| Objective:1.To investigate the distribution of traditional chinese medicine(tcm)syndromes of tic disorder with anxiety in children,so as to provide reliable basis for clinical treatment of tic disorder based on syndrome differentiation.2.To observe the clinical efficacy and safety of the method of soothing liver and purging heat,as well as tranquilizing and tranquilizing mind for the intervention of qi-stagnation-fire-type tic disorder with anxiety in children,so as to provide a safe and effective treatment idea of TCM for clinical practice.Method:1.A cross-sectional study was used to select 120 children who visited the Pediatric Encephalopathy Clinic in the First Affiliated Hospital of Tianjin University of Chinese Medicine from January 2021 to January 2022 and had tic disorder accompanied by anxiety state.The TCM syndrome questionnaire for tic disorder accompanied by anxiety state was filled in,including general information,main TCM syndromes and personality bias,to determine the TCM syndrome types,and the collected information was entered into Excel to establish a database.SPSS 26.0 software was used for frequency and frequency statistical analysis,and SPSS Modem software was used for association rule analysis to summarize the general situation,main clinical symptoms,personality characteristics and distribution of TCM syndromes of children with tic disorder accompanied by anxiety.2.A prospective study was used to select 62 children with tic disorder accompanied by anxiety(qi-stagnation and fire-melting syndrome).they were treated with the prescription of soothing liver,purging heat,and tranquilizing mind.the treatment lasted for 9 weeks.the children were evaluated before the treatment(week 0),after three weeks of treatment(week3),after six weeks of treatment(week 6),and after treatment(week 9).the Yale comprehensive tic severity scale score,the TCM syndrome classification quantification scale score and the children’s anxious mood screening scale score were observed and compared before and after the treatment,and the adverse reaction events were recorded.the statistical data were processed and analyzed by SPSS 26.0 software To analyze the clinical efficacy and evaluate the safety of the method of soothing liver and purging heat as well as tranquilizing mind in the treatment of tic disorder accompanied by anxiety in children with qi-stagnation and fire-resolving syndrome.Results:Part Ⅰ:General conditions: A total of 118 children with tic disorder and anxiety were included in the study,with the maximum age of 17 years old and the minimum age of 8 years old,and the average age of 10.48 2.32 years old.There were 91 males and 27 females,with the ratio of male to female being 3.37: 1.96 cases(81.36%)of full-term infants,22 cases(18.64%)of premature infants,84 cases(71.19%)of spontaneous delivery and 34 cases(28.81%)of cesarean section;31 cases(26.27%)had the disease within 0–1 year,23 cases(19.49%)within 1–2 years,30 cases(25.42%)within 2–3 years and 34 cases(28.81%)over3 years.2.TCM Syndrome: The most common top ten items of tic symptoms were blink of an eye,dry cough to clear your throat,single or double syllable abnormal sound from your throat,shaking your head,bulging your stomach,squeezing your eyes,sniffing,shrugging your shoulders,stretching your neck and lifting your arm in sequence.Among them,the most common top five items of motor tic symptoms were blink of an eye,shaking your head,bulging your stomach,squeezing your eyes,and sniffing in sequence.The most common top five items of vocal tic symptoms were dry cough to clear your throat,single or double syllable abnormal sound from your throat,nasal abnormal sound,foul language,and shouting in sequence.The first five items of common concurrent diseases were red tongue,distending pain in hypochondriac rib,dry stool,wiry pulse and bitter mouth in sequence.The first five most common manifestations of emotional bias in sequence were impatience and irritability,timidity and easy to be alarmed,mental tension,paranoia and sensitivity,and restlessness of mind.In terms of the distribution of TCM syndrome types,the most common syndrome of qi stagnation transforming into fire was 62 cases(52.54%),followed by the syndrome of phlegm-fire disturbing spirit 28 cases(23.73%),the syndrome of hyperactivity of liver and stirring wind 18 cases(15.25%),the syndrome of external wind driving 6 cases(5.08%),the syndrome of spleen deficiency and phlegm accumulation 3 cases(2.54%),and the syndrome of yin deficiency and stirring wind 1 case(0.85%).There was no significant correlation in the distribution of TCM syndrome types of tic disorder with anxiety among children with different tic types,tic degrees and course of disease(P > 0.05).Part Ⅱ:1.General conditions: A total of 60 children with tic disorder and anxiety due to qi-stagnation and fire-extinguishing syndrome were included in the study,including 44 boys(73.33%)and 16 girls(26.67%),with the ratio of male to female being 2.75: 1.The maximum age was 17 years old,and the minimum age was 8 years old,with an average age of 10.72 2.34 years old.Fourteen cases(23.33%)had the disease from 0 to 1 year,11 cases(18.33%)from 1 to 2 years,18 cases(30.00%)from 2 to 3 years,and 17 cases(28.33%)from > 3 years.27 cases(45.00%)of children with CTD,19 cases(31.67%)of children with TS,and 14 cases(23.33%)of children with TTD;As for the degree of tic,43 cases(71.67%)were moderate,12 cases(20.00%)were severe,and 4 cases(6.67%)were mild.2.Efficacy analysis:(1)In clinical efficacy analysis,the total YGTSS score,motor tic score,vocal tic score and defect rate score were all decreased after treatment as compared with those before treatment(P < 0.05).Except that the defect rate score reached the plateau after the sixth week of treatment,the changes of scores in other parts showed differences over time(P <0.05).One case(1.67%)was clinically controlled,15 cases(25.00%)were markedly improved,31 cases(51.67%)were effective,and 13 cases(21.67%)were ineffective.The total effective rate was 78.34%;(2)For TCM syndrome curative effect analysis,the total score in TCM syndrome classification quantization scale and the main and secondary symptom scores were all reduced after treatment as compared with those before treatment(P < 0.05),with clinical control in two cases(3.33%),marked effect in 21 cases(35.00%),effective in 33 cases(55.00%),ineffective in four cases(6.67%),and effective rate of 93.33%;(3)For the analysis of curative effect on anxiety state,the total scores of SCARED,somatization/panic,generalized anxiety,separation anxiety,social phobia and school phobia were all reduced after treatment as compared with those before treatment(P < 0.05).Except that the school phobia score reached the plateau after the sixth week of treatment,the changes in the scores of the other parts showed significant differences over time(P < 0.05).There were 22 cases(36.67%)of clinical control,38 cases(63.33%)of effective treatment,and 0 case(100.00%)of ineffective treatment.3.Safety analysis: During the study period,no obvious adverse reactions were observed in the 60 enrolled children,and adverse events occurred in two of them.One case was acute upper respiratory tract infection,and the other case was allergic rhinitis.The symptoms disappeared after symptomatic treatment.According to the integrity evaluation criteria,the intervention safety in this study was grade 2.Conclusion:1.The main clinical symptoms of children with tic disorder accompanied by anxiety are blink of an eye,dry cough to clear your throat,single or double syllable voices out of your throat,shaking your head and bulging your stomach.The concurrent symptoms are mainly red tongue,hypochondriac pain,dry stool,wiry pulse and bitter mouth.The most common emotions for emotional bias are impatience,irritability,and timidity,which are easily alarmed.The most common TCM syndrome type is qi stagnation and fire transformation syndrome.2.Soothing liver,purging heat,and tranquilizing method can effectively improve the tic symptoms of children with tic disorder and anxiety state(qi stagnation transforming into fire syndrome),improve the TCM syndrome to a certain extent,and significantly alleviate the anxiety state.3.The methods of soothing liver,purging heat,and tranquilizing have no obvious adverse reactions in the treatment process,and the curative effect is reliable,thus providing new clinical treatment ideas and methods for the clinical treatment of children with tic disorder accompanied by anxiety state. |
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