本病例為60歲女性患者，兩年前曾患右臉貝爾氏麻痺，初期顏面神經麻痹 分級為House-Brackmann Facial Paralysis Scale Grade V，經神經科及物理治療 6月餘後進展為Grade III，後續接受針灸治療2個多月後，顏面神經麻痹續改 善至Grade I~II之間。然而在結束治療後兩年間患者仍有右側面部後遺症狀存 在，若睡眠較差或身體狀況不佳時即出現右臉無力僵硬狀況，口鼻處尤為明顯 。因頻繁發作的右臉不適感，患者至本院中醫部求診。此患者在中醫療法上， 採用以脈象為主軸的診療方式，以制定患者針藥治療方針。針藥無二致，此患 者的治療重點為穩定氣血、安神扶正、通暢經絡兼除內熱，故使用印堂、腎關 、足三里、外關、蠡溝、下巨虛等穴交替治療；而主方則使用小柴胡湯合溫清 飲，及清心蓮子飲合甘麥大棗湯加減作為治療。治療後患者臉部後遺症狀況及 頭暈、眠差等兼症皆改善且病況穩定。臨床上貝爾氏麻痺後遺症之中醫治療討 論相對較少，希望以此案例分析，提供同道作為面癱後遺症治療的參考面向之 一。 【關鍵詞】顏面神經麻痺、貝爾氏麻痺後遺症、面癱後遺症、針灸、中醫治療 |
We present a case received acupuncture and Chinese medicine for sequelae of Bell’s palsy. The 60-year-old female had right Bell’s palsy about two years ago. Initially, her facial paralysis was classified as House-Brackmann Grade V. After treatments of neurology department, physical therapy and acupuncture, her facial paralysis improved to House-Brackmann Grade I to II. However, the patient still suffered from residual symptoms of sequelae of Bell’s palsy including intermittent facial weakness and stiffness. Furthermore, poor sleep and dizziness were also noticed often. The symptoms of facial sequelae worsened when the patient had poor sleep or was in unwell physical condition. Due to the frequent episodes of facial discomforts, the patient sought consultation at Traditional Chinese Medicine Department. In this case, the diagnosis and treatments for the patient’s sequelae of Bell’s palsy depended mainly on pulse diagnosis of Chinese medicine. Acupuncture and herbal medicine were collaborative in this patient’s treatment plan. The goals of Chinese medicine treatments were stabilizing qi, blood and mind, strengthening healthy qi, dredging meridians, and clearing heat. Therefore, acupoints including Yintang(EX-HN3), Shenguan(T77.18), Zusanli(ST36), Waiguan(SJ5), Ligou(LR5), and Xiajuxu(ST39) were treated, and Xiao-Chai-Hu-Tang combined with Wen-Qing-Yin and Qing-Xin-Lian-Zi-Yin combined with Gan-Mai-Da-Zao-Tang with modifications were prescribed. After acupuncture and herbal treatments based on pulse examination, the patient’s facial sequelae and accompanying symptoms including dizziness and poor sleep improved and remained in a stable condition in two months. 【Keywords】Facial nerve paralysis； Sequelae of Bell’s palsy； Acupuncture； Traditional Chinese Medicine treatment |
282.6中醫針藥併用治療貝爾氏顏面神經麻痺 後遺症之病例報告
