Department of Japanese-Oriental (Kampo) Medicine, Chiba University Graduate School of Medicine, Chiba City, Japan;
Neuropsychiatr Dis Treat. 2013;9:151-5. doi: 10.2147/NDT.S38318. Epub 2013 Jan 18.
Yokukan-san, a Japanese traditional herbal (Kampo) prescription, has recently gathered increasing attention due to accumulating reports showing its remarkable efficacy in treating a wide variety of diseases refractory to conventional medicine as well as the behavioral and psychological symptoms of dementia. As yokukan-san has become broadly integrated with conventional medicine, augmentation therapy with other Kampo prescriptions has become necessary when the yokukan-san has been only partially efficacious. In this paper, we report three cases in which the addition of orengedoku-to, another Kampo formula, to yokukan-san was remarkably effective.
Case 1 was an 85-year-old man with Alzheimer-type dementia who had become aggressive during the past 2 years. Three milligrams of aripiprazole completely suppressed his problematic behaviors but had to be stopped because of extrapyramidal symptoms. In the second case, a 44-year-old man with methamphetamine-induced psychosis had suffered from serious tardive dystonia for 2 years. No conventional approach had improved his tardive dystonia. The third case was a 29-year-old engineer who often failed to resist aggressive impulses and was diagnosed with intermittent explosive disorder. He was prescribed 5 mg of olanzapine, which did not suppress his extraordinary anger and caused somnolence even though the dose was low.
Yokukan-san was complementarily added to the patients' regular medication and exerted a definitive but partial effect in all cases. The addition of orengedoku-to to yokukan-san exerted the same efficacy as aripiprazole in controlling aggressiveness in Case 1, improved the tardive dystonia by 80% in Case 2, and was completely effective in controlling the patient's aggressive impulses in Case 3.
Together with empirical evidence demonstrating the effectiveness of both yokukansan and orengedoku-to in reducing irritability, impulsivity, and aggression, these three cases suggest that orengedoku-to augmentation can be an effective option in cases that are partially responsive to yokukan-san treatment.
横川散是一种日本传统草药（汉方）方剂，由于越来越多的报告显示其在治疗各种传统医学难治性疾病以及痴呆的行为和心理症状方面的显著疗效，因此受到了越来越多的关注。由于横川散已广泛与传统医学相结合，当横川散仅部分有效时，需要与其他汉方方剂联合增效治疗。在本文中，我们报告了三例加味逍遥散对横川散增效治疗的显著疗效。
病例 1 是一位 85 岁的阿尔茨海默病患者，过去 2 年来变得具有攻击性。三毫克阿立哌唑完全抑制了他的问题行为，但因出现锥体外系症状而不得不停药。在第二个病例中，一名 44 岁的男性因吸食冰毒导致精神病，已经遭受严重的迟发性运动障碍 2 年。没有任何常规方法可以改善他的迟发性运动障碍。第三个病例是一名经常无法抗拒攻击冲动的 29 岁工程师，被诊断为间歇性爆发障碍。他被开了 5 毫克奥氮平，但未能抑制他的异常愤怒，即使剂量较低，也导致了嗜睡。
横川散与患者的常规药物联合使用，在所有病例中都发挥了明确但部分的疗效。在病例 1 中，加味逍遥散与阿立哌唑联合使用，对控制攻击性的疗效与阿立哌唑相同；在病例 2 中，加味逍遥散改善了 80%的迟发性运动障碍；在病例 3 中，完全有效控制了患者的攻击冲动。
结合横川散和加味逍遥散在减轻烦躁、冲动和攻击性方面的有效性的经验证据，这三个病例表明，加味逍遥散增效治疗可以作为对横川散治疗部分反应的有效选择。
