注意力不足過動症中西醫病因病機探討

Analysis of Etiology and Pathogenesis of Attention Deficit Hyperactivity Disorde

陳彥光(Yen-Kuang Chen)；田莒昌(Chu-Chang Tyan)

注意力不足過動症 ； 中醫 ； 病因病機 ； ADHD ； Chinese medicine ； etiology and pathogenesis

北台灣中醫醫學雜誌

6卷1期（2014 / 06 / 01）

1 - 16

繁體中文

注意力不足過動症（Attention deficit hyperactivity disorder, ADHD）以注意力不足、過動及衝動為核心症狀，是最常見的兒童精神行為疾病，嚴重影響兒童的認知、學業、行為、情緒及社會功能。隨著診斷標準一再的放寬，此疾病的盛行率逐漸攀升，美國精神醫學會2013年出版的「精神疾病診斷與統計手冊」（The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders，簡稱DSM）第五版，更將症狀出現的年齡閾值從6歲提高至12歲。ADHD的致病因素及病理機轉尚未完全確定，研究顯示可能與基因、腦部功能失常及環境有關。西藥治療以中樞神經興奮劑為主要用藥，但有其副作用。中醫古籍中沒有此病名記載，根據臨床表現可歸於中醫「風證」、「煩躁」等範疇，病因病機可從心、肝、脾、腎四個方面去探討，分為腎虛肝亢型，腎精不足型，心脾不足型，腸胃滯熱型，痰火擾心型，肝鬱化火型等證型，中醫介入的優勢在於，經由四診合參，找出病因病機後，可以從最根本的病因做處理，而不是只有症狀控制，也可避免長期服用西藥產生的副作用。

Attention deficit hyperactivity disorder (ADHD) is the most common children's behavior disorder, and the core symptoms of the disease are hyperactivity, impulsivity, and/or inattention. It has great impact on children's cognition, academic, behavior, emotion, and social functioning. As the diagnostic criteria are more loosened, the prevalence of ADHD is getting higher. The DSM-V (The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders,fifth edition) published in 2013 elevates the age of onset from 6 years old to 12 years old. The etiology and pathogenesis of ADHD are still uncertain, but some researches have revealed that ADHD might be related to gene, brain's functional disorder and environment factors. The treatment in Western medicine is the CNS stimulants, but many side effects are reported. There is no record about ADHD in Chinese medicine before. According to the clinical sign, it can belong to the ＂wind symptom＂, ＂irritability＂ of Chinese medicine. The etiology and pathogenesis of ADHD in Chinese medicine can be discussed in four aspects: heart, liver, spleen and kidney. Also, the symptoms of the disease can be classified to kidney yin insufficiency and liver upward, kidney essence vacuity, heart and spleen vacuity, intestinal and stomach heat stasis, phlegm fire disturb heart and liver stagnation transform fire. The advantage of Chinese medicine conduction is not only for symptom control, but to deal with the root of the disease through the four examinations and find out the etiology and pathogenesis of the disease. It also can avoid the side effects of taking long term of Western medicine.

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