基于五神理论探讨强迫样抽动障碍病机及验案举隅

Exploring the pathogenesis of obsessive-compulsive tic disorder based on the Five Spirits theory and a case study

摘要

强迫样抽动障碍作为抽动障碍的一种特殊临床表型，其独特的发病特点与治疗难点尚未引起足够重视。本文基于中医五神理论初步阐释该病的中医病机，并提出以调神为核心的辨治思路。人之五神主司意识主宰、谋虑决断、记忆思虑、本能感觉与习惯动作、意志定力，共同维系着“神-形-动-思”的整体平衡。强迫样抽动障碍的病机初期以心神动荡、君主不明为始动环节；进而肝魂失制，妄动化风，表现为不自主抽动；病情进展，肺魄失司，导致动作与习惯调控失常，形成刻板行为；其根本在于脾意不藏，思虑黏滞不去，以及肾志不坚，定力无根，致使强迫思维顽固存在，病情迁延难愈。因此，本病核心病机在于五神失序，治疗当以调神为总纲，形神同调，标本兼顾，通过安神定志、柔肝息风、敛肺固魄、健脾藏意、填精固志等法，恢复五神各司其职、协调有序的状态。本文附陈玉燕主任治疗强迫样抽动障碍验案一则，详细阐述了基于五神辨证的诊疗过程，以期为该病的中医临床辨证论治提供新的理论视角与实践参考。

Abstract

Obsessive-compulsive tic disorder, as a special clinical phenotype of tic disorders, has not received sufficient attention regarding its unique pathogenic characteristics and treatment difficulties. Based on the theory of the Five Spirits in traditional Chinese medicine(TCM), this article primarily explains the TCM pathogenesis of this disease and proposes a treatment strategy centered on regulating the spirit. The Five Spirits in humans are responsible for consciousness control, decision-making, memory and thinking, instinctive sensations and habitual actions, and willpower and determination, jointly maintaining the overall balance of "spirit-body-movement-thought". The pathogenesis of obsessive-compulsive tic disorder begins with the disturbance of heart and mind and obscured heart monarch; subsequently, the liver Hun loses its control, resulting in abnormal movement and wind generation, manifested as involuntary tics; as the condition progresses, the lung Po fails to govern, leading to abnormal regulation of actions and habits, forming stereotyped behaviors; its root cause lies in the failure of the spleen Yi to be stored and the retention of thoughts unable to dissipate, and that the kidney Zhi is not firm and lacks a foundation, causing persistent obsessive thoughts and making the condition difficult to heal. Therefore, the core pathogenesis of this disease lies in the disorder of the Five Spirits. Treatment should be based on regulating the spirit as the cardinal principle, coordinating body and spirit, and taking both the symptoms and the root causes into account. Through methods such as calming the spirit to stabilize Zhi, soothing the liver to extinguish wind, consolidating the lungs to settle Po, strengthening the spleen to store Yi, and filling the essence to solidify Zhi, the normal state can be restored where the Five Spirits perform their respective functions and are coordinated in an orderly manner. This article also presents a case of treatment for obsessive-compulsive tic disorder by Professor Chen Yuyan, in which the diagnosis and treatment process based on the Five Spirits syndrome-differentiation is described in detail, aiming to provide a new theoretical perspective and practical reference for the differentiated treatment of this disease with traditional Chinese medicine in clinical practice.

关键词

强迫样抽动障碍 / 五神理论 / 病机 / 临证经验

Key words

Obsessive-compulsive tic disorder / Five Spirits theory / Pathogenesis / Clinical experience

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基金资助

国家中医药管理局科技司-浙江省中医药管理局共建科技计划项目(GZY-ZJ-KJ-23014)

浙江省中医院院级项目(2D12527)

浙江中医药大学2025年附属医院科研专项项目(2025FSYYZQ16)