抗うつ剤 SSRIやSNRIによる攻撃性や他害行為について
Since my time working at a university hospital, I have treated several patients with neuromyelitis optica (NMO) using traditional herbal medicine and observed improvements in visual acuity and visual field constriction; recently, I treated four female patients with the condition. These experiences have provided a glimpse into the causes and pathophysiology of the disease. NMO is more common in women than in men. Anti-AQP4 antibody-positive NMO is generally characterized by severe visual impairment, a high risk of recurrence, resistance to treatment, a tendency for residual sequelae, and a poor visual prognosis. Pathologically, the causative agent is the anti-AQP4 antibody; unlike multiple sclerosis, the core pathology involves astrocyte damage caused by antigen-antibody complexes, followed by acute inflammation of the optic nerve and spinal cord. In terms of traditional medical diagnosis, while there are several etiological factors, the primary direct cause is considered to be "Damp-Heat in the Liver Meridian." Consequently, the first phase of the treatment strategy involves clearing and draining Damp-Heat from the Liver and Gallbladder. The Damp-Heat in the Liver Meridian leads to damage of the *Ying* (Nutritive) and *Xue* (Blood) levels; the resulting circulatory impairment causes extensive damage to the optic nerve and spinal cord, leading to severe visual impairment, blindness, and transverse spinal cord injury. To address this, the second phase of the treatment strategy required methods to clear the *Ying* level, cool the blood, nourish *Yin*, and invigorate blood circulation. This pathology differs from that of multiple sclerosis, which involves damage to the nerve myelin sheath (demyelination) caused by T-lymphocytes. Our clinical experience showed that both the traditional medical diagnosis and the treatment strategies for NMO differed completely from those for multiple sclerosis. Although both NMO and multiple sclerosis are autoimmune diseases, immune abnormalities alone—while a necessary condition—are not a sufficient condition for the disease to manifest. Several additional conditions must be met for the disease to actually develop; specifically, the presence of abnormal pathological states within the *Zang-Fu* organs is required. By diagnosing the pathological conditions of the internal organs and administering appropriate herbal prescriptions, it is possible to treat these diseases and prevent their recurrence.
