Jang Jung-Hee, Jung Kyungsook, Kim Joong-Sun, Jung Inchul, Yoo Horyong, Moon Changjong
Department of Korean Internal Medicine, Dunsan Korean Medical Hospital, Daejeon University, Daejeon 35235, Republic of Korea.
Immunoregulatory Materials Research Center, Korea Research Institute of Bioscience and Biotechnology, 181 Ipsin-gil, Jeongeup-si, Jeonbuk 56212, Republic of Korea.
Evid Based Complement Alternat Med. 2018 Dec 20;2018:1875928. doi: 10.1155/2018/1875928. eCollection 2018.
Parkinson's disease (PD), the second most common progressive neurodegenerative disorder, is characterized by complex motor and nonmotor symptoms. The clinical diagnosis of PD is defined by bradykinesia and other cardinal motor features, although several nonmotor symptoms are also related to disability, an impaired quality of life, and shortened life expectancy. Levodopa, which is used as a standard pharmacotherapy for PD, has limitations including a short half-life, fluctuations in efficacy, and dyskinesias with long-term use. There have been efforts to develop complementary and alternative therapies for incurable PD. Yokukansan (YKS) is a traditional herbal medicine that is widely used for treating neurosis, insomnia, and night crying in children. The clinical efficacy of YKS for treating behavioral and psychological symptoms, such as delusions, hallucinations, and impaired agitation/aggression subscale and activities of daily living scores, has mainly been investigated in the context of neurological disorders such as PD, Alzheimer's disease, and other psychiatric disorders. Furthermore, YKS has previously been found to improve clinical symptoms, such as sleep disturbances, neuropsychiatric and cognitive impairments, pain, and tardive dyskinesia. Preclinical studies have reported that the broad efficacy of YKS for various symptoms involves its regulation of neurotransmitters including GABA, serotonin, glutamate, and dopamine, as well as the expression of dynamin and glutamate transporters, and changes in glucocorticoid hormones and enzymes such as choline acetyltransferase and acetylcholinesterase. Moreover, YKS has neuroprotective effects at various cellular levels via diverse mechanisms. In this review, we focus on the clinical efficacy and neuropharmacological effects of YKS. We discuss the possible mechanisms underpinning the effects of YKS on neuropathology and suggest that the multiple actions of YKS may be beneficial as a treatment for PD. We highlight the potential that YKS may serve as a complementary and alternative strategy for the treatment of PD.
帕金森病（PD）是第二常见的进行性神经退行性疾病，其特征为复杂的运动和非运动症状。PD的临床诊断依据是运动迟缓及其他主要运动特征，尽管一些非运动症状也与残疾、生活质量受损及预期寿命缩短有关。左旋多巴作为PD的标准药物治疗，存在半衰期短、疗效波动以及长期使用会导致运动障碍等局限性。人们一直在努力开发针对无法治愈的PD的补充和替代疗法。抑肝散（YKS）是一种传统草药，广泛用于治疗神经症、失眠和小儿夜啼。YKS治疗行为和心理症状（如妄想、幻觉以及激越/攻击分量表受损和日常生活活动评分）的临床疗效，主要是在PD、阿尔茨海默病等神经疾病以及其他精神疾病的背景下进行研究的。此外，先前已发现YKS可改善临床症状，如睡眠障碍、神经精神和认知障碍、疼痛以及迟发性运动障碍。临床前研究报告称，YKS对各种症状的广泛疗效涉及其对神经递质（包括γ-氨基丁酸、血清素、谷氨酸和多巴胺）的调节，以及发动蛋白和谷氨酸转运体的表达，还有糖皮质激素和酶（如胆碱乙酰转移酶和乙酰胆碱酯酶）的变化。此外，YKS通过多种机制在不同细胞水平上具有神经保护作用。在本综述中，我们重点关注YKS的临床疗效和神经药理作用。我们讨论了YKS对神经病理学作用的潜在机制，并提出YKS的多种作用可能作为PD的一种治疗方法有益。我们强调YKS作为PD治疗的补充和替代策略的潜力。
