Multiple tic disorder is also known as tic-arousal 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 the limbs and trunk appear, such as trunk twisting, throwing movements, kicking feet, etc. 30% to 40% of the children make repetitive violent and meaningless monotonous sounds, such as barking, laryngeal sounds and coughing, due to twitching of the pharyngeal muscles. 85% of the children have mild to moderate behavioral abnormalities. About half of the children may also have attention deficit hyperactivity disorder. The twitching is worse 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 etiology of multiple tics is multifaceted and is related to congenital endowment deficiency, birth injury, asphyxia, exposure to external evil, and emotional and mental disorders. 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 has wind very ” pointed out: “where the disease or new or long, all lead to liver wind, the wind moved 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 let, so the eyes even blink also.”
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, the liver wind, disturbing 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 turns into fire, depleting Yin essence, liver blood deficiency, loss of nourishment of tendons and veins, and internal movement of false wind, so the head is stretched and the brain is shrunken, and the limbs tremble.
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, retention of water and dampness, gathering liquid into phlegm, phlegm and qi are intertwined, congestion in the chest, the heart and mind are overwhelmed, then 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.
Yin deficiency and wind movement: Insufficient real yin in the body, or fever that injures yin, or liver disease and kidney, deficiency of kidney yin, water does not contain wood, and wind moves inside, so the head shakes and limbs twitch. If Yin is deficient, fire is vigorous, wood and fire punish gold, lung Yin is damaged, gold sounds abnormally, so the larynx makes strange sounds.
1.Clinical diagnosis
(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. Identification and treatment
Identifying the evidence is based on the eight principles of identification, with emphasis on the identification of yin, yang, deficiency and reality. The symptoms of the 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 gas-depression and fire, the disease is mostly characterized by hyperactivity of liver and yang, 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, with yellow face and thin body, chest tightness and cough, irregular twitching, and white tongue with white coating or greasy coating; in the case of yin-deficiency and wind-deficiency, the disease is characterized by deficiency of liver and kidney, which is a deficiency, 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 calming the liver and quenching the wind. In cases of qi stagnation and fire, it is advisable to clear the liver and diarrhea the fire, quench the wind and calm the panic. 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.
Classification of evidence and treatment
(1) Qi stagnation and fire symptoms red face and ears, irritability, frowning and blinking, open mouth, shaking head and shrugging 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 the liver and quench the 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) Symptoms of spleen deficiency and phlegm aggregation: 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, erratic seizures, temperamental misbehavior, restless sleep at night, little appetite, pale tongue, white or greasy coating, 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 Sempervisia 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) Symptoms of Yin deficiency and wind movement The body is thin, the cheekbones are flushed, the five hearts are hot and bothered, the temperament is impatient, obscene words come out of the mouth, squeezing the eyebrows and blinking the eyes, shrugging the shoulders and shaking the head, the limbs tremble, sleep is restless, the stool is dry, the tongue is red and vivid, the tongue coating is bare and the pulse is fine.
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 restless, palpitating, add Fu Shen, hooked vine, fried jujube seeds 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.
3.Other therapies
Prepared Chinese medicines.
(1) Angelica Long Huo Wan: 2 to 3g per serving, 2 to 3 times a day. Used for qi stagnation and fire evidence.
(2) Di Qing Wan: 3~5g per dose, 2~3 times a day. Used for Qi stagnation and fire.
(3) Amber Pill: 1 pill per dose, 2 times a day. Used for spleen deficiency, phlegm aggregation and phlegm-heat.
(4) Qiju Dihuang Wan: 3-6g per serving, 2-3 times a day. For yin deficiency and wind movement evidence.
Tuina therapy: pushing the spleen earth, rubbing the spleen earth, rubbing the five finger joints, transporting the internal eight trigrams, dividing yin and yang, pushing the upper three gates, rubbing the Yongquan and the foot three li.
Acupuncture therapy.
(1) body acupuncture: main points: Taichong, Fengchi, Baihui. Supporting points: Yin Tang, Ying Xiang, Si Bai, Di Cang, Neiguan, Feng Long, Shen Men.
(2) Ear acupuncture: subcortical, Shen Men, heart, liver, kidney, 2 to 3 points each time. Ear acupuncture points are buried 2 times a week. Pressure can be applied 2 to 3 times a day for 5 minutes each time.
4.Prevention and conditioning
Prevention
(1) 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 living habits.
(2) Do not eat spicy and hot food or exciting and stimulating drinks.
Care
(1) Care and love for the child, patiently explain the condition, give comfort and encouragement, do not exert mental pressure, do not scold or physically punish.
(2) Eat a light diet and do not consume excitatory or stimulating beverages.
(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.