CN116098939A - 一种治疗帕金森病抑郁的中药组合物及其应用 - Google Patents
一种治疗帕金森病抑郁的中药组合物及其应用 Download PDFInfo
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Abstract
本发明提供一种治疗帕金森病抑郁的中药组合物及其应用，选取制附子4‑6份、醋柴胡9‑11份、茯苓19‑21份、白芍9‑11份、麸炒白术9‑11份、当归9‑11份、薄荷4‑6份、生甘草4‑6份，中药常规水煮，熬制汤剂。本中药组合物代替抗抑郁药物使用，副作用少，患者接受度高；短期服用，明显改善抑郁症状和生活质量，减缓帕金森病病情进展；长期服用明显改善期运动症状，减少帕金森病药物使用。
Description
技术领域
本发明涉及中药技术领域，尤其涉及一种治疗帕金森病抑郁的中药组合物及其应用。
背景技术
帕金森病（Parkinson's disease，PD）是仅次于痴呆的第二大慢性神经退行性疾病，临床上以运动迟缓、静止性震颤、步态姿势异常等特征性运动症状和自主神经功能障碍、认知功能障碍、精神障碍等非运动症状为主要变现。帕金森病症状呈进行性加重，临床治疗效果欠佳，严重影响患者生活质量。抑郁是PD最常伴发的非运动症状之一。与不伴抑郁的 PD患者相比，伴抑郁PD患者疾病进展更速，认知下降更著，依从性更差，致残率更高，照料起来更困难。
PD患者运动迟缓为必备症状，或伴有静止性震颤，或伴有肌张力障碍；其非运动症状认知功能下降、抑郁、淡漠、疲劳感更是患者临床就诊常见之主诉。与普通抑郁病患者相比，帕金森病抑郁患者更表现为动力感缺失、不愿社交、淡漠等特点。
帕金森病抑郁临床发生率高，严重影响患者生活治疗，临床治疗效果不佳，该药物可有效缓解临床症状。帕金森病抑郁目前临床治疗主要为抗帕金森治疗和抗抑郁治疗叠加，临床患者服用药物较多，副作用叠加，患者依从性差，而且两者不具有协同增效优势。
另外，帕金森病抑郁中医病理机制目前不够明晰和统一，水寒木郁机制的提出可以为临床医生指导方向。该药物的设计依据水寒木郁机制，温肾舒肝改善患者少动、僵硬、乏力、抑郁，契合临床上症状，理法方药明晰准确。为临床医生治疗帕金森病抑郁提供较好的方向和思路。
发明内容
本发明的目的是为了解决现有技术中存在的缺点，而提出的一种治疗帕金森病抑郁的中药组合物及其应用。
为实现上述目的，本发明采用了如下技术方案：
一种治疗帕金森病抑郁的中药组合物，所述中药组合物由以下重量份的原料药组成：制附子4-6份、醋柴胡9-11份、茯苓19-21份、白芍9-11份、麸炒白术9-11份、当归9-11份、薄荷4-6份、生甘草4-6份。
进一步的，所述中药组合物由以下重量份的原料药组成：制附子5份、醋柴胡10份、茯苓20份、白芍10份、麸炒白术10份、当归10份、薄荷5份、生甘草5份。
中药组合物在制备治疗帕金森抑郁疾病的药物中的应用。
需要说明的是：PD患者运动迟缓为必备症状，或伴有静止性震颤，或伴有肌张力障碍；其非运动症状认知功能下降、抑郁、淡漠、疲劳感更是患者临床就诊常见之主诉。与普通抑郁病患者相比，帕金森病抑郁患者更表现为动力感缺失、不愿社交、淡漠等特点。诸上表现与中医理论之肾阳亏虚、肝气不舒病机挈合。《素问•生气通天论篇》载：“阳气者，精则养神，柔则养筋。”率先指出阳气与人的精神状态、筋脉柔僵均密切相关。《伤寒论》述：“太阳病发汗，汗出不解，其人仍发热，心下悸，头眩，身瞤动，振振欲擗地者，真武汤主之”“少阴之为病，脉微细，但欲寐”、“少阴病，.......小便不利，或下利，或呕者，真武汤主治”。以上均表明肾阳亏虚帕金森病和抑郁共同病机，真武汤可对其异病同治。肾为肝之母，肾病多及肝，肝体阴而用阳，肝病多为肝气不舒，故肾阳亏虚，致水寒木郁，肝气不舒。张介宾《类经》中亦言：“神之灵通变化，阳气之精明也; 筋之运动便利，阳气之柔和也……阳气去则神气乱，筋骨废。”至清朝，黄元御明确提出了“水寒土湿木郁”病机，其著作《四圣心源》有载: “盖厥阴肝木，生于肾水而长于脾土。水土温和，则肝木发荣，木静而风恬; 水寒土湿，不能生长木气，则木郁……凡病之起，无不因于木气之郁。”综上可见，水寒木郁为帕金森病抑郁患者重要的病机，临床治拟温肾舒肝，方选真武汤合逍遥散加减。
与现有技术相比，本发明的有益效果为：通过前期临床观察，该药物治疗帕金森病抑郁效果明显，患者整体症状改善明显，尤其在情绪方面的控制。帕金森病抑郁较普通抑郁患者，其动力感缺失更明显，患者表现更为淡漠，该药物君药制附子，通过培补元阳调动气机，有助于缓解患者的淡漠。代替抗抑郁药物使用，副作用少，患者接受度高。短期服用，可以明显改善抑郁症状和生活质量，减缓帕金森病病情进展。长期服用，可明显改善帕金森病患者运动症状，减少帕金森病药物使用。
具体实施方式
为使对本发明的目的、构造、特征、及其功能有进一步的了解，兹配合实施例详细说明如下。
实施例1，依照具体实施方式，方选真武汤合逍遥散加减制成本发明中药组合物。它是由以下重量份数配比的原料药制备而成的药剂：制附子5份、醋柴胡10份、茯苓20份、白芍10份、麸炒白术10份、当归10份、薄荷5份、生甘草5份，所述中药常规水煮，熬制汤剂。
制附子为君药，本品辛甘性热，小剂量用之，温肾助阳，培补元阳，调动气机，肾为肝母，肾阳壮实以助肝用，肝气畅达；
臣以醋柴胡，苦辛微寒，辛行苦泄，性善条达肝气，疏肝调畅气机，解郁除烦；
佐以茯苓甘平、麸炒白术甘温，健脾助运；
佐以白芍苦酸微寒，养血敛阴柔肝缓急，解筋肉瞤动、肢体僵硬；防止附子燥热伤阴，防柴胡劫肝伤阴，以利于久服缓治；
佐以当归甘温质润，补血之圣药，补血活血，滋养四肢百骸，肝血充足筋脉柔力，兼以润肠通便；
薄荷佐助柴胡行气解郁；
生甘草调和诸药为使药。
案例分析：
选取2021年1月至2021年12月于南京市中医院帕金森门诊及病房的帕金森病抑郁患者80例，按照随机数字表法将患者分为观察组和对照组，每组各为40例。两组患者基本情况差异无统计学意义（P＞0.05），两组具有可比性。对照组：常规抗帕金森基础用药，美多芭依据患者病情用药（用量62.6mg~1g/日，2~4次/天），普拉克索（每日0.375mg为起始剂量，逐渐增量，每日0.375mg~1.5mg，3次/天），共12周。观察组：在对照组用药基础上加服本发明中药组合物，共12周。
治疗前后HAMD-24分变化（HAMD-24分为汉密尔顿抑郁量表24题版本，汉密顿抑郁量表由Hanilton于1960年编制，是临床上评定抑郁状态时用得最普遍的量表）：
注：方差齐，符合正态分布；*观察组，与0组比较，4周、8周、12周P＜0.05；4周、8周、12周组间比较无统计学意义；#对照组，与0组比较，4周、8周、12周P＜0.05；4周、8周、12周组间比较无统计学意义；*两组相比，12周具有统计学意义，P值为0.039，4周、8周两组对比无统计学意义。
治疗前后MDS-UPDRS评分变化（MDS-UPDRS评分是国际运动障碍学会统一帕金森病评定量表）：
注：方差齐，符合正态分布；各组相比均无统计学意义。
治疗前后PDQ-39变化（PDQ-39是帕金森病患者生活质量问卷39项，该问卷由 39个问题组成，能够反映在过去 1 个月之内帕金森患者的生活质量情况）：
| 组别 | 例数 | 0周 | 4周 | 8周 | 12周 |
| 观察组 | 40 | 63.58±22.07 | 57.40±23.95 | 52.78±23.38* | 52.30±23.13* |
| 对照组 | 40 | 64.10±21.82 | 58.30±23.12 | 54.38±22.48 | 54.15±22.32# |
注：方差齐，符合正态分布；观察组与0周组相比，8周、12周P＜0.05；对照组与0组相比，12周P＜0.05，4周、8周无统计学意义；两组相比，4周、8周、12周均无统计学意义。
结果表明，该药物对帕金森病抑郁患者运动症状有改善作用，但不具有统计学意义；对患者抑郁评分和生活质量评分均有明显改善作用。我们分析这和药物服用疗程12周（3月）较短有关系，短期服用，可以明显改善抑郁症状和生活质量减缓帕金森病病程。临床使用该组合药物过程中，我们亦发现长期服用可明显改善帕金森病患者运动症状，减少帕金森病药物使用。
通过前期临床观察，该药物治疗帕金森病抑郁效果明显，患者整体症状改善明显，尤其在情绪方面的控制。帕金森病抑郁较普通抑郁患者，其动力感缺失更明显，患者表现更为淡漠，该药物君药制附子，通过培补元阳调动气机，有助于缓解患者的淡漠。代替抗抑郁药物使用，副作用少，患者接受度高。短期服用，可以明显改善抑郁症状和生活质量减缓帕金森病病程。长期服用或许可能明显改善期运动症状，减少帕金森病药物使用。
本发明已由上述相关实施例加以描述，然而上述实施例仅为实施本发明的范例。必需指出的是，已揭露的实施例并未限制本发明的范围。相反地，在不脱离本发明的精神和范围内所作的更动与润饰，均属本发明的专利保护范围。
Claims (3)
1.一种治疗帕金森病抑郁的中药组合物，其特征在于：所述中药组合物由以下重量份的原料药组成：制附子4-6份、醋柴胡9-11份、茯苓19-21份、白芍9-11份、麸炒白术9-11份、当归9-11份、薄荷4-6份、生甘草4-6份。
2.如权利要求1所述的治疗帕金森病抑郁的中药组合物，其特征在于：所述中药组合物由以下重量份的原料药组成：制附子5份、醋柴胡10份、茯苓20份、白芍10份、麸炒白术10份、当归10份、薄荷5份、生甘草5份。
3.权利要求1-2任一所述的中药组合物在制备治疗帕金森抑郁疾病的药物中的应用。
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