注意力缺陷過動症之中醫文獻回顧

Literatures Review of Attention Deficit Hyperactivity Disorder in Traditional Chinese Medicine

10.6516/TJTCM.2017.20(1)83

呂桓毅(Huan-Yi LU)；吳龍源(Lung-Yuan WU)；蔡金川(Chin-Chuan Tsai)；林立偉(Li-Wei Lin)

注意力缺陷過動症 ； 辨證分型 ； 中醫 ； Attention deficit hyperactivity disorder ； differential diagnosis ； traditional Chinese medicine

中醫藥研究論叢

20卷1期（2017 / 03 / 30）

83 - 93

繁體中文

「注意力缺陷過動症」（Attention Deficit Hyperactive Disorder，簡稱為ADHD）。它是兒童精神疾病中最常見的疾病，根據臨床表現分為注意力不集中型、過動—衝動型、複合型三種。ADHD的發病原因及病理機轉還沒有非常確定，主要認為與遺傳、中毒、環境、營養等因素有關。本文主要目的在蒐集近十年中醫治療注意力缺陷過動症的文獻，透過研究文獻的整合及歸納，提出臨床最常見的證型以及治療用方，供臨床醫師作為參考。中醫古代文獻中無本病的專門論述，根據臨床表現，屬於“風證”、“健忘”、“煩躁”等範疇，並認為本病的病因為先天稟賦不足，後天失調，或他病所傷。病機為臟腑功能失常，陰陽失調。臟腑功能失常是其主要病理改變，陰靜不足、陽動有餘是其主要病機特點。本病與心、肝、脾、腎四臟關係密切。心脾兩虛、痰熱內擾、肝腎陰虛、肝脾不合、心腎不足等為ADHD常見之證型，常用方有歸脾湯、黃連溫膽湯、知柏地黃丸、加味消遙散、右歸丸等供臨床隨證加減應用，有關其相關的藥理作用機理，仍有待未來進一步闡明。

Attention deficit hyperactivity disorder（ADHD）is one of the most common neuropsychiatric disorders in children characterized by a triad of symptoms involving age-inappropriate behaviors with attention, impulse controls and hyperactivity. The prevalence of ADHD in Taiwan is 7%-8%. A higher prevalence is often reported in males 14.9% than females 4.5%. The etiology and pathogenesis of ADHD is still unclear. Factors that may be involved in the development of ADHD include hereditary, toxic chemicals, environment and nutrition. Through literature review, the aim of this study was to summarize the most common clinical phenotypes and drugs for clinical reference. There is no record about ADHD in classics of traditional Chinese medicine （TCM）before. According to the clinical presentations, it can belong to the ＂winds＂, ＂forgetfulness＂, ＂irritability＂ of TCM. The etiology and pathogenesis of ADHD in TCM can be discussed in four aspects: heart, liver, spleen and kidney. Also, the syndrome of the disease can be classified to ＂dual deficiency of the heart-spleen＂, ＂phlegm-fire harassing the heart＂, ＂liver-kidney yin deficiency＂, ＂insufficiency of kidney essence＂ and ＂liver depression and spleen deficiency＂. There are many Chinese herbs formulas used on ADHD patients such as ＂Gui Pi Tang＂, ＂Huanglian Wendan Tang＂, ＂Zhi-Bai-Di-Huang-Wan＂, ＂Jia-Wei-Xiao- Yao-San＂ and ＂Yougui Pill＂. In conclusion, TCM has benefit for ADHD treatment and may help to avoid side effect related to conventional medication.

1. American Psychiatric Association(2013).Diagnostic and Statistical Manual of Mental Disorders.Arlington, VA.:American Psychiatric Association.
2. Arnsten, A.F.,Pliszka, S.R.(2011).Catecholamine influences on prefrontal cortical function: relevance to treatment of attention deficit/hyperactivity disorder and related disorders.Pharmacol Biochem Behav,99(2),211-6.
3. Biederman, J.(2009).Risk for switch from unipolar to bipolar disorder in youth with ADHD: a long term prospective controlled study.J Affect Disord,119(1-3),16-21.
4. Brawley, A.(2004).Allergic rhinitis in children with attention-deficit/hyperactivity disorder.Ann Allergy Asthma Immunol,92(6),663-7.
5. Iseri, E.(2007).Effects of methylphenidate on leptin and appetite in children with attention-deficit hyperactivity disorder: an open label trial.Methods Find Exp Clin Pharmacol,29(1),47-52.
6. Kovess, V.(2015).Maternal smoking and offspring inattention and hyperactivity: results from a cross-national European survey.Eur Child Adolesc Psychiatry,24(8),919-29.
7. Nigg, J.T.(2012).Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives.J Am Acad Child Adolesc Psychiatry,51(1),86-97e8.
8. Pontifex,M.B.(2013).Exercise improves behavioral, neurocognitive, and scholastic performance in children with attentiondeficit/hyperactivity disorder.J Pediatr,162(3),543-51.
9. Sinn, N.(2008).Nutritional and dietary influences on attention deficit hyperactivity disorder.Nutr Rev,66(10),558-68.
10. Thapar, A.(2012).What causes attention deficit hyperactivity disorder?.Arch Dis Child,97(3),260-5.
11. Yolton, K.(2014).Exposure to neurotoxicants and the development of attention deficit hyperactivity disorder and its related behaviors in childhood.Neurotoxicol Teratol,44,30-45.
12. 丁利忠、李春娟、金東明(2015)。中醫藥治療小兒多動症經驗分析。中國中西醫結合兒科學，28(5)，880-881。
13. 王曉紅、王曉青(2006)。小兒多動症治療方法。社區醫學雜誌，4(7)，11-12。
14. 余兆蕙、黃子玶、顏宏融(2011)。注意力缺失過動症的中西醫觀點與相關實證研究進展。中醫藥研究論叢，14(2)，79-93。
15. 李曉東(2007)。小兒多動症的中醫辨證分型。中醫兒科雜誌，3(6)，35-36。
16. 杭榮華(2010)。感覺統合訓練改善注意缺陷多動障礙兒童行為、智力及執行功能的對照研究。中國心理衛生雜誌，20(3)，713-714。
17. 夏睿明、劉榮滿(2015)。妙用逍遙散加味治癒多例小兒多動症。現代醫藥衛生，31(18)，2729。
18. 徐海霞、祝敬燕、黃嚴(2005)。黃連溫膽湯加減治療小兒多動症46例。山東中醫雜誌，24(7)，413-414。
19. 祝興超、孫秀芹(2013)。小兒多動症中醫證治淺析。光明中醫，28(5)，880-881。
20. 商志雍、高淑芬(2001)。注意力不足過動症：從行為表現型到內在表現型與基因型。台灣醫學，15(4)，375-383。
21. 張瑩翠(2007)。小兒多動症的治療。吉林中醫藥，27(12)，71-72。
22. 楊曉明、呂永興(2013)。鎮肝熄風湯治療小兒多動症。中國民間療法，21(11)，41。
23. 趙懷康(2005)。甘麥大棗湯治療小兒多動症療效觀察。中國社區醫師，21(3)，42。
24. 黎欣、楊昆(2015)。以舌象為主要辨證依據分型治療小兒多動症40例。陜西中醫，36(3)，271-272。
25. 錢建華、歐陽湘云(2013)。歸脾湯加減治療小兒多動症30例療效觀察。中國中醫藥科技，20(5)，454。