汪受传教授治疗儿童孤独症临证经验

Professor WANG Shouchuan’s experience in the treatment of children with autism in clinical practice

汪受传教授认为儿童孤独症病位主要在脑,与心、脾、肾、肝关系密切。主要病机为脑失所养、神机失用,汪教授常予归脾汤合养心汤治疗,但仍需根据病情辨证加减:气血不足、心窍失养者,治宜补益心脾,重用生晒参、炒白术、茯苓、炒酸枣仁、柏子仁等;脾虚湿盛、痰蒙清窍者,治宜健脾助运、豁痰开窍,寒痰者加法半夏、茯苓、橘红、远志、石菖蒲等,热痰则加郁金、瓜蒌皮、浙贝母、胆南星等;肾精亏虚、脑髓失充者,治宜补肾充髓、健脑益智,加黄精、山药、鹿角霜、益智仁等;肝郁气滞、肝阳亢逆者,治宜疏肝解郁、平抑肝阳,加钩藤、决明子、菊花、夏枯草、牡丹皮、栀子、石决明等;此外,汪教授常用磁石、龙骨、生龙齿、珍珠母等重镇之品,以加强宁心安神之效。儿童孤独症病程较长,故临床用药宜选平和之剂,以防戕伐正气。附案例1则,以资验证。

Professor WANG Shouchuan holds that the disease location of children with autism mainly lies in brain,which is closely related to the heart,spleen,kidney and liver.The main pathogenesis is loss of nourishment in the brain and dysfunction of vital activity.Professor WANG often treats it with Guipi Tang(归脾汤)combined Yangxin Tang(养心汤),but it still needs to be modified according to syndrome differentiation of pathological conditions.For example,those with insufficiency of qi and blood and loss of nourishment in heart aperture should be treated by nourishing heart and spleen,and sun-cured Ginseng radix et rhizoma,stir-baked Atractylodis macrocephalae rhizoma,Poria,stir-baked Ziziphi spinosae semen,Platycladi semen,etc.are heavily used.Those with superabundance of dampness due to spleen-asthenia and phlegm clouding heart should be treated by invigorating spleen and promoting transportation as well as eliminating phlegm to open orifices,those with cold phlegm are added Pinelliae rhizoma praeparatum,Poria,Citri exocarpium rubrum,Polygalae radix,Acorus gramineus Soland.etc.,and those with heat phlegm are added with Curcumae radix,Trichosanthis pericarpium,Fritillariae Thunbergii bulbus and Arisaema cum bile,etc.Those with asthenia of renal essence and insufficiency of brain marrow should be treated with invigorating kidney to supplement marrow as well as nourishing the brain and improving the intelligence,added with Polygonati rhizoma,Dioscoreae rhizoma,Cervi cornu degelatinatum,Alpinae oxyphyllae fructus,etc.Those with liver depression and qi stagnation as well as hyperactivity and counterflow of liver-yang should be treated with soothing liver and relieving depression as well as soothing and repressing liver-yang,and are added with Uncariae ramulus cum uncis,Cassiae semen,Chrysanthemi flos,Prunellae spica,Moutan cortex,Gardeniae fructus and Haliotidis concha etc.In addition,professor WANG often uses medicinals with heavy materials including magnetitum,calcined Os Draconis,Dens Draconis Recens and Concha Margaritifera Usta etc.,to enhance the effects of calming heart and mind.The course of children with autism is long,so clinical medication should be mild and harmonious to prevent impairing healthy qi.One case is attached for verification.