目的：总结1例伴精神病性症状路易体痴呆患者的诊疗经过，探讨中西医结合在复杂神经精神症状治疗中的临床价值。

方法：回顾性分析1例74岁女性伴精神病性症状路易体痴呆患者的临床资料、治疗经过及随访结局。患者以帕金森综合征相关运动症状起病，后逐渐出现认知减退、视幻觉、夜间梦境演绎行为及自主神经功能波动。住院期间在调整西药治疗基础上联合中医辨证施治，辨证属“髓海不足、痰瘀阻络”。

结果：经神经科及精神科用药动态调整，并联合以补肾填精、化痰祛瘀为法的中医辨证治疗后，患者的视幻觉、夜间梦境演绎行为及日间嗜睡情况较前改善，便秘缓解，精神状态、服药依从性及活动安全性提高，家庭照护负担较前减轻，随访期间未再发生跌倒等不良事件。

结论：伴精神病性症状路易体痴呆患者病情复杂，药物敏感性高，单纯西药治疗常面临症状控制与不良反应之间的平衡困难。在严密评估和动态调整基础上，中西医结合治疗可作为个体化综合管理的补充策略，但其独立疗效仍需更多规范研究进一步验证。

Objective: To summarize the diagnosis and treatment process of a patient with dementia with Lewy bodies accompanied by psychotic symptoms, and to explore the clinical value of integrated traditional Chinese and western medicine in the management of complex neuropsychiatric symptoms.

Methods: A retrospective analysis was conducted on the clinical data, treatment course, and follow-up outcomes of a 74-year-old woman with dementia with Lewy bodies accompanied by psychotic symptoms. The patient initially presented with Parkinsonian motor symptoms and subsequently developed cognitive decline, visual hallucinations, nocturnal dream-enactment behaviors, and autonomic dysfunction. During hospitalization, traditional Chinese medicine based on syndrome differentiation was added on the basis of adjustment of western medications. The syndrome pattern was identified as "marrow sea insufficiency with phlegm and blood stasis obstructing the collaterals."

Results: After dynamic adjustment of neurological and psychiatric medications combined with syndrome-differentiated traditional Chinese medicine treatment based on tonifying the kidney and replenishing essence, resolving phlegm, and removing blood stasis, the patient showed improvement in visual hallucinations, nocturnal dream-enactment behaviors, and daytime somnolence. Constipation was relieved, mental status, medication adherence, and activity safety improved, caregiver burden was reduced, and no further falls or other adverse events occurred during follow-up.

Conclusion: Patients with dementia with Lewy bodies accompanied by psychotic symptoms often have complex clinical conditions and high sensitivity to medications. Western medicine alone frequently faces difficulty in balancing symptom control and adverse effects. On the basis of careful assessment and dynamic adjustment, integrated traditional Chinese and western medicine may serve as a supplementary strategy for individualized comprehensive management; however, its independent efficacy still requires further validation in more rigorous studies.