文章摘要
夏鳌安,周天梅.从表论治小儿抽动障碍临床体会[J].浙江中医药大学学报,2024,48(11):1414-1418.
从表论治小儿抽动障碍临床体会
Clinical Experience in Treating Tic Disorder from the Perspective of Surface Theory
DOI:10.16466/j.issn1005-5509.2024.11.013
中文关键词: 小儿抽动障碍  从表论治  经方  外风  痉病  解表药  医案  临床经验
英文关键词: tic disorder  on governance from the perspective of appearance  classic prescriptions  external wind  febrile disease with symptoms such as convulsion  exterior-releasing medicine  medical records  clinical experience
基金项目:国家中医药管理局第四批全国中医(临床、基础)优秀人才研修项目(中国中医药人教发﹝2017﹞24号)
作者单位
夏鳌安 浙江中医药大学中西医结合临床医学院 杭州 310053 
周天梅 浙江省立同德医院 
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中文摘要:
      [目的] 探析从表论治小儿抽动障碍(tic disorder,TD)的施治策略,为辨证论治提供临床思路。[方法] 通过搜集整理文献、跟随导师周天梅临证及观察临床疗效,论述TD所属中医学范畴及各家主张病机,分析从表论治TD的理论,总结病因病机分期以及相应的治法,后附验案二则加以佐证。[结果] TD属中医“抽搐”等范畴,许多医家主张与内风相关,而经方体系重视表里观,即“首辨表里,尤重表证”。周天梅临证发现,TD的临床表现与风邪的致病特点密切相关,病因以外风为主,病位初期症状表现均以表为所急所苦,可从表论治。根据疾病进展的过程,邪气逐渐由表入里,可将TD的病机分为三期,初期则以风邪侵袭、上焦和表位官窍痹阻为主,中期以水火攻冲、里位气机升降失常为主,后期以津血亏虚、官窍失于温煦濡养为主,故临床分别治以解表散邪、平衡水火、濡养津血为主,使得里邪出表。列举的两则验案,体现了从表论治可使TD的症状得以控制甚至消失。[结论] 从表论治TD加深了对其病因病机及临床治疗的认识。临证辨证关注表位症状,施治用以表药,期以里邪出表,具有一定的疗效,为临床发挥中医药优势治疗TD提供了一定的思路。
英文摘要:
      [Objective] To explore and analyse the treatment strategy for tic disorder (TD) from the perspective of surface theory, and provide clinical insights for the diagnosis and treatment of TD based on syndrome differentiation. [Methods] Based on collating and collecting literature, following the mentor’s clinical diagnosis and treatment, and observing the curative effect, this paper discussed the traditional Chinese medicine(TCM) category of TD and the pathogenesis advocated by various schools, then analysed the theory of treating TD from the perspective of surface and summarized the etiology, pathogenesis, staging and corresponding treatment methods of TD. Two experimental cases were attached to support this. [Results] TD belongs to the category of “convulsion” of TCM, and many doctors advocate that it is related to internal wind. However, the classic Chinese medicine system attaches particular importance to the exterior and interior view, namely “distinguishing the exterior and interior with a particular emphasis on the exterior syndrome”, which reveals that the clinical manifestations of TD are closely related to the pathogenic characteristics of pathogenic wind. Through clinical practice, the tutor finds the main cause of TD is external wind and the initial symptoms of the disease are all based on the urgency and bitterness of the exterior, which can be treated from the exterior. According to the progression of the disease, the pathogenic factor enters the interior from the exterior gradually, and the disease pathogenesis can be divided into three stages. In the initial stage, it is invaded by pathogenic wind, and the upper energizer and surface are mainly characterized by obstruction of the organs. In the middle stage, the main focus is on water and fire attacking and flushing, and the internal Qi movement is abnormal. In the later stage, it is mainly due to deficiency of blood and body fluids, and the loss of warming and nourishing organs. Therefore, in clinical practice, the main treatment is to relieve exogenous pathogenic factor, balance water and fire, and nourish blood and body fluids, so as to cause internal pathogenic factor to emerge from the surface. In this paper, two experimental cases with significant clinical effects were presented, which reflected that the symptoms of TD can be controlled or even disappeared. [Conclusion] Treating TD from the perspective of surface theory deepens the understanding of TD’s etiology, pathogenesis and clinical treatment. Paying attention to the surface symptoms through syndrome differentiation, and using exterior-releasing medicinal to treat TD in order to remove internal pathogenic factor, have a certain degree of efficacy, which can provide a certain idea for the clinical use of TCM to leverage its advantages in treating TD.
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