******************************
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。
_________________________________________________________________
*******************
2015/03/05
Foreign Tourette syndrome patients treated by Chinese herbal
medicine will get well too.
∼Congratulations, this severe foreign child got better in less
than a year, better than many Taiwan or other foreign Tourette
patients.
~Write by： Lin Pao-hua Chinese Medical Clinic
Taiwan, R.O.C.
http://www.lph.com.tw/
***************
2015/3/5 下午 04:51
Dear Dr Lin,
Happy Lunar New Year to you.
We would like to order the Chinese medicine for our son again.
Over the last 3 months he has been improved pretty well. Body
shaking or sound burst突然發作 have reduced a lot and happen sometime
only. He is in rather stable condition now. We have reduced about
75% western medicine and at the moment he is taking Haloperidol
3.5mg/day only.
I send you some video for your reference諮詢 about him. The video
file is big so I will send in few emails.
Please kindly advise the Chinese medicine dose for the next….
Thank you very much.
B***
******************
2014/12/14 下午 09:40
Dear Dr. Lin,
Thank you for your advice.
Till now, we can reduce only 10pct of western medicine. We will
try to reduce more in coming months.
Rgds.
B***.
**************
Hi, Dear Mr. B*** ,
Please don't worry; your child will be fine.
1. Chinese medicine can treat neuropsychiatric, clear the brain.
2. Some Taiwan Tourette patients had ever suicide but live, they
ask me to treat them; and my patients are all happy than before,
no one patient want to hurt himself.
3. I had told you many times about western medicine:
(a) 2014/11/14『建議：a.中藥帖仍是一天一帖。b.建議西藥減一半；希望能在三個月內，不服西藥。』
(b) 2014/11/03:『Take Chinese herb medicine to 3 bags/2 days for
some days, and decrease the dosage of western medicine become
50%.』
(c) 2014/08/05『請按時服藥-西藥Haloperidol 的劑量越多，Tics會越多，病情更嚴重，中醫治療時間會越久，請您自己考慮西藥增量的問題；我的一個台灣嚴重病人服Haloperidol
劑量越來越多，至每日20mg，病情嚴重住院；來請我治療，…』
4. So, Please try to quit/stop Tourette western medicines in one
month.
Good luck to you all.
Dr. Lin 2014/12/14-20:35pm
****************
Dear Dr. Lin,
We are very sad to know this news.
Do you have any advice for parents of Tourette patient after this
accident in Malaysia.
Rgds.
Bi***.
***********
【參考】
妥瑞氏症不是小病！請關心他們的生命安全。
患抽動症 疑情緒失控 青年墜樓自殺
『自12歲被診斷患上妥瑞症，一直服藥控制病情。但因服藥後令兒子發出較響怪聲，因此他於八、九個月前開始停止服藥，大喊大叫的情況便減少了。』
『能說會道、愛打電動，就是肢體動作和聲音難以控制。他因這病而自卑及總是疑心他人對他有異樣眼光，因此變得不愛出外工作。"』
『妥瑞症是一種非常嚴重的抽動性疾病，其症狀包括身體肌肉或聲音出現不可控制的痙攣，通常在18歲前發病。據了解，環境因素並不會導致妥瑞症，但心理壓力和緊張會明顯地影響病發頻率和強度。』
《星洲網》患抽動症 疑情緒失控•青年墜樓自殺
2014-12-14 10:02
http://mykampung.sinchew.com.my/node/334918
*************
2014/11/14 上午 11:40
Dear Dr Lin,
Thank you very much for your advice. We will follow your advice.
Please tell us we should use 1bag/day or 3 bags/2 days now ?
Thank you.
B***
************
Dear Mr. B*** ,
1.這孩子早就該來服中藥治療，西藥仍服太多。
2.叫聲1次/10-20秒，音量大；這可屬於中度聲語(Moderate Vocal Tics)。
3.西醫專家常說：聲語型抽動(Vocal Tics)比動作型抽動(Motor tics)更難治療，常須治療數年。
4.建議：
a.中藥帖仍是一天一帖。
b.建議西藥減一半；希望能在三個月內，不服西藥。
c.去上學，口戴口罩，可坐教室後段。
d.增加運動，打球、跑步、…。
e.請輔導孩子的心理情緒，鼓勵他自己已可控制不抽動，可少聲語。
5.減西藥的原則，已曾告訴您：
現在，他只要漸漸減去精神科西藥50%，再一個月後減為原來的25%劑量，…，戒停西藥；剩下只服中藥，他的腦筋就清楚起來，抽動(Tics)就慢慢減少。如果在減少西藥期間，突然Tics很嚴重，也可再服原來的西藥劑量，幾天後，再減少西藥。…Now,
decrease his dosage of western medicine，if his symptoms still
severe, take back original dosage of western medicine, after some
days, decrease his dosage of western medicine again,……
祝福他早日康復！
林醫師2014/11/14-10:55am
**********************
2014/11/13 下午 11:14
Dear Dr. Lin,
Here is the video clip
Under current situation, please advise how long we should keep
dosage 3 bags/day or we should change the dosage.
*****************
2014/11/9 下午 01:01
Dear Dr. Lin,
Thank you for your advice.
1. We will try to send you his video as early as possible.
2. During whole last week (Nov 1-7), his symptom became more severe.
However, in past two days (Nov 8-9), his symptom can reduce a
little. We are still watching his situation and will report you
again in coming days.
3. In these days, we will not reduce his western medicine. But
when he becomes normal, we will try to reduce it according to
your guidance.
4. He joins new school this year and may feel pressure because
of new program and homework. We are discussing with his teachers
to have special treatment for him. However, he always feel stressful
to study when he started to have this disease two years ago.
5. We still let him stay at home (no school) for the second week
because he says he can not control it at school and will annoy打攪
his friends and teachers.
Rgds.
B***.
******************
Dear Mr. B*** ,
~藥有沒服完都可，請撥出時間，帶病人回我診所。..Please he back my clinic.
~西醫神經科醫師常說：腦神經疾病必須由醫師親眼看過，才能準確判斷；即使只看幾秒鐘，也勝過其它一般科醫師診察很久，更勝過一般民眾的判斷；精神科病人也需精神主治醫師親自診察，才能準確用藥。…Doctor
should see the patient, so can know what the patient's problem.
~妥瑞氏症病人是夾雜腦神經和精神心理情緒障礙的病，台灣的妥瑞氏症病人回診是常來診所，治療就有很好效果；外國病人不能回診常來診所，他們會提供錄影錄音，寄來以供我判斷，或修正給藥。…Foreign
Tourette patients should back to clinic or send video to doctor
for helping themselves.
~以我治療超過1,600妥瑞氏症病人的經驗，已服中藥超過100帖，這病人的病情應比他四個月前輕；如果他的病情仍像四個月前一樣，應是這孩子的生活細節有錯誤。…Does
his symptoms severe as 3-4 months ago？
~現在，他只要漸漸減去精神科西藥50%，再一個月後減為原來的25%劑量，…，戒停西藥；剩下只服中藥，他的腦筋就清楚起來，抽動(Tics)就慢慢減少。如果在減少西藥期間，突然Tics很嚴重，也可再服原來的西藥劑量，幾天後，再減少西藥。…Now,
decrease his dosage of western medicine，if his symptoms still
severe, take back original dosage of western medicine, after some
days, decrease his dosage of western medicine again,……
~如果這孩子的Tics仍很嚴重，上次我問的孩子生活細節，請您告訴我，我才能判斷，才能有效幫助他。…Does some affect
things in his everyday life？
祝早日健康！
林醫師2014/11/07-23:35pm
*********************
2014/11/7 下午 05:31
Dear Dr Lin,
It is difficult for us to take the video because our son doesn't
like us to do so.
His current situation is that he makes the big sound outburst
in every 5-10 minutes. Sometimes he makes the sound outburst together
with jumping. Apart from these symptoms, he is in normal condition:
he can eat, sleep, play well.
The western medicine he is taking is :
Haloperidol: 10mg/day,
Depakine: 1,250mg/day;
Trihex: 4mg/day.
At the same time, we have increased Chinese medicine dosage to
3bags/2days for 6 days already but his symptom doesn't reduce
much.
Can you please advise us how many days we should continue to use
the Chinese dosage of 3bags/2days ? Should we use this dosage
in longer time to reduce the symptoms ? or should we increase
western medicine to control the symptom ?
Thank you.
B***
**********************
Dear Mr. B*** ,
Thank you let me know.
請提供些資料，讓我瞭解以幫助處理病人 (Provide some information and send to me) ：
1.請您攝錄他2-3分鐘的影片，傳給我判斷。…Take his severer symptoms by video to me.
2.請問，這幾個月他服的西藥種類、劑量、…Latest months, the drug name and dosage of
western medicine？
3.請問，有其它細節可讓我知道嗎？例如2014/11/03-22:02所提的情形？…Other affect things
in his everyday life？
謝謝！
請保持聯絡，祝福他快快康復。…Keep in touch, please.
林醫師2014/11/06-13:55
*****************
Dear Dr. Lin,
We increased your medicine 3 bags/2days for 6 days already. But
his symptom still can not reduce.
Please advise usually how many days the new dosage will make the
symptom reduce.
We have to let our child stay at home (no school) for 5 days now.
We are afraid longer treatment will affect影響 his schooling.
Rgds,
B***
*************
2014/11/3 下午 10:53
Dear Dr. Lin,
Thank you. We are worried that if we reduce western medicine now,
his tics will become more severe and out of control.
We think that we need to increase western medicine more to control
his severe condition now and try to reduce it later when his tics
become normal. Is it ok ?
Rgds.
B***
*************
Dear Mr. B*** ,
1.妥瑞(Tics)症狀近日較嚴重的可能因素，包括以下：
a.嚴重妥瑞氏症病人中藥治療，症狀減輕一段時間後，餘毒未清，有些人可能發作短暫較嚴重症狀幾天。
b.感冒(Take cold)時妥瑞症狀，可能會加重。
c.服西藥類固醇(Steroid)、抗組織胺鼻藥(Antihistamine)。
d.注射疫苗(Vaccine)後。
e.現服的精神科藥(Psychiatric drugs)服太多、太久。
f.病人睡眠不足、太緊張、焦慮、壓力大。
g.病人吃辛辣食物、提神飲料。
h.其它…
2.建議：
中藥按現在方式服用，2天服3包；並且減少現服西藥劑量為一半。
Take Chinese herb medicine to 3 bags/2 days for some days, and
decrease the dosage of western medicine become 50%.
林醫師2014/11/03-22:02
***************
2014/11/3 下午 08:29
Please advice for our child case
Dear Dr. Lin,
Our child already used your medicine for 4 months now and the
treatment looks effective有效(力)的.
During this period, we still maintain dosage of western medicine
because he still have light symptoms up and down sometimes.
However, four days ago, he suddenly started to have worse and
severe symptoms. We have increased your medicine to 3 bags/2 days.
But his symptoms still keep increasing day by day.
We are worried what we should do now. Please give your advice.
We can ask western doctor to help again but they will increase
more halipedol and we do not want to use higher dosage of western
medicine.
Hope to hear from you soon.
Regards,
B***
****************
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%。
Dr. Lin 2014/09/08- 16:30
***********
Dear Dr. Lin, 2014/9/6 下午 07:43
I do not know if my child situation is medium case or severe case.
I need your advice what we should do:
1/ Increase dosage to 3 bags per 2 days
2/ or we keep one bag per day plus powder.
Please also explain more about usage and effect of the powder
you suggest.
Rgds.
B***
*****************
Dear Dr Lin, 2014/9/4 下午 03:38
Our son has taken the Chinese medicine for more than 9 weeks.
We still have medicine for another 3 weeks. Now we would like
to order more medicine for him.
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不穩定的 again.
At the moment we still remain the same western medicine dosage
for him (10mg haloperidol/day, Depakine and Trihex). ……
B***.
************
Dear Mr. B***,
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. 」
Dr. Lin.
2014/08/05-17:50pm
請按時服藥
西藥Haloperidol 的劑量越多，Tics會越多，病情更嚴重，中醫治療時間會越久，請您自己考慮西藥增量的問題；
我的一個台灣嚴重病人服Haloperidol 劑量越來越多，至每日20mg，病情嚴重住院；來請我治療，本病例是許多治療妥瑞氏症西醫師驚訝的中醫療效典範。
大致如下：(書圖片)
13歲，男。
* 2004/10/22：初診，
曾服西藥每日多達18粒。現服西藥(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。
* 初診至2006/11/03共742天，服中藥703天。
* 2007/07/21電詢：病情未加重。未服精神科西藥，讀書正常，功課中等。
* 2008/05/14複診：停診約546 天，現症狀是上半身抽動，叫聲偶發作。複診三次共34日藥，病人已嫌藥苦拒服，家長以其病情以不影響讀書，就不再勉強他。
* 自初診至2008/06/09共1324天，服中藥875劑，西藥併服451天遞減停。
*****************
2014/8/4 下午 10:58
Dear Dr. Lin,
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 Halipedol 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.
Rgds.
B***
**************
Taiwan patients do one bag per day until 300, 500, 1000 bags for
treating the acute and critical diseases.
Dr. Lin.
2014/07/04-14:30pm
*************
2014/7/4 下午 01:38
Dear Dr. Lin,
Thank you. Please advise if it is normal case that symptom may
increase in beginning days of using Chinese medicine and will
reduce it later after few weeks.
Because I heard that Chinese medicine is normally effective only
after several weeks of using.
Is it right ?
Thank you.
Rgds.
B***
*******************
Hi,
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 for a few days.
About taking western medicine, you decide it yourself.
Dr Lin
2014/07/04-13:20pm
********************
2014/7/4 下午 12:46
Dear Dr. Lin,
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.
B***
*************
Hi,
Tourette symptoms are up and down, then severer than before, you
have seen it.
Take one bag per day to treat your child until 90 bags.
西醫妥瑞書籍有寫，在台灣我也說過：
美國台灣的西醫早就告訴大家，Tourette症狀會暫時緩和，又突然嚴重，反覆，更加嚴重。你的孩子這幾年也經歷過，當然你不要以為出國旅遊後就會減輕。
請治療孩子：每天一帖藥。(1 bag per day)
…有的病人突然嚴重，則加服中藥為：2天服3帖藥。(3 bags per 2 days)
Dr Lin
2014/07/01-11:45am
**************
2014/7/1 上午 11:23
Dear Dr. Lin,
Thank you. We may be worried too much. We will follow your advice.
Rgds.
B***
****************
Dear Dr. Lin 2014/7/1 上午 10:48
Thank you for your quick feedback.
Our son started to develop more tics while he was in Taiwan last
weekend (maybe because he had to walk too much during the trip)
and he still can not control it. Today he has to take leave from
school to take rest at home.
In such situation, can we start to let him take your Chinese medicine
now or we should wait few days more until he can reduce and control
his tics.
Please advice your idea.
Best regards,
B***
***********
2014/6/21 上午 10:54
Dear Mr.***：Hi,
I read your letter more than 8 hours and helped by computer dictionary,
I can treat this patient, treating together about his motor tics、vocal
tics、allergy issue、itchy pimples、less concentration、….。
Your question：『He is now reaching the age of puberty. Does the
Chinese herbal medicine in anyway affect his normal pubescence?』
＞Answer： All of my more than 1500 Tourette patients are normal
growth.
Some my articles could be helpful to know about the Tourette disease,
suggest you read them:
(A)嚴重Tourette patients 的治療期較長：
本診所治療經驗參考：
1.先天性腦神經精神情緒心理障礙，如妥瑞氏症、亞斯柏格症、強迫症、過動症等，是腦神經醫學難題，病人常夾雜數種併發症；病情屬中度、重度者，治療300天約減去50%∼60%，治療600天以上，病情減去約70∼90%；曾長期服精神科西藥控制不能戒停四個月者，屬中度、重度患者，中醫需協助其戒停西藥，回復健康的時間加長；曾住院精神科者，屬重度，治療期可能會更久。
2.先天性腦神經精神疾病自癒者是少數。西醫統計，多達60％以上的妥瑞氏症病人在成年後未癒；損害學生時期求學、個性偏差，是重大損失。
3.先天性腦神經精神疾病可能會遺傳下一代，妥瑞氏症病人經中醫治療痊癒後，或許可避免遺傳給後代孩子。
http://www.sino-medicine.com.tw/lph/h1.htm
祝福您們！
林醫師 2014/06/21-10:45am.
**************
2014/6/20 下午 04:49… 有附件,症狀.
Dear Dr. Lin,
We would like to send you information about the tics progress
of our son to you as attached file.
Sorry we could not take any video as our son does not want us
to do so. I could take some voice recordings and we can play that
for you when we visit the clinic.
We confirm that we will come to your clinic on the next …….
Best regards,
B***
*************
2014/3/6 下午 04:08
Dear Dr. Lin,
Thanks for your quick response and we understand your request
for a direct check at Clinic.
However, we find it difficult to arrange a trip to Taiwan though
we want to do so.
Also, our child is under treatment by western medicine and we
seek for a combined treatment. Therefore, at this stage, we may
want the lightest dosage of chinese medicine treatment which you
think that it would be safe without a direct check. We will keep
reporting you about the progress of our Child when using your
medicine.
As above, we would appreciate if you could allow us to buy your
medicine via air courier service despatch and we will make payment
to bank account of Clinic prior to despatch of medicine.
Hope to hear from you soon.
Best regards,
B***
*****************
Query about TIC treatment by Huang Lian Jie Du Decoction
2014/3/5 下午 02:23
Dear Dr. Lin, Pao-hua
I am from*** City, ****.
Recently, I happened to read your Research about applying Chinese
Medicine for treatment of Tics.
I was very impressed about your Research and would like to apply
it to treatment of Tics for my…… son.
He got severe Tics with both body shaking and vocal anomalies
starting from 15 months ago and was using western medicine since
then. He was improved for certain period but Tics still returned
few times after that.
We would appreciate if you could help to guide us how or where
we can buy Huang Lian Jie Du Decoction medicine for my child while
we are from ******.
We look forward to hearing from you as early as possible.
Yours sincerely,
B***
(The end)
http://www.lph.com.tw/
