巴金森氏症的中西醫結合治療心得－中醫痺症分析

Experience of Sino-western Combined Therapy on Parkinsonism-Analysis of Paralytic Syndrome in Traditional Chinese Medicine

林寶華(Pao-Hua Lin)

《北台灣中醫醫學雜誌》 1卷1期 (2009/08) Pp. 1-19

https://doi.org/10.30127/BTWZYYXZZ.200908.0001

摘要

巴金森氏病是老年人常見的神經學退化疾病之一，病因至今不明，患者腦部黑質紋狀體選擇性的多巴胺生成減少，病人的尾狀核、殼核及黑質的多巴胺含量下降；因神經元細胞凋亡，影響神經傳導物質分泌，以致逐漸出現顫抖、僵硬及動作緩慢的運動性功能障礙，最終會造成生活上的失能、無法行動。而因腦傷、中毒所引發者，則泛稱為巴金森症候群，簡稱巴金森氏症。台灣巴金森氏病的盛行率為十萬分之一百三十，集中在五十五歲到六十歲發病，越老風險越高。巴金森氏病比較類似中醫痺症。此病肆虐人類數千年，在三百年前中醫「醫宗金鑑．痺症」有詳細的記載，尤其「痺入臟府證」描述痺症病久之病癥為「肺痺煩滿喘咳嗽，腎脹尻踵脊代頭，脾嘔痞肢懈墮，心煩悸噫恐時休，數飲臥驚肝太息，飲秘脹瀉在腸究，胞秘沃痛鼻清涕，三焦胃府膽無憂。」頗似現代醫學專家描述巴金森氏症的各種神經、精神病變，如：「聲音軟弱、呼吸困難、嗆到、肺炎等（痺入肺）」、「下肢水腫、乏力、體重減輕；頭部前傾、軀幹俯屈、肘關節屈曲、前臂內收、髖關節膝關節屈曲；身體前傾，漸成Ｃ字型（痺入腎）」、「吞嚥困難、流口水、震顫、僵直、肌力減退、行動遲緩；體力或身體協調功能下降、手臂旋轉不良、跛足、起身離椅困難、肩背痛或腰痛（痺入脾）」、「自主神經危象發生時則大汗淋漓、面部充血、心跳加快、情緒緊張（痺入心）」、「不安、抑鬱、幻覺、妄想、痴呆；睡眠障礙、有憂鬱傾向；身體上或心理上的壓力（痺入肝）」、「頑固性便秘（痺入腸）」、「陽萎、排尿困難（痺入胞）」。醫生和病人應瞭解巴金森氏症的不同病因、病程，俾在不同階段做最佳治療；結合中西醫藥治療，以避免疾病惡化，應會有最佳的療效和生活品質。

關鍵字

巴金森氏病 ； 痺症 ； 痺入臟府

並列摘要

Parkinsonism is one of the common degenerative neurological diseases in elderly. The etiology is still unclear. The production of selective dopamine decreases in the nigra substance of cerebral stratum body and decreased content of dopamine are found in the caudate nucleus, putamen and nigra substance are observed. The aptosis of neuron influences the secretion of neurotransmitters, therefore, kinetic dysfunction including muscle tremor, body stiffness and slow motion would ultimately lead to impairment in ordinary life and patients are unable to move. Those induced by brain contusion or intoxication would be generally termed as parkinsonic symptoms, in abbreviation it is termed as parkinsonism. The prevalence of parkinsonism is around 130 in 100,000 in Taiwan. It is mostly happened within 55~60 years old people. The elder the patients are, the higher risk the parkinsonism would be.Parkinsonism is similar to the ”paralytic syndrome” in traditional Chinese medical terminology. Human beings had been suffered from parkinsonism since thousands years ago. It had been detailed reported in the Chapter of Paralytic syndrome in the TCM classic Golden Medical Encyclopedia (Yi-Zhong-Jin-Jian) at 300 years ago. The term ”paralytic syndrome entering viscera” is defined as the chronic paralytic syndrome with the symptoms like ”pulmonary paralytic syndrome with gasp for breath and coughing; renal paralytic syndrome with caudal spinal swelling and swollen kidney; splenic paralytic syndrome with nausea/vomiting and loosen muscle tone of limbs; cardiac paralytic syndrome with sporadic palpitation, alas and fear; hepatic palpitation with numerous drinking, insomnia and deep sigh; intestinal paralytic syndrome with constipation or diarrhea, cystic paralytic syndrome with dysurea and rhinorrhea; and no related symptoms are concerned in sanjiao (triple energizer), stomach or gall bladder”.The description of the term is nearly close to the numerous neurologic and psychiatric symptoms found by modern doctors in parkinsonism. For example, the symptoms of ”feeble sound, difficulty in breathing, choking and pneumonia” are found in pulmonary paralytic syndrome; ”lower limbs edema, fatigue, weight loss, anteversion of head, prostrate position of trunk, flexion of elbow, inversion of forearm, flexion of thigh and knee, leaning forward of body and C-shape form of trunk gradually” are found in renal paralytic syndrome; ”dysphagia, saliva drooping, tremor, spasticity, decreasing muscle tone, bradykinesia, poor coordination of physical strength or body movement, rotation dysfunction of arms, lame, difficulty in getting up from chair and pain in shoulder, back or waist” are found in splenic paralytic syndrome; ”autonomic neural crisis with sweat pouring, facial congestion, palpitation and nervousness” are found in cardiac paralytic syndrome; ”restless, depression, hallucination, delusion, insomnia, depression tendency, somatic or psychological pressure” are found in hepatic paralytic syndrome; ”obstinate constipation” is found in intestinal paralytic syndrome; ”impotence and dysurea” are found in cystic paralytic syndrome.Physicians and patients should understand different etiologies and progressions of parkinsonism, therefore the best choice could be made in different clinical stages. Sino-western combined therapy would prevent deterioration of parkinsonism and provide the best therapeutic effect and life quality upon patients.

並列關鍵字

Parkinsonism ； Paralytic Syndrome ； Paralytic Syndrome entering Viscera