基于刘完素“火热论”探析“热-风”病因树在治疗抽动障碍中的应用

An analysis on the application of heat-wind etiology tree in treating tic disorders based on LIU Wansu’s fiery theory

抽动障碍是起病于儿童或青少年时期的一种神经精神障碍性疾病,以不自主、反复、突发、快速、重复、无节律性的一个或多个部位运动抽动和发声抽动为主要特征,亦可共患一种或多种心理行为障碍,但智力一般不受影响。研究以刘完素创立的河间流派“火热论”观点为纲领,以小儿抽动障碍的临床特征为基础,提出儿童在外感六淫、饮食调护、情志内伤、先天禀赋等因素作用下,阴阳失衡,五脏失调,肝木之气郁结,郁久而化热,热极则生风;脾土失健,难化水湿,聚而成痰,痰热胶结,引动肝风;血液受热煎熬,化为瘀血,瘀、热互结;热久伤阴,使得阳亢而风动。“热”为本病的发病始动因素,“风”为本病的发病续动因素,且与痰、火、瘀、虚等病理要素紧密相干,提出建立“热-风”病因树模型,热为“热-风”病因树之根蒂,痰、瘀、虚为“热-风”病因树之叶、枝、蔓,风则为“热-风”病因树之果。以此模型来探析抽动障碍的病因机制,确定疾病发展阶段,防治小儿抽动障碍。在确定治疗原则上以河间流派“火热论”为指导,治以伐根摘叶之清热化痰,削其结果之息风止痉,平其枝蔓之滋水涵木等,提供治疗此病的新思路,并可从其中探寻完善和高效的论治方法和临床研究方向,为患儿带来福祉。

Tic disorder is a neuropsychiatric disorder that begins in childhood or adolescence.It is mainly characterized by Tinvoluntary,repetitive,sudden,rapid,repetitive,and rhythmical movements of one or more parts and vocal movements.It can also suffer from one or more psychological and behavioral disorders,but intelligence is generally not affected.Based on the fiery theory of the Hejian school established by LIU Wansu and the clinical characteristics of children with tic disorder,this paper proposes that under the influence of factors such as six external pathogenic factors,diet,emotional and internal injury,and innate endowment,the imbalance of Yin(阴)and Yang(阳),the imbalance of the five viscera,and the stagnation of Qi(气)in the liver wood,the stagnation for a long time will turn into heat,and the extreme heat will produce wind.The spleen soil is not healthy,difficult to turn into water wet,but gathers into phlegm,phlegm heat accumulation induces liver wind.Blood suffers from heat and turns into blood stasis,resulting in stasis and heat interjunction.Heat damages Yin for a long time,making Yang hyperactive and wind moving.Therefore,the author believes that heat is the initiation factor of the disease,and wind is the continuation factor of the disease,and it is closely related to the pathological elements of phlegm,fire,blood stasis,deficiency,etc.,and proposes to establish a heat-wind etiological tree model,in which heat is the root of the heat-wind etiological tree,sputum,blood stasis,and deficiency are the leaves,branches,and vines of the heat-wind etiological tree,and wind is the fruit of the heat-wind etiological tree.This model is used to explore the etiological mechanism of tic disorder,determine the development stage of the disease,so as to prevent children tic disorder.In determining the principle of treatment,Hejian school fiery theory is used as a guide,the treatment method of cutting root and leaf is used to clear heat and phlegm,cutting the result of the wind is used to stop convulsion,and leveling its branches and vines is used to nourish water and wood.It provides new ideas for the treatment of this disease,and can explore perfect and efficient therapeutic methods and clinical research directions from which to bring well-being to children with tic disorders.