Tic disorder in children is called multiple tic disorder, also known as tic-obstruction syndrome, vocal and multiple motor combined tic disorder. The clinical features are: rapid, repeated and irregular twitching of expression muscles, neck muscles or upper limb muscles, manifested as squeezing eyes, pouting, frowning, shaking head, tilting neck, lifting shoulders, etc.; later the symptoms worsen and explosive involuntary movements of limbs and trunk appear, such as trunk twisting, throwing movements, kicking feet, etc. 30-40% of children make repetitive violent and meaningless monotonous strange sounds, such as barking, laryngeal sound and coughing, due to pharyngeal muscle twitching. 85% of the children have mild to moderate behavioral abnormalities. About half of the children may also have attention deficit hyperactivity disorder. The twitching increases during stress and disappears after sleep. The child’s intelligence is not affected. The onset of the disease is between 2 and 15 years of age, and the duration of the disease is long and may resolve or worsen on its own. The incidence is not seasonal and is about 3 times higher in boys than in girls.
The disease is related to the phlegm and wind evidence in Chinese medicine, and can be classified as slow-onset wind, convulsions, concoction S, tendon tigers and flesh p, etc. The “Guidelines for the Treatment of Evidence? The Young Branch? The “slow panic”: “Water gives birth to liver wood, wood is windy, wood grinds spleen earth, the stomach is the internal organs of the spleen, so there is wind in the stomach, and blending S gradually. The symptom of the concoction is that the two shoulders are slightly shrugged, the two hands are drooping, and sometimes the movement is incessant, which is called slow alarm.”
The clinical research of Chinese medicine and acupuncture for the treatment of this disease has been widely carried out, and the clinical effect is good.
[Etiology and pathogenesis]
The etiology of multiple tics is multifaceted, and is related to congenital endowment deficiency, birth injury, suffocation, feeling external evil, emotional and mental disorders, etc. It is mostly triggered by the excess of the five wills and the internal accumulation of wind and phlegm. The disease is mainly located in the liver and is closely related to the heart, spleen and kidney. Because the liver is Yin and Yang, it is the organ of wind and wood, the main collector of blood, and likes to be regulated and drained, its sound is call and its change is grip. liver have wind very ” pointed out: “all disease or new or long, all lead to liver wind, wind moving and on the head and eyes, the eyes belong to the liver, liver wind into the eyes, up and down, left and right like the wind blowing, not light or heavy, the child can not any, so the eyes even blink also.”
1, gas depression into fire “people have five organs into five gas, to produce joy, anger, sadness and fear.” The liver is the main drainage, nature likes to strip, if the mood is out of tune, the five organs out of harmony, the qi is not smooth, depressed for a long time into the fire, heart fire within the disturbance, led to the liver wind, on the disturbance of the clear orifices, then see frowning and blinking, open mouth crooked mouth, shaking head and shrugging shoulders, the mouth out of a different sound obscene language. Qi depression into fire, depletion of Yin essence, liver blood deficiency, loss of nourishment of tendons and veins, and internal movement of false wind, so the head is stretched and shrunken, and the limbs are trembling.
2.Spleen deficiency and phlegm gathering Insufficient endowment or loss of nourishment after illness, damage to the spleen and stomach, spleen deficiency and lack of transportation, water and dampness retention, gathering liquid to form phlegm, phlegm and gas interconnection, congestion in the chest, the mind is blinded, the chest is stuffy and irritable, the temper is perverse, the throat makes strange sounds; the spleen is the master of muscles and limbs, spleen deficiency is liver vigor, liver wind carries phlegm up and away, so the head, limbs and muscles twitch.
3, Yin deficiency and wind movement, or fever injury to Yin, or liver disease and kidney, kidney Yin deficiency, water does not contain wood, the wind is moving, so the head shaking limbs twitch. Yin deficiency is fire vigor, wood and fire penalize gold, lung yin is damaged, gold sounding abnormally, so the larynx makes strange sounds.
Clinical diagnosis
1.Diagnostic points
(1) The age of onset is between 2 and 15 years old.
(2) There are recurrent involuntary repetitive, rapid, purposeless movements involving multiple groups of muscles.
(3) Multiple articulatory twitches.
(4) May be controlled by the will for minutes to hours.
(5) Symptoms may fluctuate over several weeks or months.
(6) The duration of the disease lasts at least 1 year.
2.Differential diagnosis
Transient tic disorder: Also known as tic disorder, it is common from 4 to 6 years old. Often only a group of muscle twitches, such as blinking, frowning, showing teeth or coughing. There are often some triggers before the onset of the disorder, which is generally mild and has a good prognosis. However, there is no strict boundary between this disorder and polydactyly, and some children can develop polydactyly.
Identification and treatment
1. The identification of evidence is based on the eight categories of evidence, with emphasis on the identification of yin, yang, deficiency and reality. The symptoms of this disease are wind, fire, phlegm and dampness, while the origin is in the liver, spleen and kidney, especially the liver. Often the three organs are combined, deficiency and reality are seen together, wind, fire, phlegm and dampness coexist, and there are many variations. In the case of Qi-depression and fire, the disease is mostly characterized by hyperactivity of the liver and Yang and internal disturbance of the heart fire, which is a real evidence, with red face and ears, impatience and irritability, frequent twitching, and red tongue with yellow coating; in the case of spleen deficiency and phlegm aggregation, the disease is characterized by deficiency and mixed deficiency and reality, with yellow face and thin body, chest tightness and cough, irregular twitching, and light tongue with white coating or greasy coating; in the case of yin deficiency and wind-dampness, the disease is characterized by deficiency of the liver and kidney, which is a deficiency evidence, with thin body, flushed cheeks, weak twitching, and red tongue with little coating.
The treatment of multiple tics is based on the basic principle of pacifying the liver and quenching the wind. For those who have a deficiency of qi and fire, it is advisable to clear the liver and diarrhea the fire, quench the wind and calm the panic; for those who have a deficiency of spleen and phlegm, it is advisable to strengthen the spleen and resolve the phlegm, calm the liver and quench the wind; for those who have a deficiency of yin and wind, it is advisable to nourish yin and submerge the yang, soften the liver and quench the wind. This disease comes and goes slowly. The most important thing is to keep the law and the prescription. The disease can be relieved if the phlegm is removed, the wind and fire are extinguished, the tendons and veins are moistened, and the dirty qi is calmed. If the method is only forced to make it quiet, it is difficult to cure. It is always advisable to start with the symptoms before the root, or to take both the symptoms and the root into account.
3.Category of evidence and treatment
(1) Qi stagnation and fire
Symptoms red face and ears, irritability, frowning and blinking, open mouth, shaking head and shoulders, frequent seizures, strong twitching, strange and obscene speech, constipation, short and red urine, red tongue with yellow coating and string pulse.
The evidence is characterized by acute onset and short duration of illness, red face and red ears, irritability, frequent seizures, strong twitching, red tongue with yellow coating and string pulse. In cases with phlegm fire, the patient is foul-mouthed and cursing, unpredictable anger, restless sleep, red tongue with yellow fur and slippery pulse.
Treatment To clear the liver and diarrhea the fire, quench the wind and subdue fright.
Radicals: Clearing the liver and draining fire, quenching wind and calming fright. Commonly used drugs; Gardenia, Chrysanthemum, Dampi to clear liver fire; Chai Hu, Peppermint, Green Orange Leaf to relieve liver depression; Hooked Vine, White Peony, Cicada to calm liver and quench wind; Amber, Poria to calm the mind and tranquilize the spirit; Licorice to harmonize all drugs.
If the liver fire is strong, add gentian herb to clear the liver fire; if the stool is constipated, add hammerhead and guadua nut to smooth the qi and guide the stagnation; if the mood is uncertain and there is phlegm in the throat, add zhebei mother and bamboo rhizome to clear the phlegm heat.
(2) Spleen deficiency and phlegm gathering
Symptoms: Yellow face and thin body, mental discomfort, coughing in the chest, sound in the throat, frowning and blinking, twitching at the corners of the mouth, shaking of the limbs, unpredictable seizures, perverse temper, restless sleep at night, little appetite, pale tongue, white or greasy moss, sunken smooth or sluggish pulse.
Identification This evidence is characterized by yellow face and thin body, mental inactivity, chest tightness and less food, pale tongue with white or greasy coating and slippery pulse.
Treatment To strengthen the spleen, resolve phlegm, calm the liver and quench the wind.
Radicals: Ten Flavors Warming Gall Bladder Soup with Addition and Reduction. Commonly used herbs: Radix Codonopsis and Poria invigorate the spleen and help transport; Chen Pi and Semen Parsley dry dampness and resolve phlegm; Citrus aurantium smooths phlegm and eliminates phlegm; Yuan Zhi and Jujube Ren resolve phlegm and calm the heart; Hooked vine, White peony and Stone cassia calm the liver and quench the wind; Licorice harmonizes all herbs.
In case of very high phlegm-heat, remove the half-xia, add Huang Lian and Gua Pou Pei to clear the phlegm-heat; in case of low appetite, add Shen Qu and Mai Mai to regulate the spleen and appetite.
(3) Yin deficiency and wind movement
Symptoms: emaciation of the body, flushing of the cheekbones, irritability of the five hearts, impatience, obscene speech, squeezing of the eyebrows and blinking of the eyes, shrugging of the shoulders and shaking of the head, trembling of the limbs, restless sleep, dry stools, red and vivid tongue, bare tongue coating, and fine pulse.
Identification The evidence is characterized by emaciation of the body, flushing of the cheekbones, irritability of the five hearts, red and reddish tongue, bare and flaky tongue coating, and fine pulse.
Treatment To nourish Yin and submerge Yang, soften the liver and quench the wind.
Prescription: Add and subtract Da Ding Feng Zhu. Commonly used herbs: turtle plate, turtle shell and raw oyster nourish Yin and subdue Yang; raw earth, aconite, chicken seed yellow, maitong, hemp seed and white peony soften the liver and quench the wind; licorice harmonizes the herbs.
If the heart is unstable, palpitating, add Fu Shen, hooked vine, fried date palm to nourish the heart and calm the mind; if the blood is deficient, add He Shou Wu, Yu Zhu, Sha Yuan Zi, Tian Ma to nourish the blood and soften the liver.
Chinese medicine is more effective, but needs to be taken for a long time.
Other therapies
1.Chinese herbal medicines
(1) Danjuania Easy-going Pill, used for Qi stagnation and fire evidence.
(2) Qiju Dihuang Wan, used for yin deficiency and wind movement evidence.
(3) Long Mu Zhuang Bone Granules, Blue Scutellaria Oral Liquid, used for spleen deficiency and heat.
2.Tui Na therapy
(1) Under the age of three years, we use the Three Character Classic School of Pediatric Tuina, which is effective in identifying the evidence and taking acupuncture points.
(4) Children above three years old commonly use the point method of the internal organs chart, with good effect.
This disease is treated by Tui Na method, with short treatment course, no side effects, and children are happy to accept it, avoiding the suffering of long-term medication. It is the best treatment for this disease.
3.Acupuncture therapy
(1) Body acupuncture: qi depression and fire: Xingma, Shaofu, Baihui, Fengchi. Spleen deficiency phlegm gathering: foot three miles, spleen Yu, Fenglong, Taichong, Baihui, Fengchi. Yin deficiency and wind movement: Taichong, Taixi, Kidney Yu, Baihui, Fengchi.
Longer treatment course, more painful, effective.
(2) Ear acupuncture: subcortical, Shen Men, heart, liver, kidney, 2 to 3 points selected each time. Ear acupuncture point buried needles, 2 times a week. Can be pressed 2 to 3 times a day, 5 minutes each time, the effect of mild disease can be.
4.Western medicine treatment
(1) Oral creatinine, VB6, need to be taken for a long time, the effect of mild cases can be.
(2) The most commonly used drugs recognized as more certain are haloperidol, Tebri, thiopiridol, and so far haloperidol is still the drug of choice for the treatment of this disease (75% effective). It is usually started at 0.25mg each time, twice a day, and can be gradually increased to 2-4mg/d. It needs to be taken for a long time and has more side effects.
Prevention and care]
1.Prevention
(1) Usually pay attention to reasonable upbringing, and pay attention to the psychological state of children to ensure that children have a regular life and cultivate good habits.
(2) Do not eat spicy and hot food or exciting and stimulating drinks.
2.Adjustment of care
(1) Care and love for the child, patiently explain the condition, give comfort and encouragement, do not exert mental pressure. Parents should do everything possible to create conditions that allow the child to live in an atmosphere of calm and confidence. No matter how irritating his actions are, neither pay attention to his appearance, nor scold, physically punish, imitate, or make fun of him. It is very important for parents to maintain a calm state of mind, because parental tension and anxiety will invariably cause a lot of psychological stress to the child, which in turn will aggravate the condition. In addition, parents should communicate with the teacher in a timely manner, so that the teacher can cooperate to encourage the child more, do not criticize the child for his abnormal movements.
(2) Eat a light diet, eat locally produced food in season, try to control snacking, and do not consume excitatory and stimulating drinks.
(3) Pay attention to rest, do not watch tense, thrilling, exciting film and television programs, should not watch television, play computer and game consoles for a long time.
Finally, parents and friends are reminded that
As long as parents know how to treat their children correctly, their children’s tics will definitely disappear on their own. It is now believed that children with tic disorder, the symptoms of which are mild, can be relieved on their own and generally do not require medication. If the symptoms are severe, massage and Chinese herbal medicine are preferred and should not be used indiscriminately.
Please treat your child with tic disorder as a normal child and do not mention his abnormalities frequently.