以針刺及補腎益氣活血中藥PSUNHT1對中台灣阿茲海默氏症病人療效評估之研究

林慶鐘
行政院衛生署豐原醫院
老年癡呆」俗稱「老年失智症」、「癡呆症」，是一種好發在中老年人大腦退化的臨床症候群。老人大腦皮層經嚴重腦部功能的損害，在臨床表現上常造成嚴重記憶力減退或記憶喪失、智力減退、情緒人格障礙等一類病症。「癡呆症」包括「阿茲海默病」(Alzheimers Disease; AD) 和「血管性癡呆」(Vascular Disease;VD)，患病初期往往出現輕度至中度的短期記憶的缺損，隨著病況加重，逐漸喪失生活的能力性格改變，到最後會如同嬰孩般需要完全依賴家屬照顧。下一個世紀癡呆發病率將僅次於腦血管疾病癌症之重大疾病。據統計，65歲以上癡呆症的盛行率約3~5%。預測到 2030年，全球患老年癡呆症的人口將達到 6000萬，估計目前台灣痴呆人口約有十五萬人(1)。失智症其主要症狀是大腦認知功能的障礙：造成如判斷、理解、計算、語言、方向感喪失，並有妄想、暴力行為、焦慮、遊走、憂鬱症等症狀，造成家屬及照護者的困擾及損失。
老年失智症患者大腦在控制運動的神經之基底質部位 Basal ganglia，會有不明原因的進行性大腦神經細胞退化，使神經細胞死亡及神經傳導功能消失；尤其以大腦皮質功能退化最明顯，如思考、記憶、學習及語言能力嚴重喪失，以至於影響心智功能及日常生活能力。 
估計全球約有一千五百萬人罹患此症，六十五歲以上，每二十位就有一位；八十五歲以上則有半數罹患此症。隨著人口日漸老化，阿茲海默氏症已成為一個社會健康的問題，也給家人帶來沈重的精神和經濟負擔。
AD主要問題發生在大腦內中樞膽鹼神經系統的功能喪失，腦中神經傳導物質乙醯膽鹼量的減少；它與記憶功能有關，因而產生臨床如記憶力降低喪失，大部份治療的工作皆針對這個方向進行，這些藥物通常可以防止乙醯膽鹼在腦中神經元突觸的間隙被酵素水解，增加他們的量及利用率，乙醯膽鹼化合物夠幫助改善患者生活起居的能力及行為障礙。服用乙醯膽鹼分解酵素的抑制劑 ( AchEI) 患者 ，可改善失智者之功效。
中醫認為腎主骨，骨生髓，髓通於腦海。腎精充足,則生髓機能旺盛。髓旺則腦髓充實，神機聰靈。年邁之人，臟腑功能日漸衰竭，進而造成腎氣不足，腎精衰枯，髓海空虛，則腦竅失養，而見呆傻，出現神志淡漠健忘等症。研究顯示六味地黃丸，具有衰老反抗氧化作用，對老年癡呆癥有助於增強記憶。
本研究目的在於收集中台灣醫院，經神經內科專科醫師診斷輕中度阿茲海默氏症之90案例，分實驗組I（30名只有針）、實驗組II（30名針加中藥）、對照組（30名沒用針及沒用中藥）治療研究方式，以針刺及自擬補腎益氣活血中藥PSUNHT1（六味地黃丸10g；補陽還五湯6g；合方）探討對阿茲海默病人療效評估，期望透過以針灸及中藥來治療改善阿茲海默氏症的患者病情。研究期間施治前後並採用○1.用簡易精神狀態檢查表（MMSE）○2.知能篩檢測驗評分（CASI C:2.0）○3.臨床施治評量表（Clinical Dementia Rating CDR）等方法來評估阿茲海默氏症病人智能等病情改善程度狀態，期找出以此中醫針刺合併中藥治療模式來改善阿茲海默氏症，除了改善老人養老生活品質、並期望減少家庭及社會國家經濟損失，及增加國人生活品質提昇。
關鍵字：阿茲海默症、血管性老年癡呆、補腎益氣活血中藥PSUNHT1簡易精神狀態檢查（MMSE）、知能篩檢測驗評分（CASI C:2.0）、臨床施治評量表（CDR）。

An evaluation of effects of combination treatment of acupuncture and TCM PSUNHT1 to Alzheimers disease in central Taiwan hospitals

Chin-Chung Lin
Department of health executive yuan, R.O.C. fong yuan hospital
Azihaimo sickness (Alzheimer s Disease) is named the old age to lose the wisdom sickness, Azihaimo sickness (Alzheimer s Disease) is named the old age to lose the wisdom sickness, research goal: Creates loses the wisdom illness to have many kinds, mainly the old age which degenerates for the cerebrum loses the wisdom sickness, is also called Azihaimo sickness (Alzheimers Disease; AD) is called the dementia sickness, is one kind good sends in middle-aged persons and old persons clinical syndrome. Is mainly the memory drops, and follows at least an item of cerebrum cognition function barrier: Like the judgment, the understanding, the computation, carry out ability, the language performance, the sense of direction and so on. Moreover these abilitys decrease must to be seriously by interferes with its work or the daily life. Approximately half sickness also has the spiritual unusual behavior, like the delusion, the fantasy, the rough stuff, anxious, excited, walk randomly, the sleep disorder, to invert, melancholia and so on, day and night creates the family members and the looking after puzzle. Loses the wisdom illness, the main cerebrum degeneration old age loses the wisdom sickness, is called Azihaimo sickness (Alzheimers Disease; AD). Is one kind of unknown cause carries on the natural, nerve degeneration disease. It will cause the cerebrum nerve cell incessancy to degenerate, causes the nerve cell death and nerve conduction function vanishing; Especially is most obvious degeneration of by the cerebral cortex function, like ponder, memory, study and language part ability, affects the mental function, the behavior and daily life ability. This kind of diseases occurrence is gradually, simultaneously sickness condition is also pejoration slowly. It is causes the senior citizen to live one of barrier biggest diseases. This research point: The medicine takes Yi Zhifu to affect for a long time forms the family state economy long-term burden, therefore the research appraisal determines the Taiwan hospital light moderate patient because of the meter piquada and the traditional Chinese medicine pharmacological treatment patient to treat makes the curative effect depending on to estimate lightens the family country burden is an urgent matter gradually. The old age loses the wisdom sickness usually to start from more than 60 years old to be taken bad, 65 year-old above is in vogue rate approximately 3~5%; above 80 years old approximately is 20%. estimated that the whole world approximately has 15,000,000 people to suffer from this sickness, above 65 years old, every 20 have one *; Above 85 years old has half of suffers from this sickness to get older day after day along with the population, Azihaimo sickness has become a social health the question. This sickness lies in its influence widespread implication fearfully, because will lose the memory and the cognitive capacity seriously besides sickness patient himself, also will bring heavy energetic and the economic burden for the friends and relatives; Most fearful is, up to now, the medical arena had still not been able to discover the cause of disease, the treatment and the precautionary approach. Long this gets down, will become social inevitably a burden. Therefore this clinical research expectation takes the way by the Chinese medicine acupuncture point acupuncture and the traditional Chinese medicine, expected that found the appropriate treatment pattern, delayed the present Taiwan rapidly aging of population and improves Azihaimo sickness to increase the tendency, and improved the family, the society, the state economy to lose, and increased the people to live the quality promotion.
關鍵字：Alzheimer’s disease, vascular dementia, PSUNHT1, Acupuncture , MMSE, CASI C 2.0, Clinical Dementia Rating CDR