基于“络病理论”探讨虫类药在儿童抽动障碍中的应用

Study on the application of insect medicines in pediatric tic disorder based on "collateral disease theory"

摘要

抽动障碍是儿童期高发的慢性神经精神障碍性疾病, 临床上以不自主、反复、快速的肌肉抽动或发声抽动为核心特征, 病程多迁延难愈, 易受情绪、外感等因素诱发加重, 对患儿的生长发育、心理健康及社会适应能力均存在显著不良影响。目前该病的西医发病机制尚未完全阐明, 临床常规干预方案多存在毒副反应明显、长期疗效有限、停药后病情易复发等短板, 临床亟需安全有效的中医药诊疗新路径。络病理论是中医理论体系的重要组成部分, 其核心病机学说“久病入络”, 为各类慢性、复杂性、顽固性疾病的辨证论治提供了独特的理论指导与临床思路。虫类药药性走窜通达, 兼具通络、搜风剔邪、破瘀散结之效, 其药性特点与络病以“通”为核心的治疗原则高度契合。文章从络病理论视角出发, 深入探讨儿童抽动障碍“病邪入络、络脉瘀滞、风痰瘀互结”的核心病机, 系统分析虫类药在该病治疗中的作用机制, 并结合临床实践总结常用虫类药的辨证应用规律、配伍要点与安全用药规范, 以期为儿童抽动障碍的中医临床诊疗提供新的理论依据与实践参考。

Abstract

Tic disorder (TD) is a chronic neuropsychiatric disorder with high incidence in childhood. It is clinically characterized by involuntary, repetitive and rapid muscular tics or vocal tics. The disease has a prolonged course and is difficult to cure, and is often induced and aggravated by mood and exogenous factors, which has significant negative impact on the growth and development, mental health and social adaptability of children. Currently, its modern pathogenesis has not been fully clarified, and clinical medical treatment is associated with obvious side effects, limited long-term effect and a high recurrence rate after drug withdrawal. It is urgent to find new safe and effective diagnosis and treatment approaches of traditional Chinese medicine (TCM) in clinical practice. As an important part of the theoretical system of TCM, collateral disease theory emphasizes that "chronic diseases involve the collaterals", providing a unique theoretical guidance and clinical approach for the diagnosis and treatment of chronic, complex and refractory diseases. Insect medicines possess the properties of penetrating and unblocking collaterals, searching for wind and eliminating pathogenic factors, and resolving blood stasis and dissipating masses, which conform to the core therapeutic principle of "unblocking" in collateral disease treatment. From the perspective of collateral disease theory, the paper discusses the essential pathogenesis of pediatric tic disorder, which is "pathogenic factors invade collaterals and cause collateral stagnation, and wind, phlegm and static blood interlock with each other", systematically analyzes the action mechanism of insect medicines in the treatment of this disease, and summarizes the syndrome-differentiated application rules, key points of compatibility and standards for safe medication of commonly used insect medicines based on clinical practice, so as to provide new theoretical basis and practical reference for clinical TCM diagnosis and treatment of pediatric tic disorder.

关键词

抽动障碍 / 络病理论 / 虫类药 / 病机 / 临床应用 / 儿童

Key words

Tic disorder / Collateral disease theory / Insect medicines / Pathogenesis / Clinical application / Child

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基金资助

辽宁省自然科学基金计划项目(2022-YGJC-81)