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痰濁中阻型帕金森氏病中西醫結合診療之研究
Integrated TCM and Western Medicine Diagnosis and Treatment of phlegm turbidity obstructing the center pattern of Parkinson's Disease
摘要
目的：帕金森病的患者發病多為60歲以上，海島型氣候的臺灣極為潮濕地區，飲食習慣多肥甘厚味，痰濁中阻型帕金森氏病患者最多，擬透過循證醫學的方法探討半夏天麻白朮湯加方對帕金森氏病患者的療效評估及安全性，總結出中西醫結合帕金森氏病的病因病機，從而為帕金森氏病的中醫治療提出更好的參考依據，以提升中西結合醫學對帕金森氏病的療效與造福嘉惠病患。方法：將臺灣臺北地區屬於痰濁中阻型帕金森氏病患者隨機分配，共有治療組26例，對照組24例。對照組繼續原有的西藥治療，治療組加服用半夏天麻白朮湯加方，兩組療程均為6個月；觀察2組臨床療效及治療前後帕金森統一評分量表(UPDRS)、改良的Hoehn-Yahr(H-Y)分級情況，評價中藥療 效及安全性差異。結果：1.治療組的帕金森統一評分量表(UPDRS)、臨床療效明顯優於對照組(P＜ 0.05)；2.治療前後H-Y分級比較無顯著地差異(P＞ 0.05)。3.服用半夏天麻白朮湯加方無肝腎等其他不良反應。結論：1.半夏天麻白朮湯加方對帕金森氏病患者的療效明顯及不良反應少，能更 好地控制帕金森氏病的症狀，降低UPDRS評分，優化帕金森氏病的治療，達到推遲病程的目的。2.臺灣帕金森氏病的證型有氣虛血瘀證、痰濁中阻證、氣血兩虛證及陰陽兩虛證。並探討半夏天麻白朮湯治療帕金森氏病的相關古籍文獻探討。3.治療帕金森氏病的主流西藥，其藥物反應及副作用影響患者生活品質極大，中藥治療帕金森氏病的極為優勢，並可以單純用中藥來治療帕金森氏病，大幅降低西藥的藥物反應與副作用，改善病患生活品質。
並列摘要
Purpose： Parkinson's disease(PD) typically presents in patients over 60 years old. Taiwan is an island with a humid and damp climate and eating habits of consuming fatty and sweet rich foods. These factors result in phlegm turbidity obstructing the center pattern presenting as the predominating type of PD. An evidencebased medicine (EBM) approach is applied to assess the efficacy and safety of administering Ban Xia Tian Ma Bai Zhu Tang variant for the treatment of PD patients, and a summary of the integrated TCM and Western medicine etiology and pathomechanism provided. The results of this study will provide a better reference source for the TCM treatment of PD. Material and method： This study entails a random distribution of patients in northern Taiwan's New Taipei City municipality with phlegm turbidity obstructing the center pattern type of PD. The treatment group consisted of 26 patients and the control group 24 patients. The control group continued to be administered Western medicine drug treatment and the treatment group was administered Ban Xia Tian Ma Bai Zhu Tang variant. The period of treatment assessed for both groups was 6 months. Observations were made on the clinical efficacy and unified Parkinson's disease rating scale (UPDRS) and modified Hoehn-Yahr (H-Y) scale before and after treatment in both groups. Comparative evaluations were made on the efficacy of TCM treatment and safety. Results： 1. The treatment group's UPDRS and clinical efficacy was markedly better than the control group (P＜ 0.05). 2. The pre- and post-treatment H-Y scale did not show discernible differences (P＞ 0.05). 3. The administration of Ban Xia Tian Ma Bai Zhu Tang variant had no deleterious effects on the liver or kidneys. Conclusion： 1. The administration of Ban Xia Tian Ma Bai Zhu Tang variant proved effective in treating PD patients and there were only marginal adverse effects. This treatment effectively controlled the symptoms of PD and lowered the UPDRS score, providing an optimized PD treatment approach that achieves the goal of delaying the onset of severe symptoms that affect quality of life. 2. The PD pattern types in Taiwan can be identified as follows: qi vacuity and blood stasis, phlegm turbidity obstructing the center, dual qi and blood vacuity, and dual yin and yang vacuity. The historical literature involving the administration of Ban Xia Tian Ma Bai Zhu Tang in the treatment of PD is also discussed. 3. The actions and adverse effects of the most commonly administered Western medicine drugs for the treatment of PD negatively impact and in some cases severely compromise a patients' quality of life. The advantages of administering TCM medicinals in the treatment of PD, the potential for singularly administering TCM medicinals in the treatment of PD in the absence of Western medicine drug administration, and how the administration of TCM medicinals substantially reduces the negative effects and adverse reactions of Western medicine drugs in order to improve the patients quality of life.