基于共病视角探讨“运脾治鼻”理念治疗重度腺样体肥大合并注意缺陷多动障碍的临床应用

Exploring the clinical application of the concept of "regulating the spleen to treat nasal disorders" in the treatment of severe AH complicated with ADHD from the comorbidity perspective

摘要

重度腺样体肥大（AH）与注意缺陷多动障碍（ADHD）常存在共病现象, 二者相互影响, 形成恶性循环；重度AH引发的长期睡眠呼吸障碍所致大脑慢性缺氧, 或与ADHD症状加重存在关联。海派中医“徐氏儿科”第四代传承人姜之炎教授基于共病视角认为重度AH和ADHD共病的病机核心在于脾失健运、痰核阻窍、脾虚肝旺；脾运失常则痰湿内生, 痰浊阻滞鼻窍发为AH；脾虚失养、肝木偏亢则扰动心神, 表现为ADHD的注意力不集中、多动、冲动等症状。基于此, 姜教授提出“运脾治鼻”理论, 拟定运脾化痰通窍方, 以恢复脾的运化功能为根本, 从根源上改善痰、瘀生成的病理基础, 同时兼顾潜镇柔肝以调ADHD之变。临床实践表明, 该方在有效改善重度AH症状的同时, 可减轻ADHD相关症状, 为重度AH与ADHD共病的中医诊疗提供了新的思路。

Abstract

Severe adenoid hypertrophy (AH) is frequently comorbid with attention deficit hyperactivity disorder (ADHD), and the two conditions interact to form a vicious cycle. Chronic cerebral hypoxia induced by persistent sleep-disordered breathing secondary to severe AH may be associated with the aggravation of ADHD manifestations. Professor Jiang Zhiyan, the fourth-generation inheritor of the Shanghai School of Traditional Chinese Medicine (TCM) "Xu's Pediatrics", believes, from the comorbidity perspective, that the core pathogenesis of comorbid severe AH and ADHD lies in impaired transportation of spleen, phlegm nodules obstructing the orifices, and spleen deficiency with liver hyperactivity. Impaired transportation of spleen leads to internal generation of phlegm-dampness, and obstruction of the nasal orifices by phlegm-turbidity results in AH; spleen deficiency-induced malnutrition and hyperactivity of liver-wood disturb the mind, manifesting as ADHD symptoms such as inattention, hyperactivity, and impulsivity. Based on this, Professor Jiang has proposed the theory of "regulating the spleen to treat nasal disorders" and formulated the prescription of regulating spleen, resolving phlegm and unblocking orifices. With restoring the spleen's function of transportation as the fundamental goal, this prescription improves the pathological basis for the formation of phlegm and blood stasis at the root causes, while simultaneously exerting the effects of suppressing hyperactivity and soothing the liver to regulate ADHD symptoms. Clinical practice has demonstrated that this prescription can effectively relieve severe AH-related manifestations and alleviate ADHD-associated symptoms, offering a novel therapeutic approach for the traditional Chinese medicine management of severe AH complicated with ADHD.

关键词

重度腺样体肥大 / 注意缺陷多动障碍 / 共病 / 运脾治鼻 / 儿童

Key words

Severe adenoid hypertrophy / Attention deficit hyperactivity disorder / Comorbidity / Regulating the spleen to treat nasal disorders / Child

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基金资助

国家自然科学基金项目(82174433)