2009年3月21日 星期六

Facial palsy caused by brain tumor surgery.

A case of facial palsy caused by brain tumor surgery.
On July 31, 2007, I underwent 12 hours of brain surgery to have a 4.5 cm brain tumor removed. It’s known in layman’s terms as an “acoustic neuroma.” An acoustic neuroma (also known as a vestibular schwannoma ) is a rare, but benign, usually slow-growing tumor on the vestibular portion of the eighth cranial nerve, which connects the inner ear to the brain.
2007年7月31日,我經歷了12小時的腦部手術,摘除腦部4.5厘米腫瘤。簡單的說是一個“聽神經瘤”。聽神經瘤(也稱為前庭神經鞘瘤)是在第八對腦神經的前庭部分的一個罕見,但是良性,通常生長緩慢的腫瘤,由內耳連接到腦子。
Just to backtrack, let me list the symptoms that led up to my diagnosis. Prior to the surgery, I had been suffering with tinnitus (ringing in my ears) for 8 years – starting in 1999. A few years after the tinnitus started, my tongue started to feel numb. In 2006, while living in Taipei for 6 months, I started seeing “lightning bolts.” I went to an eye doctor , because I feared I had a detached retina. He said that my retina was fine, and attributed my vision of these lightning bolts as a symptom of “old age.” I was 43 years old!
話說回來,讓我列出我的診斷症狀,手術前,我就受到耳鳴困擾(鈴聲在我的耳朵) 8年前-從1999年開始發生的,幾年後,耳鳴開始,我的舌頭開始感到麻木,2006年,雖然生活在台北6個月,我開始看到“閃電。於是我去看眼科醫生,因為我擔心我的視網膜脫落。
他說,我的視網膜沒問題,並說這”閃電”可能是由於“年老”。 ”我才43歲!
My symptoms began to get worse in the spring of 2007. I started to get sharp headaches, and I NEVER got headaches except as a young child before getting glasses. Even scarier than the headaches were episodes of dizziness that were so bad I couldn’t walk – I would just wait several minutes for the dizziness to subside. I told my doctor about the dizziness, visions of “lightning bolts,” and severe headaches, but she brushed these symptoms off and told me I had “ocular migraine headaches.” She gave me pamphlets to read and basically said there is little help available for migraines.
2007年春天我的症狀開始變得更糟了。我開始感受劇烈頭痛,事實上我從來沒有頭痛過,除了兒童時期,我戴了眼鏡時有這樣的經驗之外。更可怕的不只是頭痛、頭暈發作,而是我不能走-我只想等待幾分鐘讓頭暈緩解。我告訴醫生頭暈症狀像“閃電”般的劇烈頭痛,但她並不重視這些症狀,並告訴我有“視覺偏頭痛”。她給我一本小冊子閱讀,並說對我的偏頭痛有幫助。

I had brain surgery en route to relocating from San Diego to Taipei. After leaving San Diego my husband, Sujoy ,and my daughter, Anjoli flew to the east coast of the United States for a 2-week visit with my family in Massachusetts. While sightseeing one day with my family, the dizziness was just awful – so bad that my cousin, who I was visiting at the time, told me that I was not to set foot on the plane without seeing a doctor in Massachusetts first. So, I ended up visiting the emergency room at a hospital in Plymouth, Massachusetts, and within 20 minutes of having a CT scan, I was correctly diagnosed with a vestibular schwannoma! I was relieved; because I had a feeling I had a brain tumor.

在離開聖地亞哥之後,我和丈夫Sujoy及女兒Anjoli,飛往美國東海岸2週,拜訪我在麻薩諸塞州的家人。有一天與我的家人出遊時,我的頭暈症狀又發生了,我的表哥告訴我說,在我還沒回去之前他可以介紹我一個在麻薩諸塞州的名醫。我最後到了麻薩諸塞州Plymouth一家醫院的急診室,做了20分鐘的CT掃描,我被正確的診斷為前庭神經鞘瘤!我很欣慰,因為我終於得知結果了”我有腦腫瘤”。

I was sent by ambulance an hour north to Massachusetts General Hospital. My brain tumor, though benign, was life threatening. It was very large and had been pressing against my brain stem.
我被送上救護車,並開了一個小時到北麻省總醫院。我的腦腫瘤,雖是良性的,但會危及我的生命。這是非常危險的並已對我的腦幹造成壓迫。
A few days after arriving in Boston, a team of the top surgeons and Ear Nose and Throat doctors operated on me. As I mentioned, the surgery was quite lengthy – 12 hours! An excellent team of doctors removed the entire tumor. My neurosurgeon was Dr. Fred Barker and my ear doctor, from Mass. Eye and Ear was Dr. Michael McKenna.
幾天後我抵達到了波士頓,耳神經外科以及喉科醫生組成了醫師團隊為我執行了手術,如我所提及的12個小時的手術是非常冗長的,醫師團隊成功的為我移除了腫瘤,我感謝替我動手術的醫生—佛瑞德貝克和麥可邁可納。
I was not afraid AT ALL going into the surgery, for I knew I was in good hands, in one of the best hospitals in the world. I placed my life in God’s hands, and knew that, through the doctors, He would take care of me.
整個手術過程當中我一點也不害怕。我相信為我操刀的醫生。我把我的生命交給耶穌。我相信祂會保佑我的。
Following the surgery, I experienced somewhat severe facial paralysis, also known as “Bell’s Palsy.” This was deeply upsetting to me, and I became very depressed. I also had terrible pain in my neck and at the “wound” area of the surgery. Also, since the tumor grew around my nerve for hearing, I lost 100% of my hearing in my left ear.
I couldn’t close my left eye, and had a platinum weight inserted on my left eyelid so I could close it. Also, after leaving the hospital I experienced terrible insomnia. This was quite disturbing to me, since I knew that my recovery was contingent upon adequate rest.
手術之後發生了後遺症,我的顏面神經癱瘓了,也就是所謂的貝爾氏麻痹(Bell’s Palsy)這使得我變得非常沮喪,同時間我頸部開刀的傷口處也產生劇烈的疼痛,也由於腫瘤長在我聽神經的附近,開刀後我喪失了左耳全部的聽力,我也無法闔上輕易的闔上左眼,離開醫院後,我嚴重的失眠,這使我相當的困擾,因為我知道適當的休息可以讓我的健康恢復。
My husband and daughter flew to Taipei a few weeks after my surgery, as my daughter had to start 4th grade at the Taipei American School. I missed them terribly. It was awful to have to recover from major surgery without them. I asked for special permission to fly to Taipei after recovering for just 4 weeks.
手術之後我丈夫和女兒從台北飛來美國看我,我非常的想念他們,之後我向醫院申請出院許可跟他們一起飛到台北,
About a week after landing in Taipei, I visited general practitioner Dr. Gao in Tienmou to see if he could refer me to a good neurosurgeon for follow up appointments, but mainly to obtain a prescription for antidepressants.
一個禮拜後我抵達到台北,我拜訪了位在天母的醫院-高醫生,請他介紹神經醫生給我,讓我能繼續治療,主要也希望能得到抗憂鬱的治療藥方。

Dr. Gao was so kind to me. I broke down and cried while telling him of my surgery and he could clearly see how severe my facial palsy was. He held my hands and said, “of course you are UPSET! You are experiencing post-traumatic stress syndrome!”
I asked him if he could also recommend a good Chinese Medicine doctor, as my neurosurgeon recommended that I try acupuncture and Chinese Medicine. (My neurosurgeon told me that he knew nothing about Chinese Medicine, but that it “couldn’t hurt to try!”).
高醫生對我非常的親切,當他檢視我左臉的面癱時,我再也止不住我的淚水,並且跟高醫生敘述我開刀的經過. 高醫生握緊我的手並感同身受的告訴我,他知道我很沮喪,同時他也告訴我正經歷著創傷後壓力症候群,我問高醫生能否介紹我一位好的中醫師,因為我在美國的主治醫師告訴我能試試中醫療法。

Dr. Gao told me that he once had an episode of hearing loss in one of his ears, so he visited Dr. Chang. To Dr. Gao’s delight, Dr. Chang restored Dr. Gao’s hearing. Dr. Gao spoke highly of Dr. Chang, and explained that he was a well-respected and highly reputable doctor – one of the best in the field of Chinese Medicine in Taiwan.
高醫師告訴我,他曾經患有聽力受損,並尋求張醫師醫治。高醫師開心的說,張醫師治愈了他的聽力,並且對張醫師有高度評價,還說張醫師是一個值得尊重和高度信賴的醫生-可以說是最棒的台灣中醫師之一。

So, in October of 2007 I visited Dr. Chang. He told me that he had success in treating facial palsy. I was so happy. He gave me powdered Chinese medicine and a special herbal tea (a “secret” blend of his). He told me that it would most likely be a very slow recovery since the tumor that was removed was so large. I felt better just visiting him; he is so caring, calm and positive.
2007年10月,我見了張醫師,他告訴我他有成功治療面神經麻痺的經驗,我聽了真是非常開心,他開了粉狀中藥和特殊藥茶給我(自製秘方)。他告訴我:由於之前腫瘤太大,所以需要一段緩慢而長的時間才有可能復原。我很開心我見到他,他讓我感受到溫暖並且給我正面想法和態度去面對我的病症。

So, for about 4 months I went to visit Dr. Chang for acupuncture and moxibustion treatments. I had read that for facial palsy, it was necessary to receive both moxibustion and acupuncture. Moxibustion is the application of heat resulting from the burning of a small bundle of tightly bound mugwort leaves to targeted acupoints.
我四個月前開始到張醫師診所進行針灸治療,我曾經讀過關於面癱的中醫治療是需要針灸同治的,至於灸法乃是燃燒一小束艾葉並施於穴位之上的一種療法。

Within 2-3 weeks of visiting Dr. Chang, I no longer had insomnia! THAT was a HUGE miracle, in my eyes. About a month after starting treatment with Dr. Chang I ran in the Terry Fox Run for Cancer – a 5k run!
經過2~3週張醫師的治療之後,我再也不失眠了,此外對我已經受損的雙眼來說,這真是很大的奇蹟,經過張醫師治療一個月之後,我就可以參加5公里的慈善長跑。
As I mentioned, I had (and still have) a platinum weight inserted in my left eyelid to help it close. Even with this weight, I could not close my left eye when I laid down on Dr. Chang’s table for my treatments. I had to close it with my index finger. Within about a month of taking Dr. Chang’s herbs and receiving acupuncture treatments, I was able to close my left eye without using my index finger.
如同我說的,我左眼皮還是閉合不全,當我躺在張醫師的治療床時,我只能用食指來閉上我的左眼皮,經過張醫師中醫治療一個月之後,我已經不再需要使用手指來閉上我的眼皮了。
My husband and I watched carefully for signs of healing from the Bell’s Palsy. Prior to getting acupuncture, the left side of my face was quite slack, and my eyebrows were quite uneven – as you can see in the “before” picture. Gradually, we noticed that my eyebrows became even and I started to develop a nasolabial fold on the left side of my face. I did not have a nasolabial fold after the surgery. (Nasolabial folds are the deep folds that run from the side of the nose to the corner of the mouth). My mouth, which sloped down on my left side slowly started to straighten over time.
我丈夫和我仔細看了的我的面癱有恢復跡象。針灸之前,我左邊的臉是很鬆弛的,我的眉毛很歪斜不正-正如你所看到的“之前”圖片,逐漸的,我們注意到我的眉毛還有鼻唇溝開始與右邊的臉變得對稱了(鼻唇溝是側面鼻子的嘴角的交合處)。我的嘴巴,這對我的斜面左側慢慢開始整頓隨著時間的推移。
By January of 2008, many people were commenting on how much by face had improved.My eyebrows were even and my mouth was nearly straight. I was much happier and the anti-depressants helped take care of my depression. I continued to exercise regularly which helped a great deal. (I still exercise regularly, of course!).
2008年1月,許多人都說我的臉有了很大的改善。我的眉毛還有我的嘴幾乎回復成直線了,我也很開心抗抑鬱藥也幫助我的抑鬱症有所改善,因為我還是繼續保持運動習慣,這是一個不錯的紓壓方式。(我還經常運動,當然! ) 。

By December of 2008, ALL of my pain – in my neck and in my head (at the wound site) disappeared. This was a great relief to me. I think the recovery from the surgery is just very lengthy, but I have no doubt that Dr. Chang’s medicines helped aid my recovery.
2008年12月之後,我的肩頸及頭痛都消失了,這對我而言是一個解脫,我想從手術到復原的過程是一段很長的路,但是無庸置疑張醫師的醫術幫助我恢復健康。

Even though my face was improving and the pain had subsided, I complained to Dr. Chang that I was ALWAYS tired. I was SO tired of feeling tired! Dr. Chang explained that I need to tonify my “chi.” Chi is the body’s life energy. So, in November of 2008, Dr. Chang prescribed his “cooked medicine” to me. Every day, I cook a wonderful mixture of all kinds of herbs – flowers, pieces of what look like bark and twigs, and small muslin bags of herbs in 1400 ml of water in a ceramic pot for one and a half hours. I am THRILLED to say that, within a week of taking Dr. Chang’s “cooked medicine,” I finally had energy! I can honestly say that I have never felt so good as I have been since taking this medicine. I drink one cup in the morning and one cup in the afternoon. I have energy, I feel strong and I no longer have “brain fog.” I have recently become addicted to crossword puzzles – and my mind has never been sharper! I complete them very quickly!
雖然我的臉及疼痛已經改善,但是我還是跟張醫師抱怨我總是感到非常疲勞,張醫師說我需要補氣,氣可以說是能量,所以2008年11月張醫師開了處方煎煮藥給我,這些處方有花類、樹根、樹枝等藥草都用紗袋包裝,用1400cc的水煎煮,我很激動地說,服用張醫師的處方不到一週,我的體力開始回復了,誠實的說,自從服藥以來我從沒感覺這麼好過,每天早上及下午各服用一杯中藥,我體力回來了,頭腦也不再混沌了,我最近迷上填字遊戲,也可以很快速的完成遊戲。

At present (February, 2009) my Bell’s Palsy continues to improve. My smile on my left side is slowly turning upward, although my mouth still is uneven with an open mouthed smile. I now keep my mouth closed when I smile for pictures, but I will never stop smiling/laughing when I am NOT posing, of course!
2009年2月我面癱的情況持續有好轉,微笑時左臉的肌肉也可以運作稍微正常,雖然我的嘴巴在我開口笑時還不是很對稱,但是我還是會保持微笑。
I am so grateful for the wonderful medical care I have received during such a tumultuous health crisis. Drs. Barker and McKenna did a wonderful job debulking my tumor - and since they were able to remove tumor in its entirety, the chances of it regrowing are slim. I had an MRI about one year after my surgery and the MRI showed NO signs of tumor regrowth! Phew!
再經過這樣健康危機後,我很慶幸我得到這樣的妥善的治療,Drs. Barker and McKenna成功的幫我開了腦部手術,而且再復發的機會也不高。我之後也照了MRI,報告也顯示出沒有腫瘤的跡象。
I know that the Lord was watching out for me when he led me to ALL of these doctors, especially Dr. Chang. I still receive acupuncture twice a week. I look forward to my acupuncture visits. I always feel peaceful after seeing him and his kind, dedicated staff. Dr. Chang gave me hope when I needed it most. He is an answer to my prayers.
我知道上帝一直眷顧著我,並引領我接觸這些幫助過我的醫生—特別是張醫生,我現在仍然接受一個禮拜2次的中醫醫治,並期待保持長期的治療。見到張醫生和他的工作團隊我總是心裡感到平和,張醫生的治療帶給我希望。

2009年3月19日 星期四

空心菜---是肝病病人值得推薦服用的蔬菜:

空心菜---是肝病病人值得推薦服用的蔬菜:
陳啟茂醫師是一位非常資深的醫師,對於肝病相當有研究在臨床上的治療相當有經驗,他發現空心菜對於肝病的病人具有清熱、解毒、排毒的功效。常推薦給肝病的病人作為一般食療之用。

其煮食的方法為:將空心菜洗淨,以清水煎煮,即可食用。莖、葉與湯皆須服用,也可將煮熟的空心菜用果汁機打成菜汁,每天隨時服用 。

空心菜在台灣容易取得,並且經濟實惠,目前市場的售價三把五十
希望各大醫院之肝病病房及一般餐廳,應該考慮以空心菜作為清湯供應一般百姓服用,不但便宜又好且對肝病又有幫忙,非常感謝陳啟茂醫師的資料提供,故本人樂意推薦。

有關空心菜本人另有一個臨床經驗就是用來治療不明原因的流鼻血病人
方法:將空心菜與香菇依等量比例配好(每樣約1台兩)洗淨、加水約2000c.c,置於鍋內煮成菜湯,酌加調味料,合料一起服用。

人生的感觸---很有哲理值得一看

這篇文章是由柯小姐所提供我覺得很有人生的哲理,故將其摘錄與大家分享

‧從前的人厚道仁慈,常將心比心;現在的人喜新厭舊,常將新比新.
‧多話的人, 嘴閉不起來; 多金的人, 錢拿不出來.
‧相信一個人, 需要時間; 嫁給一個人, 需要勇氣.
‧化好妝的女人, 歡迎觀賞; 卸完妝的女人, 謝謝收看.
‧賺錢辛苦是應該; 花錢受罪是活該.
‧千言萬語, 都是為了愛; 千辛萬苦, 都是為了錢.
‧婚前, 眉來眼去; 婚後, 大江東去.
‧微笑是不花錢的親和術, 嘲笑是不見血的殺人術.
‧說謊話, 常賊頭賊腦; 說實話, 常愣頭楞腦.
‧男人, 不知女人在想甚麼; 女人, 不知男人在做甚麼.
‧婚前的男人充滿好奇心; 婚後的女人充滿想像力.
‧情侶口角, 是情太多; 夫妻口角, 是錢太少.
‧婚前, 有話請說; 婚後, 廢話少說.
‧大舌頭, 苦自己; 大嘴巴, 害別人.
‧為了保住飯碗,往往保不住尊嚴;為了留住青春,往往留不住鈔票.
‧愛情, 會讓人拚命; 金錢, 會讓人賣命.
‧女人的好, 要問男人; 男人的壞, 得問女人.
‧談情說愛, 越肉麻越好; 談天說地, 越八卦越好.
‧年輕人找伴, 明著來; 老年人找伴, 暗著去.
‧錢多, 就是好; 人多, 就是吵.
‧戀愛時, 最想得到愛情; 結婚後, 最想得到麵包.
碰到"名醫",他會看你的病; 碰到"良醫",他會治你的病。
‧與三教九流交往, 可以開眼界; 與三姑六婆共處, 可以練唇舌.
愛「現」的人常換手機機型;愛「騙」的人常換手機號碼.
‧錢滾錢的速度, 氣死人; 債滾債的速度, 嚇死人.
‧有錢人, 利用時間算錢; 沒錢人, 利用時間賺錢.
‧上了班, 直罵老婆小心眼; 下了班, 直罵老闆大小眼.
睡到自然醒是退休的好處; 醒來何處去是退休的難處.
‧為了愛, 人會像呆子; 為了錢, 人會像瘋子.
‧老媽, 這輩子管定我; 老婆, 這輩子吃定我.
‧冷戰, 不能先開口; 熱吵, 不能先住口.
‧謝意,多半是假的; 氣話,大都是真的.
‧訴情, 都是為了愛; 訴苦, 都是為了錢.
‧見錢眼開, 當心金光黨; 見色起意, 小心仙人跳.
‧有「好處」, 就會有「油水」;有「難處」, 就會有「苦水」。
‧愛情, 年輕時的刺激品; 親情, 老年時的保養品.
‧當職業婦女,習慣三頭六臂; 當家庭主婦,習慣三姑六婆.
富人, 談養生之道; 窮人, 談養家活口.
‧常說好話, 自娛娛人; 常說狠話, 自欺欺人.
‧太自傲, 誰也管不了; 太自悲, 誰也幫不了.
‧和女友吵架, 會六神無主; 和老婆吵架, 會六親不認.
‧在外和朋友聊天永遠長篇大論;回家和老婆談心總是短篇小品.
‧閒人, 期待吃大餐; 忙人, 期待睡大覺.
‧戀愛,要出其不意; 婚姻,得按部就班.
‧愛情, 讓人刻骨銘心; 婚姻, 讓人刻苦耐勞.
銀子, 多在富人手上; 孩子, 多在窮人家裡.
‧擺架子, 要有錢有勢; 裝凱子, 要虛張聲勢.
‧不下雨,「渴」望不可求; 下豪雨,「濕」情不畫意.
‧情場裡, 常見白癡; 職場裡, 常見白目.
‧癡情的人, 沒頭沒腦; 薄情的人, 沒心沒肝.

2009年3月18日 星期三

痛經與子宮肌瘤中西醫如何防治

最近門診有一些子宮肌瘤的病人前來求診,她們都先接受西醫的治療,甚至於被告知要手術治療,但她們不喜歡接受開刀,故前來求診看中醫是否能幫上她們的忙,有關於這類的病人,我給予溫經湯配當歸芍藥散,並同時服用月安順、四物鐵,發現病人在1~2個月病情就有顯著的改善,今本人將中西醫如何防治子宮肌瘤的成因與概念加以整理與大家分享:

一、 病因:

西醫的看法:

子宮肌瘤,可概分成三大類:

1.漿膜下肌瘤:由子宮往腹腔內生長,通常臨床症狀較不明顯,可能要長到相當大才有症狀出現。

2.黏膜下肌瘤:往子宮內腔生長,臨床症狀較明顯,常常以經血量增加來表現。

3.肌層內肌瘤:位於子宮肌層內,是最常見的肌瘤形態。

子宮肌瘤形成的因素至今仍不是十分明白, 下面則列出幾種可能的因素:

1. 雌性素 ( estrogen ) 的刺激:停經後大部分的子宮肌瘤會縮小,懷孕時肌瘤通常會變大,都顯示其與雌性素有密不可分的關係,但也有不受雌性素之影響。

2. 長久的痙攣:子宮長期處於緊張的狀態,在子宮壁內引起一種肌肉纖維反應而產生子宮肌瘤。

3. 生長內分泌素 ( growth hormone ):有人認為與之有關。中醫的看法:中醫理論說子宮肌瘤為氣血兩虛者,子宮部位血瘀氣滯,造成肌腫不去而產生肌瘤。

中醫醫學認為子宮肌瘤是一血瘀之病症,原因可分為五種,

1.氣滯血瘀,因情志抑鬱致肝氣鬱結,肝功能不彰,使氣滯則血瘀,積於子宮成癥瘕。

2.氣虛血瘀,因長期體力透支致氣虛血弱,體內氣血運行停滯,日久則血瘀。

3.痰瘀互結,體型肥胖者通常痰多濕氣重,且易滯於體內,體液運化失調,痰積於子宮,日久成癥瘕。

4.寒凝血瘀,經期、產後受寒邪入侵,邪正相搏,結於腹中,牢固不移,是為癥瘕。

5.陰虛肝旺,長期血虛、陰分不足,加上情緒或是產後使氣血更瘀。血瘀積聚於子宮遂成積聚、癥瘕。

二、 症狀:

子宮肌瘤的存在不一定會產生臨床症狀,其症狀的產生主要決定於肌瘤的位置、大小、是否懷孕及變性(degeneration)的狀態,大約35-50﹪的子宮肌瘤患者有以下症狀 :

1. 不正常的子宮出血:是子宮肌瘤最重要的臨床表現,大約30﹪的病人會有此症狀,大部分以月經延長及月經量變多、或者是月經前點狀出血表現。造成此症狀原因,為子宮因長瘤而充血且肌瘤會壓迫靜脈使子宮肌肉層及內膜的靜脈怒張,進而影響子宮收縮而妨礙其止血功能;增大的肌瘤易使子宮內膜脫落增多,有時會伴有子宮內膜增生,這種不正常的出血常引起缺鐵性貧血,所造成的症狀如心悸、易疲倦等。

2. 疼痛:一般子宮肌瘤並不會有腹痛情形,但在下列情形則會有腹痛現象: 因血液循環不良或感染造成子宮肌瘤變性;有蒂的肌瘤其根部發生扭轉,當肌瘤由子宮口突出時,子宮會有排除的收縮而引起腹痛,若子宮肌瘤壓迫神經或沾連亦會因牽扯而產生痛。

3. 壓迫症狀:子宮因解剖位置,前臨膀胱,故當肌瘤壓迫周圍組織時,可能引起頻尿、尿滯留、小便失禁及輸尿管水腫等症狀,此外亦可能造成便秘、脹氣、下肢水腫和靜脈曲張等現象。

4.不孕:子宮肌瘤因影響精子的運送、不正常的輸卵管移動及不正常的子宮血流而引起不孕。

5. 自然流產:子宮肌瘤患者其流產約為正常婦女的2-3倍。

三、 診斷:

西醫的方法:

診斷子宮肌瘤方法有很多種,我們必須就病人的情況而採取不同的方法:

1. 內診:子宮肌瘤大多為多發性的,且膨大的子宮表面多半不對稱,故內診對有經驗的醫師而言是一種很好的方法。

2. 超音波:不論是由腹部或陰道超音波,都是診斷肌瘤的一大利器。近幾年來經陰道超音波診斷子宮肌腺瘤,已經被證明與核磁共振(MRI)一樣有效,然而核磁共振昂貴的費用,使其不能做為篩檢子宮肌腺瘤之工具。以彩色杜普勒超音波和能量呈像超音波,紀錄血管型式和測量血液流動速率,對辨別子宮肌瘤或子宮肌腺瘤是很好的工具。子宮肌瘤在超音波型態學標準是:子宮肌肉層內有明確界限的非均質性超音波腫塊,且有許多包圍子宮肌瘤的周邊血管存在,我們稱為外部飼養血管(outer feeding vessels);而子宮肌腺瘤則是子宮肌肉層內有較大的、界限不清楚、內含囊狀的非均質性超音波腫塊,並有雜亂分佈的小血管或稱為腫瘤內訊號。以這些超音波型態學標準,能偵測約79﹪的子宮肌腺瘤,對子宮肌瘤則有84﹪的正確診斷率。

3. 放射線診斷:有時腹部可見鈣化;腎臟攝影可見輸尿管被壓迫;而核磁共振則可清楚看見肌瘤位置和數目,但因昂貴所以極少用。

4. 子宮擴刮術(D & C):可感覺黏膜下肌瘤所引起的子宮腔表面不規則。

5. 鑑別診斷:子宮肌瘤除了須與卵巢瘤區別外,亦需注意子宮內膜異位、輸 卵管卵巢膿腫、子宮先天異常及子宮肥大的可能性,此外對 異常出血的病人,我們須以子宮擴刮術排除惡性增生的可能。

中醫的看法:子宮肌瘤初期症狀不易察覺,肌瘤增生的位置決定症狀出現的與否,與大小並不成正比,症狀多為月經不規則、量多、經期長,平常分泌物多,下腹有壓迫感或疼痛,壓迫坐骨神經造成 腰痛,壓迫腸子導致便秘,壓迫膀胱引起排尿次數增加與不適, 屬中醫醫學「崩漏」、「帶下」、「癥瘕」等範疇,臨床診治時病患舌質暗紫或有瘀斑,脈像弦。

一般更年期後,肌瘤會逐漸萎縮,如果仍然持續增生,就必須合理懷疑為惡性腫瘤,此時手 術摘除子宮肌瘤是較被建議的,另外如:異常大量的出血、長期的疼痛、藥物控制無效、肌瘤造成不孕症、增大的子宮壓迫 造成腎水腫、腹內產生壓迫症狀、有排尿困難、貧血、流產等 現象,都較適合手術治療,若症狀不須動手術,可依「崩漏」、「帶下」、「癥瘕」、「月經異常」等症狀採用中醫療法。

四、治療

西醫治療的方法取決於病人的年齡、懷孕的狀態、是否仍要懷孕、身體健康的情形、症狀的嚴重度及子宮肌瘤的大小和位置。如果肌瘤並沒於臨床產生任何症狀可以不需要任何治療, 但 須以 4-6 個月的間隔於門診繼續追蹤。若有肌瘤大小超過懷孕12週大小、肌瘤有妨礙受孕的可能、肌瘤生長迅速及肌瘤 有扭轉的可能等狀況時, 子宮肌瘤雖無症狀亦須治療。

治療的方法包括:

(1) 輸血:在大量出血時須考慮輸血, 但輸血的速度不可太 快以免引起心臟衰竭。

(2) 手術治療:

A. 子宮肌瘤摘除術 (Myomectomy): 當子宮肌瘤患者有症 狀又想保持生育能力時, 子宮肌瘤摘除術是常考慮到的手 術方法。但是若病人懷孕、有嚴重附屬器疾病、有惡性疾病或是手術會嚴重減少子宮內膜表面時, 則不考慮此種手術 方法。一般來說, 大約 1-5% 的婦女在接受子宮肌瘤摘 除術後, 仍有經血過多症, 子宮肌瘤的復發率為 15% , 40 %的患者術後有受孕的機會, 在 20年內 25% 的人仍須接受子宮切除手術,而 2/3的病人仍須再接受手術治療。

B. 子宮切除術:年齡在 40 歲以上並且不須再生育的患者,子宮切除術是最常 用的好方法, 若是子宮肌瘤不大可考慮經陰道切除,若是子宮 肌瘤大而多除了經腹部手術外亦可以腹腔鏡切除子宮。至於卵 巢是否保留, 除了考慮病人年齡外 (超過 45 歲可考慮都拿 掉) 亦須注意其外表形態是否有惡性的可能。

(3) 放射治療: 放射治療的目的是在破壞卵巢的功能, 使 病人呈現停經的狀態進而達到止血的目的。這種治療於目前 已經很少使用,但在某些嚴重疾病的病人, 如心臟衰竭、肝 衰竭及無法控制的糖尿病等患者因病無法接受手術治療時, 仍可考慮以此法治療。

(4) 藥物治療: 藉可減少血液中求偶素的藥物, 如 Medroxyprogesterone acetate ( Depo-Provera )、danazol、 GnRH analogues, 可能可減小子宮肌瘤的大小。GnRH 的相似物可使 80-100%的肌瘤患者其肌瘤減少 40-90%的體積。75 % 的體積減少發生在第 2-4個月並於第八個月減到最多, 但在 停藥後肌瘤會漸漸恢復其原來大小並於第6個月恢復成原來大 小。有人建議當肌瘤太大時, 可先以藥物使肌瘤變小後再接受 手術治療。

(5) 懷孕合併子宮肌瘤的治療: 懷孕時子宮肌瘤的發生率約 為0.6-2 %, 因為子宮肌瘤大多不影響懷孕, 故一般我們都不 做特別處理。

中醫

(一)中藥療法配合每個病人的體質和病情,消癥軟堅用夏枯草、生牡蠣、昆 布、海藻、丹參、莪朮、鱉甲、穿山甲、三棱等,來活血化淤、化痰散結、補氣益腎以扶正等,如兼有血瘀、痰濕、體質虛弱、脾腎不足再加配藥材治療。

1.血瘀:如月經量多、帶有血塊、色黑,血塊下時痛,痛有 定處,狀如針刺,積塊固定不移,舌有紫斑紫點,脈沉澀, 加桃仁、紅花、桂枝、赤芍、丹皮來活血化瘀,方用加減桂枝茯苓丸。

2.氣滯:經期長、痛經,白帶增多,經前乳房或小腹脹痛, 舌苔薄潤,脈沉弦,用加味逍遙散。

3.痰濕偏重:形體肥胖、平素多痰、舌苔厚膩,加半夏、茯 苓、浙貝母、枳實、陳皮、蒼朮以化痰散結。

4.體質虛弱:再加入黨參、黃耆、白朮、續斷、牛膝、桑寄生、狗脊,補氣益腎,扶正祛邪。

5.脾腎不足:經期長或崩或漏,經色淡,腹中積塊,帶下清稀,腰酸氣短,尿或多或少,色清,腹瀉或便秘,苔薄白,舌質淡或有齒痕,脈沉細乏力,用香砂六君子加右歸丸。

(二)故有成方

1.方名:桂枝茯苓丸出自:《金匱要略》組成:桂枝一.五錢、茯苓三錢、牡丹皮二錢、桃仁二錢、赤芍三錢功效:活血化瘀,溫化行血,消緩癥塊。主治症候:用於血癥輕證,瘀血結於子宮,瘀血內停,經脈阻 滯,久之成為癥塊之病症。

2.方名:真人活命飲出自:《證治準繩》組成:真人活命飲六克(含金銀花、陳皮、當歸、防風、白芷、甘草節、貝母、天花粉、乳香、沒藥、皂角刺、穿山甲)、半支蓮一.五克、夏枯草一.五克(科學中藥)用法:一日三次,每次三克。功效:清熱解毒,活血止痛,治療子宮肌瘤。禁忌:脾胃素虛、氣血不足者慎用。

五、保健與食療日常生活保健方面:

1.保持愉快開朗的心情,平時要有適度的運動,避免肥胖。

2.保持外陰清潔,多換洗棉內褲,避免長期用衛生護墊以免感染。

3.當月經大量出血時,避免熱水浴,不宜久站或劇烈運動,宜臥床休息及冰敷腹部及尾椎部(敷20分,休息20分)。飲食方面:少吃咖啡、茶葉、酒、油脂類、煎炸薰烤類食物。多吃蔬菜、水果 及五穀類食物。若有貧血,多食鐵質較高的食物如黃豆、芝麻、豬肝、莧菜、葡萄、枸杞、香菇或含維他命C、D、鈣、鎂、鐵劑之製 劑。

※※本人的經驗用溫經湯4.5g加當歸芍藥散4.5g配合中天生物科技產品月安順2粒 Tid,如貧血嚴重者加用四物鐵飲料,依本人的經驗服用一至兩個月,其月經量即會顯著改善,而且月經來時下腹部脹痛就會顯著改善。如果下腹部疼痛嚴重者,可針灸:內關、公孫、三陰交、灸中極、關元、氣海等穴,對於疼痛的緩解應有立即的效果。但子宮肌瘤的大小是否能改善,還是要依賴西醫的超音波或放射線診斷來評估,如果症狀一直沒有改善或子宮肌瘤一直長大,還是建議配合西醫的治療。

2009年3月15日 星期日

臺灣中醫藥未來一年急需辦理的重要事情

一、要把健保的餅做大
從最近健保局的臨床健保資料顯示,一年看中醫的人數比例不到30%,一年看兩次中醫健保的人數不到50%,所以我們中醫藥界要思考如何推展中醫的優勢,讓看中醫的人口數可以增加,同時增強病人看中醫的信心與持續性與優先考慮,這是中醫當前的重要課題。以下是如何推展中醫藥發展的幾個重要事件,我們必須正視這些相關重要議題!
1.協助台大醫院成立中醫部:
以補西醫臨床治療的不足,針對西醫臨床療效治療較差的疾病如過敏性鼻
炎、氣喘、異位性皮膚炎、神經退化性疾病(罕見疾病)、肝病、免疫調節、
糖尿病、細胞再生、腦中風等。
2.加強國立中國醫藥研究所的功能:
協助國立中國醫藥研究所成立臨床中醫特別門診結合台北榮總傳統醫學部,及陽明大學傳統醫學研究所,從基礎到臨床去開發中藥新藥及證實中醫藥的臨床療效驗證,並透過臨床療效的評估去證實針對某一個病,中藥加西藥確實比單獨的西藥或中藥的療效會更好,同時將其療效加以推廣。

二、要向衛生署及政府相關單位反應,確保行政院衛生署中醫藥委員會有單獨成立的必要,不要被併吞或裁撤。

三、肝病及腎臟病的罹患率台灣皆為世界第一:
有些西醫懷疑是否與服中藥有關,衛生單位應儘早成立藥物不良反應通報系統,以真正了解那些中草藥是否具有傷肝、傷腎的副作用,如確實證明那些中草藥具有傷害肝臟或腎臟時,應儘速公告,並同時停止使用或馬上註銷該藥的相關方藥及處方,但未經證實之前不容許污衊中草藥的功效,在媒體散佈不正確的觀念而造成民眾對中草藥產生誤解,反而中西醫要密切合作建立相關臨床療效評估技術平台,以尋求中西醫合併的優勢以改善台灣的肝病與腎臟病的罹患率及病人的健康。