雒晓东主任治疗各种帕金森病非运动症状经验
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摘要
本文总结雒晓东主任治疗各种帕金森病非运动症状的经验。雒晓东主任运用中医理论并结合临床实践,提出中医药的参与在改善帕金森病非运动症状、提高患者生活质量等方面独具优势,擅长使用乌头桂枝汤或加味桂枝加葛根汤治疗帕金森病疼痛;运用保元汤、补中益气汤等治疗帕金森病合并直立性低血压;总结对帕金森病抑郁有良好疗效的中药组方柴甘解忧汤,疏肝解郁、理气祛痰、养心安神的功效彰著;治疗帕金森病合并睡眠障碍、便秘、嗅觉减退等颇有心得。目前雒晓东主任的学术思想已形成广东省中医院帕金森病专科系列治疗方案。
This paper summarizes the experience of Director Luo Xiaodong in treating all kinds of non-motor symptoms of Parkinson′s disease(PD). By using traditional Chinese medicine theory and combining with clinical practice,Director Luo Xiaodong points out that the participation of traditional Chinese medicine has distinct advantages in improving the non-motor symptoms of PD and the quality of life, he is good at using Wutou Guizhi Decoction or modified Guizhi and Gegen Decoction to treat the pain caused by PD; he uses Baoyuan Decoction and Buzhong Yiqi Decoction to treat PD combined with orthostatic hypotension; he summarizes Chaigan Jieyou Decoction for depression caused by PD, which has good effects of dispersing stagnated liver qi for relieving qi stagnation, regulating qi-flowing and expelling phlegm, tranquilizing by nourishing the heart; he has rich experience in the treatment of PD combined with sleep disorder, constipation and hyposmia. At present, the academic thoughts of Director Luo Xiaodong have formed specialist series treatment program of PD.
This paper summarizes the experience of Director Luo Xiaodong in treating all kinds of non-motor symptoms of Parkinson′s disease(PD). By using traditional Chinese medicine theory and combining with clinical practice,Director Luo Xiaodong points out that the participation of traditional Chinese medicine has distinct advantages in improving the non-motor symptoms of PD and the quality of life, he is good at using Wutou Guizhi Decoction or modified Guizhi and Gegen Decoction to treat the pain caused by PD; he uses Baoyuan Decoction and Buzhong Yiqi Decoction to treat PD combined with orthostatic hypotension; he summarizes Chaigan Jieyou Decoction for depression caused by PD, which has good effects of dispersing stagnated liver qi for relieving qi stagnation, regulating qi-flowing and expelling phlegm, tranquilizing by nourishing the heart; he has rich experience in the treatment of PD combined with sleep disorder, constipation and hyposmia. At present, the academic thoughts of Director Luo Xiaodong have formed specialist series treatment program of PD.
引文
[1]中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会.中国帕金森病的诊断标准(2016版)[J].中华神经科杂志,2016,49(4):268-271.
[2]Ha AD,Jankovic J.Pain in Parkinson′s Disease[J].Movement Discorders,2012,27(4):485-491.
[3]Zambito-Marsala S,Tinazzi M,Vitaliani R,et al.Spontaneous pain,pain threshold,and pain tolerance in Parkinson′s disease[J].J Neurol,2011,258(4):627-633.
[4]Santos-Garcia D,Abella-Corral J,Aneiros-Daz A,et al.Pain in Parkinson′s disease:prevalence,characteristics,associated factors,and relation with other non-motor symptoms,quality of life,autonomy,and caregiver burden[J].Rev Neurol,2011,52(7):385-393.
[5]Defazio G,Berardelli A,Fabbrini G,et al.Pain as a nonmotor symptom of Parkinson disease:evidence from a casecontrol study[J].Arch Neurol,2008,65(9):1191-1194.
[6]Hwang H,Jeon H,Ock J,et al.2-hydroxy-cinnamaldehyde targets low-density lipoprotein receptor-related protein-1 to inhibit lipopolysaccharide-induced microglial activation[J].J Neuroimmunol,2011,230(1/2):52.
[7]Sikora E,Bielak-Zmijewska A,Mosieniak G,et al.The promise of slow down ageing may come from curcumin[J].Curr Pharm Des,2010,16(7):884.
[8]Bonuccelli U,Lucetti C,Del Dotto P,et al.Orthostatic hypotension in de novo Parkinson disease[J].Arch Neurol,2003,60(10):1400-1404.
[9]Allcock LM,Ullyart K,Kenny RA,et al.Frequency of orthostatic hypotension in a community based cohort of patients with Parkinson's disease[J].J Neurol Neurosurg Psychiatry,2004,75(10):1470-1471.
[10]Colosimo C,Morgante L,Antonini A,et al.Non-motor symptoms in atypical and secondary parkinsonism:the PRI-AMO study[J].J Neurol,2010,257(1):5-14.
[11]Velseboer DC,de Haan RJ,Wieling W,et al.Prevalence of orthostatic hypotension in Parkinson′s disease:a systematic review and meta-analysis[J].Parkinsonism Relat Disord,2011,17(10):724-729.
[12]Moya A,Sutton R,Ammirati F,et al.Guidelines for the diagnosis and management of syncope(version 2009)[J].Eur Heart J,2009,30(21):2631-2671.
[13]Maule S,Papotti G,Naso D,et al.Orthostatic Hypotension:Evaluation and Treatment[J].Cardiovasc Hematol Disord Drug Targets,2007,7(1):63-70.
[14]中华医学会神经病学分会帕金森病及运动障碍学组.中国帕金森病治疗指南(第二版)[J].中华神经科杂志,2009,42(5):352-355.
[15]吴文涛,张秋池,朱元,等.补中益气汤联合盐酸米多君治疗帕金森病直立性低血压疗效研究[J].陕西中医,2018,39(6):713-716.
[16]郑春叶,雒晓东,许山山.保元汤治疗帕金森病体位性低血压临床研究[J].新中医,2013,45(8):22-24.
[17]van Praag HM,Asnis GM,Kahn RS.Monoamines and abnormal behaviour:a multi-aminergic perspective[J].B r J Psychiatry,1990,157:723-734.
[18]季宁东,李娟好,李明亚,等.柴胡皂苷对石菖蒲醇沉液抗抑郁作用的影响[J].江苏医药,2006,32(11):1049-1051.
[19]李明亚,陈红梅.石菖蒲对行为绝望动物抑郁模型的抗抑郁作用[J].中药材,2001,24(1):40-41.
[20]胡霜,马义泽.石菖蒲等五味中药抗抑郁作用的实验研究[J].山东中医药杂志,2009,28(11):799-800.
[21]孙艳,谢婷婷.中药远志对慢性应激抑郁大鼠BDNF及其受体TrkB mRNA表达的影响[J].南方医科大学学报,2009,29(6):1199-1203.
[22]Claassen DO,Josephs KA,Ahlskog JE,et al.REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century[J].Neurology,2010,75(6):494-499.
[23]Iranzo A,Molinuevo JL,Santamaria J,et al.Rapid-eyemovement sleep behavior disorder as an early marker for a neurodegenerative disorder:A descriptive study[J].Lancet Neurol,2006,5(7):572-577.
[24]Postuma RB,Gagnon JF,Vendette M,et al.REM sleep behavior disorder in Parkinson′s disease is associated with specific motor features[J].J Neurol Neurosurg Psychiatry,2008,79(10):1117-1121.
[25]Nomura T,Inoue Y,Kagimura T,et al.Clinical significance of REM sleep behavior disorder in Parkinson′s disease[J].Sleep Med,2013,14(2):131-135.
[26]Scherfler C,Frauscher B,Schocke M,et al.White and gray mater-abnormalities in idiopathic rapid eye movement sleep behavior disorder:A diffusion-tensor imaging and voxel-based morphometry study[J].Ann Neurol,2011,69(2):400-407.
[27]Bagetta G,De Sarro G,Priolo E,et al.Ventral tegmental area:Site through which dopamine D2-receptor agonists evoke behavioral and electrocortical sleep in rats[J].Br J Pharmacol,2005,95(3):860-866.
[28]喻哲明,丁正同.帕金森病与快动眼睡眠行为障碍[J].中国临床神经科学,2011,19(2):203-208.
[29]董理,张伟,罗晓光.帕金森病与快动眼睡眠行为障碍[J].中国全科医学,2009,12(4B):702-703.
[30]Toffoli M,Dreussi E,Cecchin E,et al.SNCA 3′UTR genetic variants in patients with Parkinson′s disease and REM sleep behavior disorder[J].Neurol Sci,2017,38(7):1233-1240.
[31]卢丽玉,张丽.特发性快动眼睡眠行为障碍与帕金森病研究进展[J].临床神经病学杂志,2018,31(3):235-237.
[32]吴丹,白景珍.帕金森病伴快速眼动睡眠期行为障碍的发病机制及诊治的相关研究[J].医学综述,2018,24(2):326-329.
[33]清·陆廷珍.六因条辨[M].北京:人民卫生出版社,2008:103-105.
[34]陈治林.加味黄连温胆汤治疗失眠症32例[J].云南中医中药杂志,2010,31(10):34-35.
[35]Byrne KG,Pfeiffer R,Quigley EM.Gastrointestinal dysfunction in Parkinson′s disease:a report of clinical experience at a single center[J].J Clin Gastroenterol,1994,19(1):11-16.
[36]Martignoni E,Pacchetti C,Godi L,et al.Autonomic disorders in Parkinson′s disease[J].J Neural Transm,1995,45:11-19.
[37]袁昌文,杨柏林.莫沙比利联合聚乙二醇4000治疗帕金森综合征便秘疗效观察[J].四川医学,2006,27(10):1023-1024.
[38]徐珑珑,王小同.帕金森病的植物神经系统功能障碍[J].神经疾病与精神卫生,2003,3(3):239-241.
[2]Ha AD,Jankovic J.Pain in Parkinson′s Disease[J].Movement Discorders,2012,27(4):485-491.
[3]Zambito-Marsala S,Tinazzi M,Vitaliani R,et al.Spontaneous pain,pain threshold,and pain tolerance in Parkinson′s disease[J].J Neurol,2011,258(4):627-633.
[4]Santos-Garcia D,Abella-Corral J,Aneiros-Daz A,et al.Pain in Parkinson′s disease:prevalence,characteristics,associated factors,and relation with other non-motor symptoms,quality of life,autonomy,and caregiver burden[J].Rev Neurol,2011,52(7):385-393.
[5]Defazio G,Berardelli A,Fabbrini G,et al.Pain as a nonmotor symptom of Parkinson disease:evidence from a casecontrol study[J].Arch Neurol,2008,65(9):1191-1194.
[6]Hwang H,Jeon H,Ock J,et al.2-hydroxy-cinnamaldehyde targets low-density lipoprotein receptor-related protein-1 to inhibit lipopolysaccharide-induced microglial activation[J].J Neuroimmunol,2011,230(1/2):52.
[7]Sikora E,Bielak-Zmijewska A,Mosieniak G,et al.The promise of slow down ageing may come from curcumin[J].Curr Pharm Des,2010,16(7):884.
[8]Bonuccelli U,Lucetti C,Del Dotto P,et al.Orthostatic hypotension in de novo Parkinson disease[J].Arch Neurol,2003,60(10):1400-1404.
[9]Allcock LM,Ullyart K,Kenny RA,et al.Frequency of orthostatic hypotension in a community based cohort of patients with Parkinson's disease[J].J Neurol Neurosurg Psychiatry,2004,75(10):1470-1471.
[10]Colosimo C,Morgante L,Antonini A,et al.Non-motor symptoms in atypical and secondary parkinsonism:the PRI-AMO study[J].J Neurol,2010,257(1):5-14.
[11]Velseboer DC,de Haan RJ,Wieling W,et al.Prevalence of orthostatic hypotension in Parkinson′s disease:a systematic review and meta-analysis[J].Parkinsonism Relat Disord,2011,17(10):724-729.
[12]Moya A,Sutton R,Ammirati F,et al.Guidelines for the diagnosis and management of syncope(version 2009)[J].Eur Heart J,2009,30(21):2631-2671.
[13]Maule S,Papotti G,Naso D,et al.Orthostatic Hypotension:Evaluation and Treatment[J].Cardiovasc Hematol Disord Drug Targets,2007,7(1):63-70.
[14]中华医学会神经病学分会帕金森病及运动障碍学组.中国帕金森病治疗指南(第二版)[J].中华神经科杂志,2009,42(5):352-355.
[15]吴文涛,张秋池,朱元,等.补中益气汤联合盐酸米多君治疗帕金森病直立性低血压疗效研究[J].陕西中医,2018,39(6):713-716.
[16]郑春叶,雒晓东,许山山.保元汤治疗帕金森病体位性低血压临床研究[J].新中医,2013,45(8):22-24.
[17]van Praag HM,Asnis GM,Kahn RS.Monoamines and abnormal behaviour:a multi-aminergic perspective[J].B r J Psychiatry,1990,157:723-734.
[18]季宁东,李娟好,李明亚,等.柴胡皂苷对石菖蒲醇沉液抗抑郁作用的影响[J].江苏医药,2006,32(11):1049-1051.
[19]李明亚,陈红梅.石菖蒲对行为绝望动物抑郁模型的抗抑郁作用[J].中药材,2001,24(1):40-41.
[20]胡霜,马义泽.石菖蒲等五味中药抗抑郁作用的实验研究[J].山东中医药杂志,2009,28(11):799-800.
[21]孙艳,谢婷婷.中药远志对慢性应激抑郁大鼠BDNF及其受体TrkB mRNA表达的影响[J].南方医科大学学报,2009,29(6):1199-1203.
[22]Claassen DO,Josephs KA,Ahlskog JE,et al.REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century[J].Neurology,2010,75(6):494-499.
[23]Iranzo A,Molinuevo JL,Santamaria J,et al.Rapid-eyemovement sleep behavior disorder as an early marker for a neurodegenerative disorder:A descriptive study[J].Lancet Neurol,2006,5(7):572-577.
[24]Postuma RB,Gagnon JF,Vendette M,et al.REM sleep behavior disorder in Parkinson′s disease is associated with specific motor features[J].J Neurol Neurosurg Psychiatry,2008,79(10):1117-1121.
[25]Nomura T,Inoue Y,Kagimura T,et al.Clinical significance of REM sleep behavior disorder in Parkinson′s disease[J].Sleep Med,2013,14(2):131-135.
[26]Scherfler C,Frauscher B,Schocke M,et al.White and gray mater-abnormalities in idiopathic rapid eye movement sleep behavior disorder:A diffusion-tensor imaging and voxel-based morphometry study[J].Ann Neurol,2011,69(2):400-407.
[27]Bagetta G,De Sarro G,Priolo E,et al.Ventral tegmental area:Site through which dopamine D2-receptor agonists evoke behavioral and electrocortical sleep in rats[J].Br J Pharmacol,2005,95(3):860-866.
[28]喻哲明,丁正同.帕金森病与快动眼睡眠行为障碍[J].中国临床神经科学,2011,19(2):203-208.
[29]董理,张伟,罗晓光.帕金森病与快动眼睡眠行为障碍[J].中国全科医学,2009,12(4B):702-703.
[30]Toffoli M,Dreussi E,Cecchin E,et al.SNCA 3′UTR genetic variants in patients with Parkinson′s disease and REM sleep behavior disorder[J].Neurol Sci,2017,38(7):1233-1240.
[31]卢丽玉,张丽.特发性快动眼睡眠行为障碍与帕金森病研究进展[J].临床神经病学杂志,2018,31(3):235-237.
[32]吴丹,白景珍.帕金森病伴快速眼动睡眠期行为障碍的发病机制及诊治的相关研究[J].医学综述,2018,24(2):326-329.
[33]清·陆廷珍.六因条辨[M].北京:人民卫生出版社,2008:103-105.
[34]陈治林.加味黄连温胆汤治疗失眠症32例[J].云南中医中药杂志,2010,31(10):34-35.
[35]Byrne KG,Pfeiffer R,Quigley EM.Gastrointestinal dysfunction in Parkinson′s disease:a report of clinical experience at a single center[J].J Clin Gastroenterol,1994,19(1):11-16.
[36]Martignoni E,Pacchetti C,Godi L,et al.Autonomic disorders in Parkinson′s disease[J].J Neural Transm,1995,45:11-19.
[37]袁昌文,杨柏林.莫沙比利联合聚乙二醇4000治疗帕金森综合征便秘疗效观察[J].四川医学,2006,27(10):1023-1024.
[38]徐珑珑,王小同.帕金森病的植物神经系统功能障碍[J].神经疾病与精神卫生,2003,3(3):239-241.