| 引用本文: |
陈力为, 林源城, 林淑惠, 林宇棋, 林丽莉.从“治中焦如衡”推拿法辨治儿童抽动障碍[J].湖南中医药大学学报,2026,46(5):952-956[点击复制] |
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| 从“治中焦如衡”推拿法辨治儿童抽动障碍 |
| 陈力为,林源城,林淑惠,林宇棋,林丽莉 |
| (福建中医药大学第一临床医学院, 福建 福州 350122;福建中医药大学附属厦门中医院, 福建 厦门 361000;福州市鼓楼区瑞来春堂中医门诊部, 福建 福州 350003;福建中医药大学针灸推拿学院, 福建 福州 350122;福建中医药大学国医堂门诊部, 福建 福州 350003;福建中医药大学附属康复医院, 福建 福州 350003) |
| 摘要: |
| 儿童抽动障碍是儿童期常见的神经精神发育障碍性疾病，病程迁延，易反复发作。既往中医辨治多从“肝风内动”立论。这一思路虽能解释抽动、摇头、眨眼、清嗓等风动表现，但对其病症反复发作、痰湿夹杂、情志异常与脾胃症状并见等特点，阐释仍有不足。“治中焦如衡”出自吴鞠通的《温病条辨》，原为温病中焦病证的治疗法度，其核心并不局限于温病范畴，而在于权衡寒热、虚实、燥湿、升降，使中焦枢机恢复平衡。儿童脾常不足，中焦运化失司则痰湿内生；痰湿阻滞，则气机升降失常；气机逆乱又易引动肝风，最终形成“中焦失衡-痰湿内伏-气机逆乱-肝风内动-抽动发作”的病机演变链条。据此，本文从病机演变、推拿治则与手法运用方面，论述“治中焦如衡”辨治儿童抽动障碍的理论依据与临床思路，提出脾虚痰伏者宜通补兼施、化痰通络，中焦壅滞者宜斡旋气机、恢复升降，肝脾不和者宜润燥并行、调和肝脾，并结合典型验案阐释具体应用，以期为儿童抽动障碍的中医外治提供临床参考。 |
| 关键词: 儿童抽动障碍|治中焦如衡|小儿推拿|中医辨治|痰湿|气机升降 |
| DOI：10.3969/j.issn.1674-070X.2026.05.011 |
| 投稿时间：2025-11-03 |
| 基金项目:福建省属公益类科研院所基本科研专项项目（2023R1003006）；福建省中医药重点学科建设项目“针灸工程学”。 |
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| Differentiation and treatment of pediatric tic disorder with tuina therapy based on "Treating the Middle Jiao as a Balance" |
| CHEN Liwei, LIN Yuancheng, LIN Shuhui, LIN Yuqi, LIN Lili |
| (First Clinical Medical College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China;Xiamen Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, Fujian 361000, China;Ruilai Chuntang Traditional Chinese Medicine Outpatient Clinic, Gulou District, Fuzhou, Fujian 350003, China;College of Acupuncture and Tuina, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China;Guoyitang Outpatient Department, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350003, China;Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350003, China) |
| Abstract: |
| Pediatric tic disorder is a common neurodevelopmental and neuropsychiatric disorder in children with a prolonged course and frequent recurrence. In Chinese medicine, previous pattern differentiation and treatment have often been based on internal stirring of liver wind. Although this perspective can explain wind-movement symptoms such as tic, head shaking, eye blinking, and throat clearing, it cannot fully elaborate the clinical characteristics of recurrent onset, intermingled phlegm-dampness, emotional disturbances, and spleen and stomach symptoms. The therapeutic principle of "Treating the Middle Jiao as a Balance" originates from Wen Bing Tiao Bian (Treatise on Differentiation of Warm Diseases) by WU Jutong. Although it was initially formulated as a therapeutic rule for middle-jiao patterns in warm diseases, its core implication is not confined to the category of warm diseases. Rather, it emphasizes the dynamic regulation of cold and heat, deficiency and excess, dryness and dampness, and ascending and descending movements, thereby restoring the pivotal balance of the middle jiao. In children, the spleen is often constitutionally insufficient. When the transformation and transportation functions of the middle jiao are impaired, phlegm-dampness may arise internally. The obstruction caused by phlegm-dampness further disrupts the ascending and descending movements of qi, while disordered qi movement may in turn stir liver wind. Consequently, it forms a pathological evolution chain: middle-jiao imbalance-latent phlegm-dampness-adverse qi movement-internal stirring of liver wind-tic attack. "On this basis, the article discusses the theoretical rationale and clinical approach of applying" Treating the Middle Jiao as a Balance" to the pattern-based management of pediatric tic disorder, focusing on the evolution of pathogenesis, therapeutic principles of pediatric tuina, and the application of manual techniques. It proposes that cases characterized by spleen deficiency with latent phlegm should be treated by combining supplementation with unblocking methods to resolve phlegm and free the collaterals; cases with middle jiao stagnation should be managed by regulating qi movement and restoring the proper ascent and descent of qi; and cases with liver-spleen disharmony should be treated by simultaneously moistening dryness and harmonizing the liver and spleen. A representative clinical case is further presented to illustrate the practical application of this approach, with the aim of providing a clinical reference for the external treatment of pediatric tic disorder from the perspective of Chinese medicine. |
| Key words: pediatric tic disorder|Treating the Middle Jiao as a Balance|pediatric tuina|TCM differentiation and treatment|phlegm-dampness|ascent and descent of qi movement |
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