Study On The Distribution And Rules Of Tcm Syndromes Elements And Medicine Of Tic Disorders In Children

Objectives: Based on the syndrome differentiation system of "syndrome elements",the clinical cases of children with tic disorder were cross-sectional investigated,to arrange and analyze the characteristics of syndrome elements and medication rules.To provide a new objective basis for TD syndrome differentiation and treatment,and a reference for the systematic diagnosis and treatment of TCM.Methods:1.Preliminarily drafted the TCM syndrome differentiation item scale.Through a small clinical investigation of 30 children with tic disorder from the Pediatrics Outpatient Department of the Sichuan Provincial Hospital of TCM,the scale of TCM syndrome differentiation items were refined and determined.The children tic disorder clinical case survey scale was finally finished;2.According to the inclusion and exclusion criteria,selecting the cases what collected the general information,four-diagnosis information and Chinese medicine prescriptions of 185 children,which from the Pediatric Clinic of the Sichuan Provincial Hospital of TCM;3.We input all collected data and information into Excel.According to the diagnostic criteria of TCM syndrome elements,syndrome elements were extracted and syndrome names were composed,then build the databases.4.Using SPSS software statistically analyze the data,for the purpose of summarize the general information and the distribution of TCM syndromes elements and herbs in children with tic disorder.Results:1.Results of the general information:Among 185 cases of childhood tic disorder,the male to female ratio was 4:1;the average age of the cases was(7.49±2.73)years,and the highest incidence of school-age children(55.70%),most of the cases first occurred in 4 ～7 years old(69.73%);in the past history,allergic rhinitis(42.70%)has the highest constituent ratio,followed by ADHD(24.32%),and the third is repeated respiratory infections(14.05%);patients without family history have Of the 166 cases,only 10.27% had family history.Among them,there were 15 cases of tic disorder in the third-generation immediate family members,and only 1 case had chorea,frostbite,hepatitis B and epilepsy;the average course of disease was(1.99±1.05)In 2015,the cumulative frequency of the disease course within 5 years was as high as 90.27%;TTD accounted for 42.16% of all cases,CMVT accounted for 26.49%,and TS accounted for 31.35%.The condition of TS was heavier than TTD and CMVT(P<0.05).Among the symptoms of motor tics,there were 166 cases of simple motor tics,74 cases of complex motor tics,and 49 cases of both,in simple motor tics.The top three percentages are blinking(62.16%),slight movement of the eyes,mouth or nose(42.70%),and shoulder shrugging(17.30%);there are 102 cases of vocal tic symptoms,98 cases of simple vocalization,and 8 cases of complex vocalization.There are 3 cases of both.Among the cases with simple vocal symptoms,the proportion of throat-clearing cough is the highest,accounting for 45.41% of the total.2.Results of syndrome elements: A total of 24 effective TCM syndrome factors were extracted,8 disease location syndrome factors,and 16 disease syndrome factors.The disease location syndrome factors from high to low are liver(96.76%),spleen(48.65%),lung(30.81%),surface(29.19%),stomach(11.35%),kidney(10.81%),mind(10.27%)),gallbladder(1.08%).The disease factors from high to low are Qi stagnation(76.22%),heat(65.41%),phlegm(59.46%),dampness(48.11%),blood deficiency(33.51%),yin deficiency(27.03%),Yang hyperactivity(22.70%),external wind(16.76%),qi deficiency(15.14%),moving wind(8.11%),not solid/cold/food accumulation(2.16%),yang deficiency/essence deficiency/drinking(0.54%).Disease location syndrome elements often appear in compound disease locations,and the most frequent occurrences are "liver +spleen + X"(89 cases,48.11%)and "liver + lung + X"(54 cases,29.19%).Syndrome of disease is more common in combination of deficiency and excess.Perform cluster analysis on all syndromes and divide them into six categories: category I: liver,qi stagnation,and heat;category II: spleen,dampness,and sputum;category III: blood deficiency;category IV: lung,surface,and external wind;V Category: Yin deficiency,Yang hyperactivity,and moving wind;Category VI: The rest of the syndromes belong to the first category.The frequency of tic disorder syndrome types from high to low were Qi stagnation and transformation of fire syndrome(52 cases,28.11%),spleen and stomach damp-heat syndrome(37 cases,20.00%),phlegm-heat internal accumulation syndrome(32 cases,17.30%),and external wind.Initiation syndrome(32 cases,17.30%),liver stagnation and blood deficiency syndrome(16 cases,8.65%),spleen deficiency and phlegm accumulation syndrome(13 cases,7.03%),liver and kidney yin deficiency syndrome(3 cases,1.62%).There was no statistical difference in the distribution of syndrome types in different ages,genders,types of tics and the course of the disease(all P>0.05).3.Results of herbs: According to the frequency statistics of TCM categories,the top 8 are anti-epidermic drugs,anti-wind and antispasmodic drugs,heat-clearing drugs,tonic drugs,dampness drugs,phlegm drugs,liver and yang drugs,and qi promoting drugs.According to the frequency,the top five of the four qi are flat,cold,warm,slightly cold,and lukewarm.The five flavors from high to low are pungent,bitter,sweet,salty,and slightly bitter.From high to low,the first five Chinese medicines returning to the meridian are the liver meridian,lung meridian,stomach meridian,spleen meridian and heart meridian.The top 15 traditional Chinese medicines in frequency are Stiff silkworm,Cicada slug,Scorpion,Centipede,Tribulus,Gardenia,White peony root,Agastache,Platycodon grandiflorum,Fructus Aurantii,Pueraria lobata,Almond,Forsythia,Magnolia officinalis,Uncaria.According to clinical experience,Chinese medicines are grouped into four categories.The first category: stiff silkworm,cicada slough,centipede,and whole scorpion;the second category: white peony,terrestris,gardenia,ageratum;the third category: magnolia,almond;the fourth category: kudzu root,uncaria,forsythia,Campanulaceae,Citrus aurantium.The association rules are used to explore the correlation between tic symptoms and traditional Chinese medicine.The minimum support is set to10%,and the minimum confidence is set to 70%.In blinking symptoms,the symptoms are sorted from high to low confidence as horsetail,prunella vulgaris,fangfeng,and green.Fructus argentea,Tribulus terrestris;in the symptoms of mild eye,mouth,or nose movement,with a confidence level of ≥70%,the traditional Chinese medicine is only Xanthium;in the symptoms of throat-clearing cough,it is ranked as perilla leaves,Magnolia,almonds.Conclusions:1.There are more boys than girls suffering from tic disorder.The age group with the highest incidence is school-age children.The age of onset is mostly 4 to 7 years old.The past history is mostly allergic rhinitis,hyperactivity,and repeated respiratory infections,and the course of the disease is prolonged.TS is generally more severe than TTD and CMVT.Motor tics are mainly simple motor tic symptoms such as blinking,slight movement of the eyes,mouth or nose,and shoulder shrugs.The vocal symptoms are mainly simple vocal symptoms such as throat-clearing cough.2.Tic disorder has the characteristics of multiple disease positions and multiple disease.The disease position is mainly responsible for the liver,and is closely related to the spleen and lungs.The disease is often mixed with deficiency and excess,mainly related to stagnation of qi,heat,phlegm,dampness,wind,blood deficiency,and yin deficiency.3.Syndrome types include Qi stagnation transforming fire syndrome,spleen and stomach damp-heat syndrome,phlegm-heat internal accumulation syndrome,and external wind induced syndrome.4.The treatment targets of tic disorders often focus on the liver,lungs,and spleen,calming the liver,relieving spasm,and eliminating evil,as well as strengthening the body.