臨牀消化器内科 Vol.33 No.11(1)


特集名 消化器病漢方治療―理論と実践
題名 「証」と「症状」と「診断」いずれを優先するか?
発刊年月 2018年 10月
著者 佐藤 弘 新潟医療福祉大学医療系管理学部医療情報管理学科
【 要旨 】 本稿では,「証」「症状」「診断」の相互の関係およびそれぞれに基づいた治療法の特長・問題点を論じた.治療の順序として,最初に近代医学的「診断」に基づいた使用法を行ってみる.次に,中心症状に着目し,それに対し頻用される薬方をいくつか使い分ける.この際には,それぞれの使用目標となる2,3の症候と不適応となる条件を覚えておく.上記のアプローチが奏効しない場合には,「証」に随って漢方薬の選択を行う.このアプローチの特長は,診断がつかない例などにも対応できる点にある.漢方薬を用いた治療の特長は,目標とした症状以外にも思わぬ効果が得られることがあり,漢方薬の活用を是非お勧めしたい.
Theme Kampo Medicine for Gastrointestinal Diseases -- Theory and Practice
Title Which Method of Treatments Given Priority? -- Based on "Sho (evidence)", "Symptoms" or "Diagnosis"
Author Hiroshi Sato Department of Health Informatics, Faculty of Healthcare Management, Niigata University of Health and Welfare
[ Summary ] In this study, we evaluated sho (evidence) (diagnosis based on Kampo medicine), symptoms, diagnosis (based on modern medicine) and their mutual relationships, and the characteristics of treatment based on information related to each aspect. Treatment approach through Kampo medicine involves the use of Kampo formulae based on the diagnosis. Currently, there are few evidence-based Kampo formulae available for usage according to the diagnosis. In the absence of suitable Kampo formulae or invalidity of the approach, attention is focused on the target symptom of the patient, and the most frequently used appropriate Kampo formula is selected. It is important to recognize maladaptive cases of the Kampo formula to prevent adverse events. For patients non-responsive to the above approach, selection from among the several Kampo formulae frequently used for the few symptoms and/or signs is required. When the desired treatment effect is not attained, Kampo formula is administered according to the sho. The feature of therapy based on sho is its applicability to patients without confirmed diagnosis or patients who are non-responsive to other treatments. Treatment using Kampo medicine is characterized by unexpected effects besides those on target symptoms. Therefore, use of Kampo medicines is recommended.
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