当院の症例
認知症http://mahotukai.net/category/%E8%AA%8D%E7%9F%A5%E8%A8%BC/
認知症（にんちしょう、英: Dementia、独: Demenz
http://ja.wikipedia.org/wiki/%E8%AA%8D%E7%9F%A5%E7%97%87
後天的な脳の器質的障害により、いったん正常に発達した知能が低下した状態をいう。これに比し、先天的に脳の器質的障害があり、運動の障害や知能発達面での障害などが現れる状態は、知的障害という。
日本ではかつては痴呆（ちほう）と呼ばれていた概念であるが、2004年に厚生労働省の用語検討会によって「認知症」への言い換えを求める報告がまとめられ、まず行政分野および高齢者介護分野において「痴呆」の語が廃止され「認知症」に置き換えられた。各医学会においても2007年頃までにほぼ言い換えがなされている（詳細については#名称変更の項を参照）。
「認知症」の狭義の意味としては「知能が後天的に低下した状態」の事を指すが、医学的には「知能」の他に「記憶」「見当識」の障害や人格障害を伴った症候群として定義される。
従来、非可逆的な疾患にのみ使用されていたが、近年、正常圧水頭症など治療により改善する疾患に対しても認知症の用語を用いることがある。
単に老化に伴って物覚えが悪くなるといった誰にでも起きる現象は含まず、病的に能力が低下するもののみをさす。また統合失調症などによる判断力の低下は、認知症には含まれない。逆に、頭部の外傷により知能が低下した場合などは認知症と呼ばれる。
Treatment of Neurodegenerative Disorders By Dr. John K. Chen and Dr. Hua Long Zhang
http://www.acupuncture.com/newsletters/m_nov05/main1.htm
Alzheimer's, Stroke and Parkinson's Disease
"The silent epidemic" is regarded by many as the disease of the 90's. The silent epidemic is a term which refers to neurodegenerative disorders (such as Alzheimer's disease, sequelaes of stroke & Parkinson's disease) which plagues the majority of the geriatric population but is poorly recognized by the society due to their low public visibility and their social isolation. Though neurodegenerative disorders include a vast number of illnesses, this article will attempt to focus its discussion on Alzheimer's disease, stroke sequelaes, and Parkinson's disease. This article will approach these three illnesses from the viewpoints of both Western and Oriental medicine, and will further explore treatment options specifically with acupuncture and herbal therapies.
Neurodegenerative Disorders According to Western Medicine
The fundamental principle in Western medicine is that nerve cells cannot regenerate once they die. Alzheimer's disease, sequelaes of stroke, and Parkinson's disease each involves the death and atrophy of neurons (nerve cells) in the brain. Therefore, this is no cure for neurodegenerative disorder at the present time. All available treatment options focus on symptomatic treatment only.
Though the causes may differ, patients with neurodegenerative disorders are likely to show localized to generalized atrophy of brain cells leading to compromises in both mental and physical functions. Mentally, the patients will exhibit forgetfulness, poor memory, decrease in mental capacity, emotional disturbances, poor speech, etc. Physically, the patients will exhibit partial to complete incontinence, aspiration of food particles, tremor, poor balance, muscle rigidity, muscle paralysis, etc. These decreases in mental and physical functions dramatically reduce the quality of life for the patients and increase the burden of the family and care-takers.
Neurodegenerative Disorders According to Oriental Medicine
Neurodegenerative disorders are complex with an onset that is followed by progressive deterioration. Their clinical manifestations are determined by the location and the seriousness of neurodegenerative disorders. Its pathogenesis is a mixture of deficiency and excess conditions, represented by the deficiency of kidney essence or the blocking of the brain channel by blood stasis (an excess condition) - or both.
The cause of neurodegenerative disorders lies not so much in the brain (though it is the brain that shows the symptoms) as in the kidney, which according to the theories of Traditional Chinese Medicine controls the bone and generates the marrow. From the point of view of disease differentiation through viscera and their interrelations, the root of the disease is due to the deficiency of the kidney and the bone marrow. While the blood stasis and the phlegm accumulation are considered as the symptoms, not the cause. Therefore, the keys to treating neurodegenerative disorders are to tonify the kidney, eliminate the phlegm, remove blood stasis and induce resuscitation.
Treatment of Neurodegenerative Disorders with Acupuncture
According to the theories of Oriental Medicine, the spirit (shen) resides within the heart and the brain. The spirit is affected by the overall mental and physical health of a person. If the spirit is damaged, both the mental and the physical functions of a person would be greatly compromised. Deterioration in mental functions may result in delirium and dementia with the decline in physical functions resembling complications of stroke. Therefore, the treatment for neurodegenerative disorders should focus on awakening up the spirit (shen), opening up the sensory orifices and stimulating the brain. Dr. Zhang's treatment of neurodegenerative disorders and stroke involves awakening the spirit (shen), opening up sensory orifices and stimulating the brain. He focuses his treatment by selecting acupuncture points from the Yin channels. The selection of points are as follows:
Selection of Main Points: neiguan (P6), renzhong (Du 26) & sanyinjiao (Sp6).
Neiguan (P6) has the function to nourish the heart, calm the spirit, and promote smooth circulation of Qi and blood. Renzhong (Du 26) opens up sensory orifices, stimulates the brain and awakens the spirit. The combination of Neiguan (P6) and Renzhong (Du 26) has been found to increase the contractile strength of the heart and the cardiac output of blood circulation to the brain. Sanyinjiao (Sp 6) is the meeting point of the three yin channels of foot. Sanyinjiao (Sp 6) nourishes the kidney as well as tonifies the essence and the marrow to improve the function of the brain.
Selection of Local points:
Jiquan (H 1), chize (Lu 5), weizhong (UB 40), and hegu (LI 4) are local points which open up the channels and collaterals and improve the circulation of Qi and blood. Jiquan (H 1), chize (Lu 5), and hegu (LI 4) are used for paralysis and tremor of the arms and the hands; and weizhong (UB 40) is used for paralysis of the legs. Fengchi (GB 20), yifeng (SJ 17), wangu (GB 12) and tianzhu (UB 10) are four excellent points which help patients who may have speech impairment or frequent aspiration of food particles leading to respiratory infections.
Shanshangdien (upper thunder point) and xiashangdien (lower thunder point) are two extraordinary points which were discovered through clinical trial and experience. These two acupuncture points are very potent and should be reserved for those patients who have partial to complete paralysis. Shanshangdien (upper thunder point) is located on the lateral side of the neck, on the same level with Adam's apple, and between the sternal head and clavicular head of m. sternocleidomastoideus. Its is three cun posterior to the Adam's apple and one cun posterior-inferior. It is located slighted inferior to Neck-Futu (L.I.18). Its indications include frozen shoulder, shoulder pain, paralysis of the arm, stiff and rigid muscle of the arm, and tremor of the hand. Xiashangdien (lower thunder point) is located in the buttock region. Xiashangdien (lower thunder point) is the posterior tip of an equalateral triangle with greater trochanter and the iliac crest as the anterior two points. It is located slightly superior to Huantiao (G.B. 30). Its indications include pain in the lower back and hip region, muscular atrophy, sciatica, pain, weakness and muscular atrophy of the lower extremities, and hemiplegia.
Needling Technique: Dr. Zhang has proposed that stroke is an excess condition and sedation is warranted. This is because stroke is characterized by the spirit trapped inside with the head with the complete or partial closure of the sensory orifices. Therefore, the overall treatment focus should be to open up the sensory orifices, release the spirit, and awaken the brain.
To achieve the maximum benefit from acupuncture, Dr. Zhang recommends slightly different location for some of the acupuncture points and their corresponding needling techniques. Both neiguan (P6) should be needled first. Insert the needle 1 to 1.5 cun, then stimulate the point for at least one minute by slightly turning the needle and moving it up and down. The healthy side should be tonified while the diseased side should be sedated. Next, needle renzhong (Du 26). Aim slightly upwards toward the top of head and stimulate strongly until the patient shows tears in his or her eyes. Stimulation should be done with quick rapid movements, a motion similar to a woodpecker drilling on trees. The third point is sangyinjiao (Sp 6). The point of insertion for sangyinjiao (Sp 6) should be moved 0.5 cun toward the dorsal side of the body (or towards kidney channel) for greater stimulation. Tonify sangyinjiao (Sp 6) by moving the needle up and down until the patient shows a "jerking motion" of the lower leg three times.
Jiquan (H1) should be needled with the patient raising his or her arm upward in the air. The point of insertion is moved 0.5 cun toward the fingers and away from the body. Jiquan H1 should be sedated by moving the needle up and down until the patient shows "jerking motion" of the arm three times. Weizhong (UB 40) may be needled with the patient lying on the back or on the stomach. Point of insertion should be moved 0.5 cun higher toward the buttocks along the UB channel. The needle should be inserted for 1 to 1.5 cun, and the point should be sedated until the leg shows "jerking motion" three times. Hegu (LI 4) should be needled obliquely with the tip of the needle pointing toward sangjian (LI 3). This point should be sedated until the index finger jerks three times. Shanshangdien (upper thunder point) should be needled perpendicularly 1 cun deep, and stimulated until there is an "electric sensation" that runs through the entire length of the arm. The needle is then withdrawn at that time. Shanshangdien (upper thunder point) should never be needled downward toward the lung as it may puncture the lung and cause pneumothorax. Lastly, xiashangdien (lower thunder point) should be needled perpendicularly 1.5-3.0 cun deep, and stimulated until there is an "electric sensation" that runs through the entire length of the leg. The needle is then withdrawn at that time.
