Multiple tic disorder is a chronic abnormal mental behavior disorder in childhood, the cause of which is still unclear. The disease has been classified as “slow-onset wind” and “liver wind” by traditional Chinese medicine practitioners based on its clinical manifestations. In recent years, with the increasing understanding of this disease, there are more and more clinical reports on the dialectical treatment of pediatric hyperactivity in Chinese medicine, and the etiology and pathogenesis of the disease have been elaborated. Throughout its clinical manifestations, combined with long-term clinical experience, the author believes that phlegm and wind are closely related to the condition of polycythemia vera. Feng Bin, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine 1. phlegm gathering and wind movement, pathogenesis evolution 1.1 phlegm gathering is the initiating cause of hyperactive tic disorder The spleen of children is often deficient, if they like to eat fatty, sweet, thick and greasy, small foods, etc. or are injured by diseases or emotions, resulting in loss of spleen health. “The spleen is the source of phlegm, and the spleen is responsible for the transport of water and dampness, which accumulates as water, and water accumulates as drink, and drink condenses into phlegm. According to Han Xue [2], most children with this disease have symptoms of spleen deficiency, such as tiredness and weakness, yellowish complexion, poor appetite, and paranoia in diet; while spleen deficiency cannot properly transport phlegm and dampness, and phlegm and dampness are internally generated, and the meridians are blocked, leading to liver wind and twitching symptoms. “Phlegm is a tangible yin evil, sticky in nature, cohesive in the body, with qi rising and falling in and out of the body, up against the clear orifices, then blinking eyes and eyebrows, nose twitching, pouting; up against the throat, then throat clearing, throat abnormalities, obscene words; flowing meridians, then limbs stereotypical twitching; phlegm blocking the heart, the mind is blinded, then inattentive, behavior If phlegm is blocking the heart and mind, the mind and spirit are clouded, then the concentration is not good and the behavior is strange. Thus, the flow of phlegm through the internal organs and the meridians of the limbs leads to various clinical manifestations of tic disorder, and is an important pathological factor in the recurrence and persistence of the disease. The main pathological mechanism is the delusional movement of wind and phlegm. 1.2 Wind movement is the main cause of multiple tics. The liver is the organ of wind and wood, the body of yin and use of yang, the main drainage. One of the physiological characteristics of children is that the liver often has excess, and if phlegm blocks the meridians leading to poor qi flow, the depression will turn into fire and lead to liver wind. The “Straight Guide to Pediatric Medicine – Liver Wind” says: “All diseases, whether new or prolonged, lead to liver wind.” Liver Qi stagnation can turn into fire and hurt Yin, Yin blood dark depletion, Yin deficiency blood less able to moisten the liver meridian, Yin deficiency wind moving. “Wind is a Yang evil, and its nature is good at moving and changing several times”, and internal wind is the pathological basis of tic attacks, and external wind can lead to internal wind, with a series of symptoms such as frequent blinking, facial muscle twitching, pouting, chest puffing, and limb twitching. According to Liu Bichen [4], the pathology of multiple twitching disorder is located in the liver. If there is excess liver hyperactivity and insufficient yin and fluid, the liver wind may move inside or feel external evil, and the external wind may lead to the internal wind, and the internal and external winds interact with each other to cause twitching symptoms. The “Ancient and Modern Medical System” cloud: “The spleen and earth are weak, the liver and wood take advantage of it, so the tendons contract and make convulsions.” If the liver is hyperactive for a long time and the liver wood is strong, it will overcome the spleen earth, but the spleen is weak and cannot effectively restrain the liver wood, so the liver wood becomes more hyperactive and uncontrolled, and the liver wind gradually rises, and the liver wind carries phlegm, so the twitching of the head, face and limbs is seen. Therefore, Wang Kentang said in the book “The Standard Rules for the Treatment of Disease – Juvenile Section – Slow Fright”: “Water gives birth to liver wood, and wood is transformed by wind, and wood grinds spleen earth. The stomach is the internal organs of the spleen, so there is wind in the stomach, and blending S is gradually born. 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 main reason for this is that the symptoms of the disease are not only the result of the disease, but also the result of the disease. The clinical treatment of multiple tics requires evidence-based treatment based on deficiency and reality. For example, in cases of spleen deficiency and phlegm aggregation, the common accompanying symptoms are atrophy, loss of appetite, loose or dry stools, light red tongue, white greasy moss, and weak pulse, the treatment is to strengthen the spleen and resolve phlegm, which is the essence of phlegm treatment. The commonly used drugs are Fu Ling, Atractylodes macrocephala, Radix Codonopsis pilosulae, Chen Pi, Fu Ling, etc. Ma Rong [7] believed that pediatric tic disorders are caused by the lack of healthy movement of the spleen, the internal growth of phlegm and dampness, and the internal movement of liver and wind, and were treated with Er Chen Tang with addition and subtraction, with good results. In cases of phlegm-degenerated heat, the common concomitant symptoms are phlegm in the throat, irritability and thirst, sleep disturbance, constipation, short and red urine, red tongue, yellow and greasy coating, and slippery pulse. If the phlegm is dissolved, water and dampness will circulate smoothly and the twitching will stop. He Shaoqi [8] observed that phlegm in pediatric hyperactivity is due to the coalescence of fire and fluid, and clinical treatment is based on the addition and subtraction of Huanglian Wenchu Tang. 2.2 Resting the wind is the law of pediatric hyperactivity from the beginning to the end of pediatric hyperactivity. The liver of children often has a surplus, if the parents spoil, impulsive and capricious or learning pressure, emotional problems, liver qi is not relaxed, qi depression and fire cause wind movement, if due to external sensation and other factors, and often can lead to internal wind. The “disease cause pulse treatment・external phlegm disease” said: “the cause of wind and phlegm, external wind, attack into the muscle surface, bundle its internal fire, can not be released, the external evil in the internal, internal and external fumigation, then the wind and phlegm of the evidence to carry on”. Liver depression into fire, burning liver yin, and over time, yin deficiency wind movement. In the case of external wind movement, there is often a history of allergic rhinitis and recurrent respiratory tract infections, commonly accompanied by nasal congestion, runny nose, sneezing, cough, fever, red throat, etc. The tongue is red, the moss is thin yellow or thin white, the pulse is floating, and the treatment is to relieve the surface of the wind. In cases of liver hyperactivity, the common accompanying symptoms include hyperactivity, irritability, headache, dizziness, redness of the face and eyes, red tongue, white or yellow fur, string or string pulse, the treatment is to calm the liver and calm the wind. In cases of yin deficiency and wind movement, and in those with prolonged illness, blood-stasis activating drugs such as angelica and chuanxiong can be used as appropriate. Zeng Xiangyun [9] divided the disease into four types: hyperliver and wind-driven evidence, phlegm and fire disturbing the mind, spleen and liver deficiency, and yin deficiency and wind-driven evidence; in the treatment of the four evidence, the rule of resting wind is always implemented. Xuan Guiqi treats paediatric polydactyly by dialectical treatment. If the twitching is caused by external wind, the main treatment is to remove the wind; if the twitching is caused by internal wind, the treatment is to rest the wind; if the blood is stasis, the treatment is to activate the blood and remove the stasis [10].3. The child had been treated with haloperidol and other drugs, and the child’s symptoms were reduced, but the family discontinued the drugs on their own due to concerns about the side effects of western drugs. 3 months ago, the symptoms worsened again, accompanied by hyperactivity and inattention. He had poor appetite and a yellowish complexion. On examination: frequent blinking, twitching at the corners of the mouth, throat clearing, inattentiveness, hyperactivity, poor food intake, loose stools, light red tongue, white greasy coating, smooth pulse. The pathogenesis of the disease is spleen deficiency and liver hyperactivity, and the pathogenesis of the disease is spleen loss of health, phlegm and turbidity, which block the qi flow and lead to throat clearing and mouth twitching. The treatment is to strengthen the spleen, resolve phlegm and calm the liver and wind. The formula is based on Si Jun Zi Tang and Si Wei San, plus or minus 10 doses, one dose a day with water. At the second consultation, the child’s twitching and other symptoms were reduced, so he added 10g of Yuan Zhi and took 30 more doses. Considering that the long-standing disease has entered the ligament, we added 10g of Salvia miltiorrhiza and removed the whole scorpion, and continued to take it for about 3 months.