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転がるイシあたま
中山間地・島・三角州……様々な田舎や町や街を転々として様々な経験をしてきた１９５０年代生まれの内科医の呟きです（最近はリハ科も兼任しています）。昔の思い出・今の思いなどを、アトランダムに語ります。「次に一体何が出てくるか」と楽しみにしてもらえるようなブログを目指します。
「偉い医師」は存在するが「医師だからエライ」ではない、がモットーの一つです。「先生様」でも「患者様」でもなく、お互いに「さん」で呼び合えるような世の中に、が秘かな望みです（書いちゃいましたけど）。
タイトル履歴
2008年４月に「医師アタマ」という本の存在を知り、あまりに似ているので本ブログのタイトルを「いしあたま（医師頭）」から「転がるイシは苔むさず」に変更しました。ただ、前のタイトルへの愛着捨てがたく、同年５月31日に「転がるイシあたま」に再変更しています。
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2008.01.03 18:11
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頭を冷やせ（２）
これまた年越しをしたネタです。
ものすごく基本的な疑問ですが「熱は下げなければいけないもの」ですか？
もちろん、悪性過高熱症や熱中症だったら命にかかわるから熱を下げなければいけないでしょう。しかし、逆に言えば、命にかかわる「熱」はそれ以外にそんなに多いのでしょうか？ 熱病の治療の場合はどうでしょう。私は熱病には詳しくありませんが、たとえば「熱を下げたら黄熱病が治る」わけではなさそうです。（たしか黄熱病に有効なのはワクチンのみと聞いたことがあります） もちろん「生命の質」「快適性」の観点からは、熱にうなされているよりは平熱に近い方がよろしいでしょうが、それは「命を救う」よりは重要性が落ちるでしょう。
まず私は熱を下げることの危険性を考えてしまいます。解熱剤が効きすぎて、熱は下がったがついでに血圧も下がった、という経験を持っている医者は多いはずです。私は内科ですが、自分の経験ではどちらかというと痩せて水分量が少ない感じの老人でそうなることが多いようです。子どもで血圧を測ることはあまりないでしょうけれど、解熱剤で熱をがんと下げた子どもの血圧はどうなっているんでしょう？ ちょっと気になります。
発熱は生体の防御反応です。細菌やウイルスに対して好ましい温度から外れた「不快な環境」を用意することで、彼らがどんどん増殖することを妨害する効果があります。ということは、解熱することは細菌やウイルスにとっても快適な環境を作ってあげることになります。それは“良い”ことなんでしょうか？ 結果として病原体を元気にして病気を長引かせている可能性はないですか？
命にかかわる熱はもちろん下げるが、命にかかわらない熱はできたら我慢してもらって自然に下がるのを待つ方が結局は“お得”（病気が早く治る可能性が高まる）ということになるのではないか、が現時点での私の結論です。少なくとも、機械的にダイアルを回すように「どんな場合でも体温38度５分は37度にする」という態度は病気の「治療」とは無関係でしょう（念のために繰り返しますが、命にかかわる熱は話が別です）。
余談です。病棟でよく「高熱時指示」を求められます。で「何度何分以上だったら○○を使え、と指示を下さい」と言われることがあるのですが、これって、たとえば「38度５分」と私が書いたら、８度５分だとその薬を絶対使い、８度４分だとその薬を絶対使わない、ということになりそうで逆にコワイです。
漢方医学の講演で「漢方では、熱があっても悪寒や寒気を訴えるときには解熱ではなくてむしろ体を温める。同じ体温でも熱さを訴えて汗がだらだらだったら解熱をする」と聞いたことがあります。自分自身の発熱体験からもそれには納得でした。大切なのは「その人の（現在および未来の）状態」ですよね。体温計の目盛りばかり見つめることではなくて。
余談の追加です。どうも風邪のようだなと思いながら本日は出勤したのですが、朝のミーティング中に突然悪寒戦慄が生じました。まさか自分の書いていたものが自分の体に影響を与えたわけではないでしょうが、歯の根が合わない震えというのは、本当に久しぶりです。顔や手も真っ白。正月出勤のスタッフが心配してくれます。体温を測ると39.8度。おやおやおやおや、医者が病人です。でまあ、上に偉そうなことを書いた以上、それに従って行動しようと、悪寒を感じる間は電気毛布にくるまって（病棟の隅っこ→医局で）じっとしていました。服用したのは、漢方薬の麻黄附子細辛湯医療用エキスを倍量、お湯に溶かしたものです。こんな時に使われる漢方薬としては葛根湯や麻黄湯が有名ですが、私の胃にはちょっときついので127番にします。朝一回、昼に一回計四包服用すると汗が出始めて体がすーっと楽になってきました。（あ、これを読んで何も考えずに真似はしないで下さい。漢方薬の場合「証」（ふだんの体質と病気の状態のからみ）に合わせた薬の選択が重要ですから、「その時私にとって良いもの」が「別の時の別の人間であるあなたの別の病態にとって良いもの」である保証はありません）
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