针刺治疗停抗病毒药致肝性脊髓病截瘫伴慢加急性肝衰竭案

Treating hepatic myelopathy with chronic and acute liver failure caused by stopping antiviral drugs by acupuncture

文章详细介绍针刺治疗1例停抗病毒药致肝性脊髓病截瘫伴慢加急性肝衰竭。患者7年前无明显诱因出现乏力、纳差,当地检查后诊断为慢性活动性乙型病毒性肝炎(简称乙型肝炎)。口服中药及恩替卡韦片抗病毒治疗。6年前,症状改善,停服中药;1年前,自行停服恩替卡韦;2个月前病情反复加重,出现腰部及双下肢麻木僵直、活动障碍。当地医院诊断为“乙型肝炎后肝硬化失代偿期,肝性脊髓病”,给予抗炎保肝、降酶、退黄及输血等对症治疗。后病情加重,5天前出现身目黄染。中医诊断:黄疸病(湿热蕴蒸证);西医诊断:肝性脊髓病、截瘫、乙型肝炎后肝硬化失代偿期、慢加急性肝衰竭、门脉高压性胃病、慢性活动性乙型肝炎。经院内及北京专家会诊治疗1周后肝功能有所好转,症状、体征无改善。会诊考虑为黄疸合并痿躄病。在原治疗基础上,加用中医气针疗法,选取足阳明胃经、足厥阴肝经、足少阴肾经及经外奇穴为主腧穴治疗。患者康复出院,随访1年,无复发。

This paper introduces in detail acupuncture on 1 case of hepatic myelopathy paraplegia with chronic and acute liver failure caused by stopping antiviral drugs.The patient troubled fatigue and anorexia without obvious inducement 7 years ago,was diagnosed as chronic active hepatitis B after local hospital examination,and took oral TCM medicine and entecavir tablets for antiviral treatment.He stopped taking TCM medicine when his symptoms ameliorated 6 years ago,and stopped taking antiviral Western medicine by himself 1 year ago.Two months ago,the condition was aggravated repeatedly,and the numbness and rigidity of the waist and lower limbs and movement disorders appeared.The local hospital diagnosed it as“decompensated cirrhosis after hepatitis B,hepatic myelopathy anemia”,given enzyme-lowering,jaundice-reducing,blood transfusion and other symptomatic treatment,the condition worsened,and yellow-dyed body and eyes appeared 5 days ago.Diagnosis of TCM:jaundice disease(syndrome of dampenees and heat accumulation and steaming).Diagnosis of Western medicine:hepatic myelopathy;paraplegia;decompensation stage of posthepatitic cirrhosis;chronic and acute liver failure;portal hypertensive gastropathy;chronic active hepatitis B.After one week’s consultation with experts,the liver function was improved,but the symptoms and signs did not ameliorate significantly.The illness is considered to be jaundice complicated with paralysis.On the basis of the original treatment,the Qi-acupuncture(气针)therapy of TCM was added to select acupoints such as stomach meridian of Foot-Yangming(足阳明胃经),liver meridian of Foot-Jueyin(足厥阴肝经),kidney meridian of Foot-Shaoyin(足少阴肾经)and Extra-meridian distinctive points.The patient recovered and was discharged from hospital,and no recurrence was found after one year of followed-up.