中医药研究论丛

202.7 Clozapine 引起过度流涎中西医病机与治疗的文献回顾

 

Clozapine 引起过度流涎中西医病机与治疗的文献回顾
Pathophysiology and Treatment of Clozapine Induced Hypersalivation by
Chinese Medicine and Western Medicine
冯瀞仪1 黄怡嘉2*
1 高雄荣民总医院台南分院传统医学科,台南,台湾
2 三军总医院中医部,台北,台湾
【摘要】
Clozapine 是第二代抗精神病药物, 主要用於治疗思觉失调症(Schizophrenia)。对於顽固型或其他抗精神病药物无效时为最佳用药。但是它的过度流涎副作用容易造成患者不适及可能引发吸入性肺炎,因而使用上受到限制。西医认为Clozapine 使用所导致的过度流涎,与增加口水分泌或减少吞咽反射有关。依上述理论,目前虽然有一些抗胆硷药物或交感神经活化剂被用来改善此副作用,但疗效仍未获得大规模的临床试验来证实。因此这个副作用还未有最佳改善方法。
中医认为口水属於「五液」之一。人体津液的生成虽与五脏均有关联,但口水过多主要与脾、胃、肾相关。由中医生理及西医对於服用Clozapine造成过度流涎的机转来分析,我们认为此药性味苦寒,服用後造成胃寒脾热之证,久服更会导致肾虚。因此要以中医辅助治疗便拟定下列治疗方针:初期服药者以温降胃气搭配养脾阴之法治疗,若久服者则需酌加温肾之品。治疗期间若有湿热现象出现,则可配合辨证选用燥湿清热、温中化痰的药物。
【关键词】
Clozapine、过度流涎、中药治疗
 
Ching-Yi Feng1 Yi-Chia Huang2*
1Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital Tainan
Branch, Tainan, Taiwan
2Department of Chinese Medicine, Tri-Service General Hospital, Taipei, Taiwan
【Summary】
Clozapine is one of the second-generation antipsychotics (SGA) for schizophrenia. However, the use of Clozapine is limited due to the side effect of hypersalivation, which may result in aspiration pneumonia. In Western medicine, Clozapine induced hypersalivation is considered to be related to increase in saliva output or decrease in swallow reflex. Although some anticholinergic agents or alpha 2 agonists were applied to the treatment, there are currently insufficient data to confidently validate this clinical practice.
In Chinese medicine, saliva is one of the “five humors”. Production of fluid and humor in the human body is related to the “five viscera”. Moreover, hypersalivation is mainly related to spleen, stomach, and kidney. As we think Clozapine is a bitter and cold drug, use of Clozapine causes “stomach cold and spleen heat pattern”, and “kidney deficiency pattern” if case of long-term use. For Clozapine-using patients, the solution lies in the use of traditional Chinese medicine as adjuvant therapy. At first, treatment policy include warming the stomach, directing qi downward and enriching spleen yin; then we can add drugs to tonify the kidney if need be. If dampness-heat is noted, we can treat the patient
under the principle of “draining dampness and clearing heat”, as well as “warming the middle and resolving phlegm”.
Keywords:Clozapine, Hypersalivation, Chinese medicine treatment