何常春教授针药结合治疗小儿抽动障碍的临证经验

Clinical experience of Professor HE Changchun in terating tic disorders in children by acupuncture plus medicine

抽动障碍(Tic Disorders,TD)为儿科神经精神类疾病,由遗传、围生期、中枢神经系统、感染与免疫、心理和社会环境等多个因素相互作用引起,特征为不自主、突发、重复、快速、无节律性的一个或多个部位运动抽动和/或发声抽动。它严重影响患儿情绪、行为和学习。TD被包含在中医学的“肝风”“慢惊风”“筋惕肉瞤”“抽搐”等范畴中。目前西医治疗“抽动障碍”以药物、心理行为疗法、饮食环境和手术治疗等为主。药物不良反应较多,容易复发。心理行为疗法和多方面干预疗效慢、疗程长。手术治疗出于手术指征、费用、安全性等原因难以广泛开展。中医药在治疗TD方面优势突出并取得良好进展。吾师何常春教授临床采用针刺结合中药方剂治疗TD,效果明显。文章总结何教授应用针药结合治疗小儿TD的经验。他认为TD致病因素主要为风邪,病位在肝,其关键病机是肝风内动,治以疏散风邪、舒筋利节、疏肝利胆、调畅气血、阴阳双补等,同时要关注小儿“稚阴稚阳”体质状态。

Tic disorder is a pediatric neuropsychiatric disease,which is caused by the interaction of multiple factors such as genetics,perinatal period,central nervous system,infection and immune,psychological and social environment,and it is characterized by involuntary,sudden,repetitive,rapid,and unrhythmic motor tics and/or vocal tics in one or more parts of the body.It seriously affects children’s mood,behavior and learning.Tic disorders are included in the category of traditional Chinese medicine“liver wind”,“low convulsion”,“muscular twitching”,“convulsion”and so on.At present,Western medicine treats tic disorder mainly with drugs,psycho-behavioral therapy,dietary environment and surgical treatment.There is more adverse drug reaction,and it is easy to relapse.The effect of psychobehavioral therapy and various intervention is slow,and the course of treatment is long.Surgical treatment is difficult to be widely carried out due to surgical indications,cost,safety and other reasons.The advantages of traditional Chinese medicine in the treatment of tic disorder are prominent,and good progress has been made.Professor HE Changchun applies acupuncture combined with traditional Chinese medicine in treating tic disorder,and the effect is significant.This article summarizes Professor HE’s experience in the treatment of children with tic disorder by combining acupuncture and medicine.He believes that the main pathogenic factor of tic disorder is wind evil,the disease is located in the liver,the key pathogenesis is the internal movement of liver wind,the treatment should be used to evacuate wind evil,relax the tendons and improve the knot,ease the liver and gallbladder,regulate Qi(气)and blood,balance Yin and Yang(阴阳),and pay attention to children’s“immature Yin and Yang”physical state.