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認知症予防研究所

水嶋医師のヤマブシ茸と加味温胆湯の抗認知症改善効果①

(ドネペジルとの比較)
・水島クリニック:水嶋丈雄
認知症予防と改善には、現在ドネルベジルが認知症に適応があり、また新しい薬剤が4種発売されたが、いずれもアルツハイマー型認知症に対する適応のみであり、レビー小体性認知症や血管性認知症には有用な薬剤がないのが現状である。そこで長野県中信地方にて昔から認知症に効果があるとされていたヤマブシ茸と北里大などの研究でChAT活性化効果があるとされる加味温胆湯を認知症患者に投与し、その効果を2年にわたり追跡調査をしたので報告する。

1.方法
2008年1月から4月まで当院を受診され、認知症と診断され薬剤性やNPH・慢性硬膜下血腫など治療可能な認知症を除外診断された28名について、ドネペジルの効果とその副作用をよく説明して納得された方にはドネペジル5mg/日を投与、それ以外の方には加味温胆湯の証である心胆痰濁の証の認められない方にはヤマブシ茸をホクト株式会社粉末錠6錠/日を投与した。ドネペジルの群は10例、平均年齢76.8±2.2歳、全例がアルツハイマー型認知症であった。ヤマブシ茸の群は10例、平均年齢73.2±3.2歳、アルツハイマー4例、レビー小体性4例、血管性2例、加味温胆湯の群は8例、平均年齢76.1±1.7歳、アルツハイマー3例、レビー小体3例、血管性2例であった。これらの群を2年間にwたり、3ヶ月毎にMMSE(簡易認知症スケール)を測定し経過を観察した。

2.加味温胆湯
加味温胆湯は備急千金要方に原著があり「治大病後虚煩不得眠、此胆寒故也、宣服之方」とあり、また三因方には胆胃不和証、嘔吐、不眠、口苦微渇、脈滑数或弦数者と表記される。これらを踏まえ中医老年病学には老年性痴呆には加味温胆湯が良いとされ、その投与証は悪心、嘔吐、口苦、精神不安定、驚きやすい、不眠、多夢、健忘となる。つまり認知症であることを隠してしまうような方で怒りっぽく、舌の苔が特徴的な「心胆痰濁上憂」を投与目標として備急千金要方に準じ、半夏3、茯苓3、陳皮2、甘草2、生姜1、人参2、遠志2などを湯液として1日3回内服させた。

症例 加味温胆湯群
75歳女性、身長155cm、体重40kg

既往歴:2006年1月ころから体が固くなり、歩行困難を訴え近医にてMRI撮影するも異常なくパーキンソン病の疑いとしてメネシットR2T、セルシンR2Tを内服していた。

現病歴:2008年1月、歩行障害が良くならないと当院受診。顔面仮面様願貌、左手の振戦あり、笑顔がなく応答もほとんどない。右手関節・右足関節などに固縮があり、歩行は歩容狭小突進性歩行は認められない。寝返りが一人では困難。夜間にせん妄があり幻想がある。深部健反射は正常、病的反射は認められない。血液生化学検査では近医にて異常を認めない。腰痛があり、圧痛は脊柱起立筋にあり、レントゲン検査にてL2-5に扇平椎と陳旧性圧迫骨折を認める。MMSE16点。びまん性レビー小体認知症に伴うパーキンソン病ヤール2と診断する。東洋医学的診断では舌診乾燥あるも舌根部に黄色苔、脈診細渋、腹診1/5不仁あり、腰椎変形のため上腹部は胸脇苦満様圧痛あり。証を肝腎陰虚と胆濁阻窮と考え加味温胆湯として栃本天海堂生薬 半夏3、茯苓3、陳皮2、甘草2、枳実2、大棗2、生姜1、人参2、酸棗仁4、遠志2を湯液として処方400CCの水から30分煮立て、約200CCの漢方湯液を1日3回分服した。

経過:3ヶ月後まだあまり変わらない。ただ、夜間によく眠るようになってきた。幻覚が消失。MMSEは20点にて少し改善傾向にある。6ヶ月後、少し会話が増えたが短期記憶はまだ改善がしない。MMSE18点、12ヶ月後、診察室に入るのに笑顔が見られるようになり、歩行状態が改善、家の中を一本杖で歩けるようになった。左手の振戦もない。18ヶ月後、会話が増えお礼を言えるようになった。外を一本杖で歩いている。歩容が改善、方向転換もできる。昨日の食事を覚えている。MMSE26点、24ヶ月後良い状態が続き、一人で病院に来られるようになった。住所や名前が言えるようになり、短期記憶が改善している。MMSE30点。

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