The pathogenesis is not clear, which may be related to the decline of ascending activation system in brainstem reticular structure or the hyperfunction of caudal pontine reticular nucleus.
At present, the etiology is unknown, but it can be found that the disease is related to genes, environmental factors and some central nervous system diseases. Little is known about the environmental factors that may induce narcolepsy. Literature reports include head trauma, changes in sleep habits, mental stimulation, virus infection and so on. The relationship between narcolepsy and heredity is a hot topic in recent years. About 8%- 10% of narcolepsy patients have family history, and the probability of their immediate family members is 10-40 times that of the control group. 25%-3 1% identical twins suffer from narcolepsy, suggesting that genetic factors play an important role in their pathogenesis. The positive rate of HLA allele DQB 1*0602 in narcolepsy patients is high, reaching 88%- 100%.
Western medicine treatment
(A) the treatment of excessive sleepiness
1. Central stimulant: It can activate reticular activation system and exert a strong exciting effect. It is an effective drug for treating sleep attacks.
2. Other drugs: Because narcolepsy is related to DA metabolism, narcolepsy can be treated by increasing the presynaptic DA level.
(2) Treatment of cataplexy
1. Norepinephrine drugs: can reverse cataplexy, such as desipramine, weizine, venlafaxine, etc., and can effectively fight cataplexy.
2. tricyclic antidepressants: they can increase the content of monoamine substances such as ne in blood, and are commonly used anti-cataplexes.
3. Sodium hydroxybutyrate: a derivative of GABA, with a peak time of 40 minutes and a half-life of 53 minutes. After taking 1 week, cataplexy decreased by 53%, and decreased by 69% after 4 weeks. It can also improve daytime sleepiness, sleep paralysis, hallucinations before going to bed and other symptoms to a certain extent.
(3) Treatment of insomnia
Patients who use stimulants during the day may suffer from insomnia or restless sleep at night. At this time, hypnotics with short half-life should be taken orally before going to bed, such as zolpidem, and hypnotics with long half-life should be avoided as far as possible to prevent drowsiness from aggravating during the day.
Chinese traditional treatment
(1) Deficiency of both heart and spleen
1. Symptoms include drowsiness, dreaminess before going to bed, listlessness, palpitation, pale face, thin and white fur, and thready pulse.
2. Treat the heart and spleen.
3. Jiawei Guipi Decoction.
Poria, Pogostemon Pogostemonis and Magnolia Officinalis are added to patients with abdominal distension, abdominal distension, anorexia and greasy tongue coating, so as to remove dampness by fragrance, strengthen spleen and promote qi circulation; Ophiopogon japonicus, Polygonatum odoratum and Radix Glehniae are added for patients with deficiency of heart yin, dizziness and hallucinations before going to bed.
(2) Weakness of temper
1. Symptoms include drowsiness all day, sallow complexion, listlessness, insomnia and dreaminess, palpitation, shortness of breath, forgetfulness, pale tongue, thin and white tongue coating and thready pulse.
2. This therapy can tonify qi and blood and refresh the mind.
3. Compound Yangxin Decoction
Polyporus, Areca catechu, and Alisma orientalis are added for patients with water stagnation and palpitation; For those who can't wake up all day, add Styrax, Acorus gramineus and Alpinia oxyphylla to wake up.
(3) Deficiency of kidney yang
1. Symptoms include drowsiness, drowsiness, soreness in the waist and knees, chills in the limbs, impotence, long urination, frequent urination at night, pale tongue, thin and white tongue coating, and deep and thin pulse.
2. Warming and tonifying kidney-yang method.
3. Prescription Youguiyin is added and subtracted.
Such as qi deficiency and blood deficiency. Ginseng can be reused, and Atractylodes macrocephala and Astragalus can be added.
(d) insufficient medullary sea
1. Symptoms include drowsiness, soreness of waist and knees, dizziness, tinnitus and deafness, dull expression, mental retardation, listlessness, memory loss, red tongue, thin and white tongue coating, and thin or thin pulse.
2. Treatment: replenishing essence and marrow, strengthening brain and inducing resuscitation.
3. Zuo Gui Wan Fang is added and subtracted.
Spermatorrhea, adding Concha Ostreae, Fructus Rosae Laevigatae, Semen Euryales, and Lotus Root to tonify kidney and astringent essence; For those with hot flashes, night sweats and dry mouth, Cornus officinalis and cornu Cervi should be removed, and Anemarrhena asphodeloides and Cortex Phellodendri should be added to nourish yin and purge fire.
(5) deficiency of heart-yang
1. Symptoms include drowsiness, mental fatigue, chills and cold limbs, pale complexion, pale tongue, thin and white fur, and deep and thin pulse.
2. The treatment method warms and tonifies the heart yang, and tonifies the heart qi.
3. Prescription Guizhi Gancao Decoction and Ginseng Yiqi Decoction.
For those with cold limbs, cassia twig should be removed, cinnamon and dried ginger should be added to replenish fire and help yang and warm menstruation; For those with pale complexion and blood deficiency, Colla Corii Asini, Radix Rehmanniae Preparata, Fructus Lycii and Polygoni Multiflori Radix are added to replenish blood.
(6) Obstruction of gallbladder heat and phlegm
1. Symptoms include drowsiness, dizziness, bitter and dry mouth, nausea, fullness in chest and hypochondrium, red tongue with yellow fur and rapid pulse.
2. Clearing gallbladder and resolving phlegm.
3. Prescription Haoqin Qingdan Decoction is modified.
Because of phlegm and turbid internal resistance, qi does not fall, the heart is swollen and hard, and qi is not removed. Fu Xuandai Zhetang is added to replenish qi and stomach, and phlegm is reduced. If you are sleepy, you can add Angong Niuhuang Pill to refresh your mind and begin to understand.
(7) Summer dampness hurts qi.
1. Symptoms include drowsiness, drowsiness of limbs, loss of appetite, chest tightness, spontaneous sweating due to body heat, headache, thirst, loose stool, short and red urine, greasy tongue coating and pulse deficiency.
2. Treat summer heat and benefit qi.
3. Self-made Qingshu Yiqi Decoction.
If it is too hot, add gypsum; If the tongue coating is white and greasy, remove Ophiopogon japonicus and Anemarrhena asphodeloides and add Pogostemon cablin and Amomum villosum.
(VIII) Spleen Dampness and Liver Depression
1. Symptoms include: frequent drowsiness, lethargy, listlessness, heavy limbs, fatigue, heavy menstrual flow, dark purple, heavy back pain, leucorrhea, cough with excessive phlegm, dizziness and headache, gastrointestinal disturbance, listlessness, poor memory, dry and yellow stool, red tongue and yellow fur.
2. Treat the spleen and soothe the liver, dispel dampness and refresh the brain.
3. Prescription Wandai Decoction is modified.
Adding cuttlefish bone, Euryale Semen, and Concha Ostreae preparata; Rhizoma Pinelliae and Rhizoma Arisaematis are added for patients with turbid expectoration; Chrysanthemum, Chuanxiong, Gastrodia elata, etc. For patients with dizziness and severe headache.
(9) Stagnation of spleen due to dampness and turbidity
1. Symptoms include frequent drowsiness, drowsiness and listlessness; Heavy limbs, fatigue, chest tightness, fullness, greasy mouth, pale tongue, thick greasy white tongue coating, slow or slippery pulse.
2. Treat spleen dampness and begin to understand.
3. Add and subtract Banxia Baizhu Tianma Decoction.
If there is too much wet phlegm and the tongue coating is white and slippery, add Alisma orientalis and Guizhi Lishui Drink; If the liver-yang is hyperactive, Uncaria rhynchophylla, mother-of-pearl and ochre are added to stop the wind and subdue the yang.
(10) blood stasis block
1. Symptoms include drowsiness, long onset time, mental fatigue, lethargy, memory loss, headache, insomnia and dreaminess, dark purple tongue, frequent petechiae or ecchymosis, and thready pulse.
2. Treat qi and promote blood circulation, and enlighten the brain.
3. Tongqiao Huoxue Decoction is modified.
Radix Puerariae and Rhizoma Corydalis are added for patients with severe headache; Bombyx Batryticatus, Scorpio and Scolopendra are added to those with blood stasis and convulsion.
Acupuncture therapy of traditional Chinese medicine
1. Body acupuncture
(1) method 1
Key points: nasal communication.
Matching points: Shenmen, Sanyinjiao and Taichong.
(2) Method 2
Key points: Shenmai and Zhao Hai.
Matching points: Baihui and Sanyinjiao.
2. scalp acupuncture
Key points: the national standard head needle top midline and forehead midline.
Acupoint matching: two lines (double lines) and frontoparietal belt are added for patients with spleen deficiency and dampness; For patients with deficiency of both heart and spleen, add the first line (right) and the second line beside the forehead; For patients with kidney-yang deficiency, add parafrontal third line (double line), supraoccipital middle line and supraoccipital second line; If the medullary sea is insufficient, add three lines (double lines) beside the forehead.
3. Warm acupuncture
Acupoints: Tongli, Dazhong, Xinshu and Pishu.
4. Ear points are attached to Shenmen, brain stem, subcortical, occipital nerve points, liver, spleen and heart meridians.
massotherapy
Massage along the meridian was adopted. Let the patient take a prone position, relax and breathe smoothly. The operator is located on the right side of the patient and operates on the patient's body surface with the thumb, food, middle finger and ring finger of both hands.
psychotherapy
1. Some narcolepsy patients have symptoms of reactive depression, so they should be given psychological support to enhance their confidence in treatment and gain the understanding and support of their families and colleagues.
2. Behavioral therapy: change the original lifestyle.
3. Arrange work and rest time reasonably, emphasize regular work and rest, and try to ensure adequate sleep at night. Avoid emotional excitement and excessive tension. Strengthen physical activity during the day and improve excessive sleepiness during the day.