膵頭十二指腸切除術後の胃内容排出遅延に対して茯苓飲合半夏厚朴湯が有効であった1症例―気虚型・気滞型の食欲低下を鑑別する重要性―

Improvement of Post-Pancreaticoduodenectomy Delayed Gastric Emptying by Treatment with Bukuryoingohangekobokuto：The Importance of Differentiating Between Qi Deficiency and Qi Stagnation

要旨

　胃内容排出遅延（delayed gastric emptying：DGE）は膵頭十二指腸切除術（PD）後に生じる合併症の一つであり，患者の早期回復を妨げる要因となる。DGEは東洋医学的病態の気滞に該当すると考えられ，同病態を治す茯苓飲合半夏厚朴湯を用いたところ食事摂取が著明に改善した。周術期に生じる食欲低下に対しては，気虚型と気滞型を鑑別することが重要である。

　We present a case of delayed gastric emptying（DGE）that developed after a pancreaticoduodenectomy and was improved by treatment with the Kampo medicine Bukuryoingohangekobokuto. The 80-year-old male patient’s food intake improved significantly from the day after the prescription was changed from Rikkunshito to Bukuryoingohangekobokuto. In Kampo medicine, it is important to differentiate qi deficiency and qi stagnation. DGE is a type of post-surgery gastrointestinal dysfunction, and it can be diagnosed as qi stagnation. Rikkunshito is effective for patients with qi deficiency who lack the desire to eat, whereas Bukuryoingohangekobokuto is effective for patients with qi stagnation who want to eat but cannot eat due to abdominal distension.