探討育生補陽還五湯加方用於治療巴金森氏病的療效研究

Discussion YuSheng BuyanghuanwuTang add-on for the treatment of Parkinson's patients to study its efficacy

10.6528/CAMS.2015.0002

程維德(Wei-De Cheng)；吳哲豪(Che-Hao Wu)；廖炎智(Yan-Chih Liao)；李政育(Chen-Yu Lee)

中醫治療巴金森氏病 ； 巴金森氏病 ； 育生補陽還五湯 ； traditional Chinese medicine (TCM) treatment of Parkinson's disease (PD) ； Parkinson's disease (PD) ； (Yu Sheng) Bu Yang Huan Wu Tang

中國鍼灸學雜誌

3卷1期（2015 / 12 / 27）

18 - 46

繁體中文

巴金森氏病(PD)簡單來說就是大腦局部的退化，中腦黑質緻密區的多巴胺細胞退化凋亡引起的疾病，相對於小腦萎縮症(SCA)表現是在整個小腦，阿茲海默症(AD)表現在整個大腦的退化上，尤其是額葉、頂葉的皮質。所以巴金森氏病(PD)相對影響比較小、比較局部，用育生補陽還五湯加方治療上相對也比較容易。本研究三個病例及臨床上的經驗來看，越早治療效果越顯著，越沒有L-dopa(左旋多巴胺)類藥物的介入，中醫的療效越佳；L-dopa類藥物劑量愈小，越容易治療，究其原因，是此時患者巴金森氏病的病程都在早期或中期，也就是第一到第三期之間。若在一二期之間表示黑質細胞仍存在有一定的數量，服藥進步比較快，療程也較短，但最好能至少維持一年以上的治療。若是L-dopa類藥物依賴愈大、劑量越大，都已進入晚期，也就是巴金森氏病(PD)第四或五期，治療效果比較差，需要治療時間比較久。臨床上，巴金森氏病已接受西醫藥物治療，中醫藥要介入，剛開始必須中西藥物並用，再經歷減量並到停用除L-dopa類藥物外藥物，如COMT抑製劑、多巴胺釋放促進劑、多巴胺受體激動劑、MAO-B抑制劑、抗乙醯膽鹼劑等等;大補陽及補氣活血化瘀的中藥能很快的替代。最後是遞減L-dopa類藥物，建議在服用育生補陽還五湯加方半年後，開始慢慢遞減是比較好，每隔至少三個月以上的服藥才遞減一次，這樣的遞減時間通常要一到三年，遞減結束後大約可回到患者初發作時的階段，然後至少在持續服用中藥一年以上，這與胚胎腦移植，或幹細胞移植有異曲同工之妙，只是用誘導神經細胞再生或修復功能，隨後療程再將中藥慢慢遞減，或改成調養劑量的保健模式來維持療效。本文在臨床上發現，所有的神經退化疾病包括巴金森氏病，越早期治療效果越顯著，以中醫的觀點看巴金森氏病，並不是一種持續、進行性病程，中醫藥介入是可以截斷病程惡化的進展，逆轉病程回到正常，並不是只有改善其症狀而已，中醫治療就如同胚胎腦移植、或幹細胞移植一樣，但中醫藥效果應該更超越，因為它改變的不只巴金森的症狀，連其他包括大腦退化、或心血管疾病等等都會改善，如病例一、出現的好轉狀況，因為中藥作用是全面性、多系統性功能、多途徑的全方位療效。

Parkinson's disease (PD) put in simple terms is a type of localized cerebral degeneration in which the dopaminergic cells of the substantia nigra pars compacta (SNc) at the base of the forebrain breakdown and die resulting in disease. This differs from spinocerebellar ataxia (SCA), which involves the entire cerebellum and Alzheimer's disease (AD), which involves degeneration of the entire cerebrum and especially the frontal parietal cortex. In PD, only a relatively small, localized area of the cerebrum is affected thus making the administration of (Yu Sheng) Bu Yang Huan Wu Tang variant a promising treatment approach with proven efficacy. Based on clinical experience and results of three case studies included in this paper, it is clear that the two main factors influencing efficacy of traditional Chinese medicine (TCM) treatment for PD patients are the earlier the administration the better and the absence of L-dopa drug administration. The smaller the dose of L-dopa the easier it is to treat this condition; the likely reason for this being that these PD patients are still in the early to intermediate stages of disease (Stage 1 to Stage 3). When the disease is in Stage 1 and Stage 2 this indicates the dopaminergic cells SNc are still present in significant amounts, thus the TCM treatment duration will be relatively shorter and efficacy will appear relatively faster. However, once relief of symptoms and efficacy has been achieved the patient should continue being administered TCM treatment for at least 1 year. When PD patients become more dependent upon L-dopa drugs (frequency and dose) this indicates they have entered the advanced stages of disease (Stage 4 and Stage 5), thus making treatment less effective and the duration much longer. In the clinical setting, patients who have already been administered Western medicine drugs and then begin TCM treatment must continue taking the Western medicine drugs at first and then gradually reduce and then discontinue administration. This is true for all Western medicine drugs (e.g., COMT inhibitors, dopamine agonists, dopamine receptor agonists, MAO-B inhibitors, and anticholinergics) except for L-dopa. TCM great yang-supplementing and blood-quickening and stasis transforming medicinals can quickly supplant the need for these Western drugs. Later on in the treatment regimen L-dopa can also be gradually reduced. Six months of (Yu Sheng) Bu Yang Huan Wu Tang variant administration is recommended prior to beginning the reduction of L-dopa with a dose reduction occurring at least 1 time every 3 months. A duration of 1 to 3 years is usually required for complete discontinuation of L-dopa. At that time, the patient's condition will have recovered to the point of when the disease first presented at the early stage, requiring a minimum of 1 more year of TCM medicinal administration. The result of TCM treatment offers the same effects as fetal brain tissue transplantation and neural stem cell transplantation, but instead simply promotes the natural regeneration and repair function of neural tissues. Eventually, the administration of the TCM medicinal regimen can be gradually reduced or the amount and composition can be adjusted to regulate the constitution and ensure optimal sustained efficacy. For the clinical presentation of all types of neurodegenerative diseases, including PD, the earlier treatment is initiated the greater the efficacy. TCM does not view PD as a persistently progressive condition. The administration of TCM treatment will halt further deterioration of the condition and initiate a reversal setting the patient back on the path to normal. TCM treatment not only improves symptoms, but also functions like fetal brain tissue transplantation and neural stem cell transplantation. In fact, TCM treatment offers even better overall efficacy since it also functions to deter cerebral deterioration and cardiovascular disease. Case study 1 provides evidence of TCM's efficacy in improving symptoms, stabilizing the condition, and remedying the disease with a comprehensive, multisystem, and holistic treatment approach.

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