从《黄帝内经》核心观念辨析小儿多动症之“象”的诊疗

Analysis of the diagnosis and treatment of attention deficit hyperactivity disorder based on the core concepts of Huangdi Neijing

小儿多动症是目前较为常见的儿童疾病,但因其症状表现多样,且常以精神、神志异常为主,导致辨证较为困难。文章从“象”的角度入手,以《黄帝内经》核心观念探究小儿多动症的临床诊疗。认为当从物象与气象两方面对小儿多动症之“象”进行考察,其主要特征表现为活动量过多、情绪不稳定、注意力不集中、理解力较差等几方面。将小儿多动症的核心病机总结为“风象、火象有余,土象、水象不足”,认为活动过多、情绪不稳为风、火有余之象;注意力差、精力分散为土、水不足之象;理解力差、沟通不利属心难“任物”之象。同时,结合临床经验提出相应的治法方药,为小儿多动类疾病的临床诊疗提供参考。

As a common pediatric disease,attention deficit disorder(ADHD)is hardly differentiated in patterns,both because of its various syndromes,and the main symptoms are mental and spiritual disorders.Based on the core concept of Huangdi Neijing,we discuss the clinical diagnosis and treatment of ADHD based on images.ADHD is studied using both physical and functional images,which mainly represent clinical symptoms of hyperactivity,unstable emotions,distractibility,and poor comprehension.We summarize the characteristics of ADHD as“excess in wind and fire image,deficiency in earth and water image”,considering that“excess in wind and fire image”is responsible for the symptoms of hyperactivity and unstable emotions,while“deficiency in earth and water image”is responsible for distractibility.Further,the symptoms of poor comprehension and difficulties in communication indicate a disability of“renwu”(cognition of world)in the heart.We suggest corresponding therapies and prescriptions based on our clinical experience in order to provide a reference for the clinical diagnosis and treatment of hyperkinetic diseases in children.