从“脑与脾肾相关”浅析孤独症谱系障碍的病机与辨证论治要点

A brief analysis of the pathogenesis and syndrome differentiation of autism spectrum disorders from the "brain-spleen spleen and kidney correlation"

孤独症谱系障碍(ASD)以社交能力持续受损、行为或兴趣重复、刻板为特征,是中医儿科临床常见的危害巨大的儿童神经精神系统疾病,2020年国内发病率高达7.0‰,常因诊断不及时、治疗措施有限、不能坚持治疗、家长调护不当等错过最佳治疗时期。ASD发病责之“元神”受损,病位在脑,本文从物质基础、结构基础、运行基础与病理联系分析脑与脾肾相关性,从而得出脾肾亏虚为ASD的根本病机,痰瘀互结为ASD的重要病理因素。王俊宏教授认为,临床上应抓住儿童生理、病理特点,以补肾运脾,化痰祛瘀为基本治法,同时不妄投滋补,以调节患儿全身运化功能为要。治疗上选用经典名方六味地黄丸、六君子汤合方而成的补肾运脾益智方为主方,根据不同的脏腑兼症四诊合参进行治疗,每获良效。结合临床验案对补肾运脾益智方治疗ASD的辨证要点与治疗、随证用药经验进行介绍。

Autism spectrum disorders(ASD) is characterized by sustained impaired social ability,repetitive behaviors or interests,and stereotyped behavior.It is a common pediatric neuropsychiatric disease with great harm in TCM pediatrics,and in 2020,the domestic incidence has reached 7‰.The optimal treatment period is often missed due to delayed diagnosis,limited treatment measures,failure to adhere to treatment,improper parental care and so on.The "Original Spirit" of ASD is damaged,and the lesion is in the brain.This paper analyzes the correlation between brain and spleen and kidney from the material basis,structural basis,operational basis and pathological connection,and concludes that the deficiency of spleen and kidney is the fundamental pathogenesis of ASD,and phlegm and blood stasis is the important pathological factors of ASD.Professor Wang Junhong thinks that the physiological and pathological characteristics of children should be considered clinically,and the basic treatment should be to tonify the kidney and spleen,eliminate phlegm and remove blood stasis.At the same time,there should be no improper tonification,and the focus is to regulate the whole body movement and chemical function of children.In the treatment,the classic prescription Liuwei Dihuang pills and Liujunzi decoction are selected as the main prescription of Bushen Yunpi Yizhi prescription.According to the viscus syndrome,the treatment combines comprehensive analysis of the four examination methods and achieves good effects.Based on clinical cases,this article introduces the key points of syndrome differentiation,treatment and medication experience of Bushen Yunpi Yizhi prescription in the treatment of children with ASD.