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林寶華醫師 臨床短札
網址：http://www.lph.com.tw
A.請注意：(1)依法令規定，禁止轉錄本網址之內容供人點閱；但以網路搜尋或超連結方式，進入本醫療機構之網址直接點閱者，不在此限。
(2)所有文章僅提供醫藥護同道參考用。
B.緣起：在2011/10/30，一位素未謀面的三軍總醫院神經外科主治醫師稱讚我對妥瑞氏症(Tourette syndrome)的貢獻，他的主任推薦「天使的鬼臉」，經閱讀後，有很深刻的啟發。當時我頗訝異，因我是學教育，半路轉進中醫師特考，歷經多位老師指導後，幸運地能幫助妥瑞病人。
所有已出版的書，其內容都是舊聞，醫學書籍也是如此；但醫學觀念技術日新月異，若醫者及時提出近日臨床研究狀況，對醫療可能有助益。
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2014/09/13
Tourette patients out of control
should take Traditional Chinese Medicine.
妥瑞氏症服精神科西藥仍失控者之中醫療法
(敬供中西醫藥護道長參考)
~中醫清熱療法可穩定現狀、降低病情、戒停西藥，使頭腦思緒清楚，回復健康；
~病情嚴重者之中藥劑量該增加；
~中藥應每天服用，病情穩定或減輕後，精神科西藥可階梯式遞減；若症狀又回增，則仍服原西藥劑量；病情穩定後，西藥再遞減；…。
~參考案例：
2014.09.08-醫生：醫生都希望病人早日康復。
Doctors hope the patients get
back health quickly, as their parents.
Dear Mr. ○
A patient who takes western Psychiatric
medicine more than 4 years,
those medicine dosages were increase than before, and can not
to stop it,
can not to quit it, and his
Tourette symptoms are increase,
so, please you should understand and agree all of
the neurologic doctor say,
western Psychiatric medicine can not treat Tourette patients.
Recently, in 3 months, your child
add/take Chinese herb medicine to treat Tourette
disease; I have ever treated more
than 1,600 Tourette patients, according to my
experience, he is a severe case,
if his parents wish it belong medium degree, or
some families say that nothing;
all in our mind, but, the child patient is still in
pain.
Of course, you can also ask the
western doctor, how many patients take the
dosage in his/her clinic？ Why
your child can’t quit western medicine？ Does
Psychiatric medicine maybe hurt
patient’s brain in the future？(10mg
haloperidol/day, Depakine and
Trihex)
Yale Global Tic Severity Scale
Yale Child Study Center 1992
http://dcf.psychiatry.ufl.edu/files/2011/06/TIC-YGTSS-Clinician.pdf
耶魯抽動症整體嚴重程度（YGTSS）判斷和療效評定
1. YGTSS整體嚴重程度判斷評分為三級：
(1)輕度：<25分。(2)中度：25~50分。(3)重度：>50分。
2. YGTSS療效評定：
臨床總療效按完全緩解、顯效、有效、無效四級評定。
療效減分率＝ 1 －（療後評分 / 療前評分 × 100%）。
(1)痊癒：完全緩解，症狀消失，減分率≧95.00%。
(2)顯效：症狀大部消失，減分率≧66%,<95%。
(3)有效：症狀減輕，減分率≧33%,<66%。
(4)無效：症狀無變化，減分率＜33%。
(5)總有效率：（完全緩解數+顯效數+有效數）*100%。
2014.09.06-病人家長：中等或嚴重病情？
I do not know if my child situation
is medium case or severe case. I need your
advice what we should do:
2014.09.05-醫生：現在可嘗試減少精神科西藥。
Suggestion：
The western medicine dosage for
him could try to reduce, just take 50% dosage
of all western medicine; maybe
some patients increase the symptoms, if that, take
back the original dosage, until
the symptoms are reduce again, take 50% dosage
again,…
Or, take out/quit one kind of
western medicine. Try it!
2014.09.04-病人家長：服中藥兩個月後，病情逐漸穩定，西藥未增加。
Our son has taken the Chinese
medicine for more than 9 weeks. We still have
medicine for another 3 weeks.
…
As we reported to you, for the first 6 weeks of taking Chinese
medicine, his
symptoms did not improve and even
got worse. However, in the recent 3 weeks
his symptoms seem improving well.
Just in the last 3-4 days the symptom is a little bit unstable
again.
At the moment we still remain the same western medicine dosage
for him (10mg
haloperidol/day, Depakine and
Trihex). …
Thank you very much.…
2014.08.07醫生：病情嚴重，中藥劑量需增加。
Please your son keeps taking Chinese
medicine,
「Taking Chinese medicine 1 bag
per day, until 90 bags, if his Tourette symptoms are increasing,
he could take Chinese medicine with 3 bags per 2 days. 」
請按時服中藥。西藥Haloperidol 的劑量越多，Tics可能會越多，病情更嚴重，中醫治療時間會越久，請您自己考慮西藥再增量的問題；
我的一個台灣嚴重病人，曾服西藥每日多達18粒。初診時服西藥
(1)Trihexyphendyl，hcl，2mg 早晚服用，每次2粒。
(2)Haloperidol，5mg，早晚服用，每次2粒(每日20mg)。
(3)Bupropion，150mg，早晚服用，每次半粒。
病情嚴重住院2次，來請我治療；742天內，服中藥703天；西藥併服451天，才完全遞減停；順利上學。
本例是許多妥瑞氏症西醫師、媒體記者驚訝的中醫療效典範。
2014.08.04 家長：孩子服中藥一個月，病情仍嚴重，信心動搖。
Our son already take one bag per
day for over one month.
During this month, his symptom
is still critical so our western medicine doctor
decide to increase Halipedol from
7.5 mg per day to 10mg per day. However, his
symptom still can not control
as expected. Our western medicine doctor also do
not understand why he becomes
more severe in this month.
Because of this situation, we
still can not reduce western medicine after one month as you advise
us in Taiwan and he still need to take 10mg Haloperidol per day.
He will continue to take one bag
per day of Chinese medicine but we are worried what will happen
to him in next month as he will start school next week.
Please share your experience if
situation of our son is unusual or not when combine both western
medicine and Chinese medicine.
Thank you….
2014.07.04 家長：中藥沒神效，已服3天，病情仍增加。
Our son takes Chinese medicine
for 3 days now and we see that his Tourette
symptoms keeps increasing. We
are a bit worried.
Pls advise your experience on
this case.
The Doctor of western medicine
request us to increase dosage of Butyro medicine
from 7.5mg/day to 8.5mg/day.
Tks.
2014.06.28 越南國來診
8歲發作Tics，現13歲，服精神科西藥4年，劑量增加。
症狀：各期變化多，不列出。
( 2014/09/13-祝福苦難的病人早日脫離病海 )
