基于“象-形神-气”从脏腑气机辨治儿童抽动障碍

Syndrome Differentiation and Treatment of Tic Disorders in Children from the Theory of Qi Movement of Zang-Fu Organs Based on“Manifestation-Body and Spirit-Qi”

基于“象-形神-气”思维认为儿童抽动障碍的病机涉及“风、痰、火”三象,以风象为主导,痰、火二象为伴随,主张临证时辨识形神异常,总结象的演变,针对脏腑气机灵活辨治。其中抽动相关常见症状多属风象,源自肺失宣肃、肝升太过,采用疏肝木、肃肺金之法,可选小柴胡汤、苍耳子散等方加减;病情迁延、症状怪异者多夹杂痰象,源自脾不升清、胃不降浊,采用升己土、降戊土之法,可选异功散、二陈汤等方加减;病情进展、症状严重者多夹杂火象,源自水火不济、心火偏亢,采用交心肾、济水火之法,可选泻肝丸、六味地黄丸等方加减,以期调气机、和形神、化象于冥冥。

Based on the theory of“manifestation-body and spirit-qi”,it is considered that the pathogenesis of tic disorders(TD)involves three manifestations of“wind,phlegm and fire”,with wind as the leading factor and phlegm and fire as the accompanying factors.It is advocated to identify the abnormality of body and spirit,summarize the evo⁃lution of manifestation,and prescribe flexibly based on qi movement of zang-fu organs.Among them,the common symptoms related to tics are mostly belong to wind symptoms,which originated from lung qi failing to purify and liver qi over-ascent.The method of soothing liver wood and purifying lung gold is adopted,and modified Xiaochaihu Decoc⁃tion(小柴胡汤)and Cangerzi Powder(苍耳子散)are recommended;Patients with prolonged illness and strange symp⁃toms are often mixed with phlegm,which stemmed from the fact that spleen failing to rise clear and stomach failing to downward turbid.The method of raising spleen-earth and lowering stomach-earth is adopted,and modified Yigong Powder(异功散)and Erchen Decoction(二陈汤)are recommended;Patients with severe symptoms are often mixed with fire symptoms,which originated from discordance of water and fire and hyperactivity of heart fire.The method of interacting heart and kidney and coordinating water and fire is adopted,and modified Xiegan Pill(泻肝丸)and Liuwei Dihuang Pill(六味地黄丸)are recommended,in order to regulate qi movement,harmonize body and spirit,and improve the symptoms.