庄礼兴分型论治左旋多巴引发的帕金森病异动症经验

ZHUANG Lixing's Experience in Differentiating and Treating Levodopa-Induced Dyskinesia in Parkinson's Disease

总结庄礼兴教授分型论治左旋多巴引发的帕金森病异动症(LID)的临证经验。认为LID以筋脉失约或失养为根本病机,临证将剂峰LID辨为肝阳化风型、肝肾不足型,肝阳化风型治当平肝熄风、舒筋止颤,方以镇肝熄风汤加石决明、珍珠母加减,肝肾不足型治当补益肝肾、育阴熄风,以大补阴丸为主方加减;将关期LID辨为痰湿中阻型、气血两虚型,痰湿中阻型治当化痰除湿、濡养筋脉,予温胆汤或二陈汤加减,气血两虚型治当补益气血、濡养筋脉,可以补中益气汤或八珍汤或参苓白术散为主方加减;将双相LID辨为少阳枢机不利型,治当和解少阳、调达枢机,予小柴胡汤加减。

This paper summarized Professor ZHUANG Lixing's clinical experience in differentiating and treating levodopa-induced dyskinesia(LID) in Parkinson's disease.It is believed that the fundamental pathogenesis of LID lies in the disharmony or malnourishment of tendons and vessels.Based on the clinical manifestations,peak-dose LID is differentiated into two syndromes:syndrome of hyperactive liver yang causing wind and syndrome of deficiency of both liver and kidney.For the syndrome of hyperactive liver yang causing wind,the treatment focuses on calming the liver to stop the wind,and relaxing the tendons to stop tremors.The main prescription used is Zhengan Xifeng Decoction (镇肝熄风汤) with the addition of Shijueming (石决明) and Zhenzhumu (珍珠母).For the syndrome of deficiency of both liver and kidney,the treatment focuses on nourishing the liver and kidneys,and replenishing yin to stop the wind.The main prescription used is Dabuyin Pills (大补阴丸) with modification.LID in the acoustic phase is differen-tiated into syndrome of phlegm-damp blocking middle jiao and syndrome of deficiency of both qi and yin.For the syn-drome of phlegm-damp blocking middle jiao,the treatment focuses on dissipating phlegm and eliminating dampness,and nurturing tendons and vessels.Wendan Decoction (温胆汤) or Erchen Decoction (二陈汤) with modification is used.For the syndrome of deficiency of both qi and yin,the treatment focuses on replenishing qi and nourishing blood,and nurturing tendons and vessels.The main prescriptions used are Buzhong Yiqi Decoction (补中益气汤) or Bazhen Decoction (八珍汤) or Shenling Baizhu Powder (参苓白术散) with modification.Biphasic LID is differentiated as the Shaoyang pivot disadvantageousness,and the treatment focuses on harmonizing Shaoyang and regulating the pivot.The main prescription used is Xiaochaihu Decoction (小柴胡汤) with modification.