臨床醫案來回顧來探討中醫治療血管性失智症（VaD）中「迷路」行為（getting lost, GL）的臨床療效

Exploring the clinical efficacy of TCM treatment of ＂getting lost, GL＂ behavior in Vascular dementia (VaD) from a case review

10.6528/CAMS.201812_6(1).0004

程維德(Cheng Wei-De)；廖炎智(Liao Yan-Chih)

血管性失智症 ； 失智症 ； 育生補陽還五湯 ； 補陽還五湯 ； 育生五苓散 ； 五苓散 ； Vascular dementia (VaD) ； Dementia ； YuSheng Buyanghuanwutang ； Buyanghuanwutang ； YuSHeng Wuling San ； Wuling San

中國鍼灸學雜誌

6卷1期（2018 / 12 / 16）

44 - 57

繁體中文

從長者四年來治療過程中回顧我歸納幾個重點：用育生補陽還五湯合育生五苓散(腎炎方)的加味來治療血管性失智症是有效，且無副作用，更無後遺症。長者服用近四年飲片水藥，共發生四次迷路行為(getting lost, GL)，發生在第二、三年，迷路情形都不算嚴重，都集中在10個月之間發生，第四次迷路後到長者往生約一年七個月都未再發生，可見中藥對失智症的幫助非常大。故失智症一開始中醫藥就應該介入，並且效果不錯。最好在極輕度的疑似失智（CDR≦0.5或MMSE25~30）或輕度失智（CDR≦1或18~24）時就積極介入及治療。在中度時效果也還不錯，重度或極重度的效果就比較差，會改善但進展很緩慢，尤其有許多慢性病纏身的臥床高齡者。雖然飲片水藥健保不給付，要花照顧者的錢，但若經濟許可這些都是值得的。我為什麼不強調用健保給付的濃縮藥粉，因為有效劑量不足用在腦病或重病的效果不張，若要用到與飲片水藥相同的劑量大概一天要吃60g~100g，光吞賦形劑的澱粉就已經吃飽了。

From the father's four years of treatment, I reviewed several key points: It is effective to treat vascular dementia with a combination of YuSheng Buyanghuanwutang and Yusheng Wuling San (Nephritis Fang), with no side effects and no sequelae. My father took four years of drinking water medicine, and there were four getting lost behaviors (getting lost, GL). In the second and third years, the lost situation was not serious. They all concentrated in 10 months. After the fourth getting lost, it was not getting lost until the father passed away for about one year and seven months. It can be seen that TCM has a great help to dementia. Therefore, TCM should be involved in the beginning of dementia, and the effect is good. It is best to actively intervene and treat when there is a mild suspected dementia (CDR≦0.5 or MMSE 25~30) or mild dementia (CDR≦1 or 18~24). Although water medicine Pieces health insurance does not pay, it takes the caregiver's money, but if the economy permits these are worthwhile. Why don't I emphasize the use of concentrated medicine powder for health care, because the effective dose is not enough for encephalopathy or serious illness? If you want to use the same dose as the water medicine, you should eat 60g~100g a day. The excipients of the light-swallowing starch are already full.

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