注意力缺陷過動症之中醫文獻回顧

Literatures Review of Attention Deficit Hyperactivity Disorder in Traditional Chinese Medicine

「注意力缺陷過動症」（Attention Deficit Hyperactive Disorder，簡稱為ADHD）。它是兒童精神疾病中最常見的疾病，根據臨床表現分為注意力不集中型、過動—衝動型、複合型三種。ADHD的發病原因及病理機轉還沒有非常確定，主要認為與遺傳、中毒、環境、營養等因素有關。本文主要目的在蒐集近十年中醫治療注意力缺陷過動症的文獻，透過研究文獻的整合及歸納，提出臨床最常見的證型以及治療用方，供臨床醫師作為參考。中醫古代文獻中無本病的專門論述，根據臨床表現，屬於“風證”、“健忘”、“煩躁”等範疇，並認為本病的病因為先天稟賦不足，後天失調，或他病所傷。病機為臟腑功能失常，陰陽失調。臟腑功能失常是其主要病理改變，陰靜不足、陽動有餘是其主要病機特點。本病與心、肝、脾、腎四臟關係密切。心脾兩虛、痰熱內擾、肝腎陰虛、肝脾不合、心腎不足等為ADHD常見之證型，常用方有歸脾湯、黃連溫膽湯、知柏地黃丸、加味消遙散、右歸丸等供臨床隨證加減應用，有關其相關的藥理作用機理，仍有待未來進一步闡明。

Attention deficit hyperactivity disorder(ADHD) is one of the most common neuropsychiatric disorders in children characterized by a triad of symptoms involving age-inappropriate behaviors with attention, impulse controls and hyperactivity. The prevalence of ADHD in Taiwan is 7%-8%. A higher prevalence is often reported in males 14.9% than females 4.5%. The etiology and pathogenesis of ADHD is still unclear. Factors that may be involved in the development of ADHD include hereditary, toxic chemicals, environment and nutrition. Through literature review, the aim of this study was to summarize the most common clinical phenotypes and drugs for clinical reference. There is no record about ADHD in classics of traditional Chinese medicine (TCM) before. According to the clinical presentations, it can belong to the ＂winds＂, ＂forgetfulness＂, ＂irritability＂ of TCM. The etiology and pathogenesis of ADHD in TCM can be discussed in four aspects: heart, liver, spleen and kidney. Also, the syndrome of the disease can be classified to ＂dual deficiency of the heart-spleen＂, ＂phlegm-fire harassing the heart＂, ＂liver-kidney yin deficiency＂, ＂insufficiency of kidney essence＂ and ＂liver depression and spleen deficiency＂. There are many Chinese herbs formulas used on ADHD patients such as ＂Gui Pi Tang＂, ＂Huanglian Wendan Tang＂, ＂Zhi-Bai-Di-Huang-Wan＂, ＂Jia-Wei-Xiao- Yao-San＂ and ＂Yougui Pill＂. In conclusion, TCM has benefit for ADHD treatment and may help to avoid side effect related to conventional medication.