-HT3 antagonist Aprepitant NK1 antagonist [15] [16]

9 馮瀞儀周書慧林時逸李奕德宋育民王俊興蔡嘉一 47 [5,8] [17] [7,18] [7] [19,20] [9] [5] [21,22]

10 48 糖尿病性胃癱中西醫整合治療病例報告 [23,24] mL mL [25,26] PEJ 1000mL-3000mL PEJ 260mL mL 9 25 PEJ PEJ [17] Primperan 參考文獻 1. Camilleri M, Bharucha AE, Farrugia G. Epidemiology, Mechanisms and management of diabetic gastroparesis. Clin. Gastroenterol. Hepatol., 9:5-12, Kofod-Andersen K, Tarnow L. Prevalence of gastroparesis-related symptoms in an unselected cohort of patients with Type 1 diabetes. J. Diabetes Complications, 26:89-93, Farmer AD, Kadirkamanathan SS, Aziz Q. Diabetic gastroparesis: pathophysiology, evaluation and management. Br. J. Hosp. Med. (Lond.), 73: , 2012.

11 馮瀞儀周書慧林時逸李奕德宋育民王俊興蔡嘉一 Jaffe JK, Paladugu S, Gaughan JP, Parkman HP. Characteristics of nausea and its effects on quality of life in diabetic and idiopathic gastroparesis. J. Clin. Gastroenterol., 45: : : : : : : pp pp Cherian D, Parkman HP. Nausea and vomiting in diabetic and idiopathic gastroparesis. Neurogastroenterol. Motil., 24: , e103, Panda H, Mitchell P, Curley M, Buresi M, Wilsack L, Andrews CN. Prospective evaluation of gastric neurostimulation for diabetic gastroparesis in Canada. Can. J. Gastroenterol. Hepatol., 29: , Chong K, Dhatariya K. A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant. Nat. Rev. Endocrinol., 5: , : : : : : : Pang B, Zhou Q, Li JL, Zhao LH, Tong XL. Treatment of refractory diabetic gastroparesis: Western medicine and traditional Chinese medicine therapies. World J. Gastroenterol., 20: , : : : :

12 J Chin Med 28(2): 39-50, 2017 DOI: / Case Report Treatment of Diabetic Gastroparesis with Combination of Traditional Chinese Medicine and Western Medicine: A Case Report Ching-Yi Feng 1, Shu-Huey Chou 1, Shih-Yi Lin 2, 3, I-Te Lee 3, Yuh-Min Song 3, Jun-Sing Wang 3, Chia-Yi Tsai 1, 4, * 1 Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 2 Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 4 Department of Nursing, Hungkuang University, Taichung, Taiwan The case, a 28-year-old female with 13 years of type 1 diabetes mellitus, has been admitted for diabetic ketoacidosis multiple times. This time she was admitted due to nausea and vomiting. Vomiting was exacerbated as blood glucose increased (>300 mg/ dl). Furthermore, gastric emptying study showed prolonged gastric emptying time. She was diagnosed as diabetic gastropresis. Five months later, she requested Chinese Medicine for curing refractory vomiting. She was diagnosed as "spleen-kidney yang deficiency syndrome, sthenia pathogenic factor in stomach, accompanied with liver qi depression." The symptoms above improved significantly after treatment with acupuncture at ST44, LR3, ST40 and prescription of Chinese herbal drug modified Fu- Zi-Li-Zhong decoction. Key words: Diabetic gastroparesis, vomiting, acupuncture, Chinese herbal drugs, integrated traditional Chinese and Western medicine *Correspondence author: Chia-Yi Tsai, Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan., Tel: ext. 4755, citsai777@gmail.com Received 24 th June 2016, accepted 24 th August 2016

84 針藥併施治療偏頭痛次發作症狀為左顳側頭脹痛, 多為夜間發作影響睡眠或工作, 頻率為一天發作一次, 持續一至二小時, 疼痛指數 7 分 (0 分為不痛, 最痛為滿分 10 分 ), 需

84 針藥併施治療偏頭痛次發作症狀為左顳側頭脹痛, 多為夜間發作影響睡眠或工作, 頻率為一天發作一次, 持續一至二小時, 疼痛指數 7 分 (0 分為不痛, 最痛為滿分 10 分 ), 需 J Chin Med 26(1): 83-91, 2015 DOI: 10.3966/101764462015062601008 83 針藥併施治療偏頭痛經驗 - 病例報告 1, 眞 # 1, #, * 1, 2 1, 2 1 高雄長庚紀念醫院中醫科系, 高雄, 台灣 2 長庚大學中醫系, 桃園, 台灣 103 12 26 104

40 糖尿病性胃癱中西醫整合治療病例報告 [5,8,9] [10] 病例闡述 1. 基本資料 28 / 153 cm/58 kg 主訴 現病史 Levemir 5 NovoRapid

40 糖尿病性胃癱中西醫整合治療病例報告 [5,8,9] [10] 病例闡述 1. 基本資料 28 / 153 cm/58 kg 主訴現病史 Levemir 5 NovoRapid