何建成教授分期治疗帕金森病痴呆的经验

HE Jiancheng’s Experience of Staged Treatment of Parkinson's Disease with Dementia

帕金森病(Parkinson disease, PD)是中老年患者常见的神经系统变性疾病,30%~40%PD患者在疾病发展过程中会出现痴呆表现,即帕金森痴呆(Parkinson disease with dementia, PDD),给患者及其家属带来了极大痛苦与负担。何建成教授汇集多家医者经验并结合临床,对于PDD的治疗形成了完整的辨证治疗思路。何教授认为PDD属于中医学中“颤证”与“痴呆”并病或合病,涉及肝、脾、肾三脏,肝脾肾气血亏虚为本,风、火、痰、瘀为标等。临床治疗PDD要充分结合帕金森本虚标实的病机,辨证、辨病、辨症一体,综合施治,方可获得满意效果。PDD早期多以肝肾阴虚,髓海不足型为主,主抓“风、火”;中期多以脾肾亏虚、元阳不足型,主抓“虚损”,或痰瘀阻滞,脑窍不通型为主,主抓“痰、瘀”;晚期以阴阳两虚,浊毒阻络型为主,主抓“虚、毒”。除不同阶段的辨证治疗外,何教授处方用药不乏特色,“调理中焦,固护胃气”“善用药对,结合药理”“分期辨治,重视通调”“配合康复,重视情志”亦值得临床借鉴。此外,还应嘱患者健康饮食,以改善生活状态。

Parkinson’s disease(PD)is a common neurodegenerative disease in middle-aged and elderly patients.30%to 40%of PD patients will develop dementia in the process of disease development,namely PD with dementia(PDD).It brings great pain and burden to patients and their families.Professor HE Jiancheng has gathered the experience of many doctors and combined clinical practice to form a complete syndrome differentiation treatment idea for the treatment of PDD.Prof.HE believes that PDD belongs to the co-disease of"tremor syndrome"and"dementia"in traditional Chinese medicine,involving liver,spleen and kidney.The clinical treatment of PDD should fully combine the pathogenesis of PD,syndrome differentiation,disease differentiation and symptom differentiation,and the comprehensive treatment can achieve satisfactory results.In the early stage of PDD,the liver-kidney Yin deficiency and marrow sea deficiency are the main types which mainly focus on"wind and fire".In the middle stage,most patients are characterized by deficiency of spleen and kidney and deficiency of Yuanyang,focusing on"deficiency",or stagnation of phlegm and blood stasis,and blockage of brain orifices.In the late stage,deficiency of Yin and Yang and the turbid toxin obstructing collaterals are the main types which mainly focus on"deficiency and toxxin".In addition to different stages of treatment based on syndrome differentiation,Professor HE's prescriptions have many distinctive features,such as"regulating the middle Jiao,strengthening stomach Qi","being good at using drug pairs and combining pharmacology","diagnosing and treating by stages,emphasizing regulation","cooperating with rehabilitation and emphasizing emotion".It is also worthy of clinical reference.In addition,patients should also be instructed to eat a healthy diet to improve their living conditions.