中醫辨證施治落日症候群之失眠病例報告

患者為一64歲女性，體格肥胖，有高血壓、糖尿病、高血脂病史。於103年11月暫時性腦缺血發作後，於104年4月又因缺血性腦中風送醫治療。患者自從104年4月中風後開始接受復健治療，然而家屬發現患者出現下午注意力不集中且容易動怒煩躁、情緒低落、食慾不佳、不易入睡、淺眠易醒、健忘情形加重等情況，西醫診斷為日落症候群，服用西藥之抗憂鬱藥物與安眠藥效果有限，尤其睡眠狀況一直未見起色，故於104年7月會診中醫。患者面色晦滯，精神不佳，表情淡漠不欲言語，口氣重，腹脹，舌紅瘀斑尖朱點，中根苔黃厚邊齒痕，脈象左寸浮數關弦數尺細數，右寸滑關滑尺細。中醫辨證屬痰熱擾心，痰瘀阻絡，治以清熱化痰，寧心安神，活血通絡之法，處方以白虎加人參湯合葛根芩連湯與二陳湯加減，加入安神與活血涼血藥物，症狀漸獲改善。

關鍵字

日落症候群；不易入睡；淺眠易醒；痰熱擾心；痰瘀阻絡

並列摘要

The 64 years old female patient who is obese figure with hypertension, diabetes, and Hyperlipidemia history, had transient ischemic attack in November 2014 and ischemic stroke in April 2015 with treatment. She had received rehabilitation therapy after the onset of the stroke since April 2015, but her family noticed she would be agitated and depressed in the afternoon with poor appetite, difficulty falling asleep, restless and light sleep, aggravated forgetfulness. Diagnosed with sundown syndrome by western medicine but the effect of the anti-depressant and sleeping pills were limited, while the sleep condition has been no better, she consulted Traditional Chinese Medicine in July, 2015. Her four examinations results included dark and gloomy complexion, lassitude, indifferent, bad breath, distended abdomen, red tongue with purple spots and teeth marks, red spots on the tip of the tongue, yellow and thick coating on the center and the root of the tongue. Pulses were left cun floating and rapid, left guan wiry and rapid, left chi thin and rapid; right cun and guan slippery, chi thin. Diagnosed as the pattern of phlegm heat disturbing heart, and phlegm and stasis obstructing collaterals, the therapeutic principles were clearing heat and dissolving phlegm, nourishing the heart and tranquilizing the spirit, improving blood circulation and unclogging the collaterals. Prescribed with modified Bai-Hu-Jia-Shen-Tang, Er-Chen-Tang, Ge-Gen-Huang-Qin Huang-Lian-Tang, and some herbs tranquilizing the spirit and cooling blood and improving the blood circulation, her symptoms have been gradually improved.