基于王旭高“治肝三十法”探析儿童抽动障碍的病机和辨治思路

Pathogenesis and Differentiated Treatment Strategies of Childhood Tic Disorders Based on WANG Xugao's“Thirty Methods of Treating the Liver”

基于王旭高“治肝三十法”,认为儿童抽动障碍的发生发展以肝气病→肝火病→肝风病的动态演变规律为主线,三个阶段分别以肝气郁结、肝火亢盛、肝风内动为基本病机;同时以肝血虚滞、肝阴失养为主的肝之气血阴阳偏颇为要点,以他脏累及或渐及他脏的五脏关系失衡为补充。以治肝三十法为指导原则,TD肝气病治以疏肝理气法、疏肝通络法,可用小柴胡汤、四逆散;TD肝火病治以清肝法、泻肝法、化肝法,可用龙胆泻肝汤、泻青丸、当归龙荟丸、化肝煎;TD肝风病治以熄风和阳法、熄风潜阳法,可用羚角钩藤汤、六味地黄丸;同时全程兼顾调和肝之本脏气血阴阳以及他脏病变的治疗。

Based on WANG Xugao's“thirty methods of treating the liver”,it is believed that the occurrence and development of childhood tic disorders follow the dynamic progression from liver qi disease to liver fire disease and then liver wind disease.The basic pathogenesis of three stages are characterized by binding constraint of liver qi,liver fire hyperactivity,and internal stirring of liver wind.Moreover,liver-blood deficiency and stagnation,and malnutrition of liver yin as the main point in terms of the imbalance of liver qi,blood,yin,and yang should be considered,as well as the imbalance relationship of the five zang organs such as the involvement of other organs and the gradually reach of the other organs.Guided by the principles of“thirty methods of treating the liver”,the treatment of tic disorders in liver qi stage should focus on soothing the liver and rectifying qi,soothing the liver and unblocking the collaterals,using Xiaochaihu Decoction(小柴胡汤)and Sini Powder(四逆散).The treatment of tic disorders in liver fire stage involves clearing,draining and resolving liver heat,using Longdan Xiegan Decoction(龙胆泻肝汤),Xieqing Pill(泻青丸),Danggui Longhui Pill(当归龙荟丸),and Huagan Decoction(化肝煎).The treatment of tic disorders in liver wind stage involves extinguishing wind and subduing yang,using Lingjiao Gouteng Decoction(羚角钩藤汤)and Liuwei Dihuang Pill(六味地黄丸).Throughout the treatment process,attention should be paid to harmonizing the liver's qi,blood,yin,and yang,as well as addressing the pathology of other organs.