Study On The Characteristics Of TCM Syndrome Type Distribution And Medication Rule Of Refractory Tic Disorder In Children

ObjectiveTo explore the distribution of TCM syndrome types and drug use rule of refractory tic disorder in children through retrospective study of clinical cases in outpatient department of pediatric encephalopathy in our hospital.MethodsPatients with intractable tic disorder aged 3 to 18 years old who visited the Department of pediatric Encephalopathy of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from October 2015 to January 2022 were randomly selected,and Microsoft Office Excel 2016 and IBM SPSS Statistics 26 were used.Frequency descriptive analysis,systematic cluster analysis and principal component analysis were performed on the general data and clinical symptoms of the children to preliminatively explore the clinical characteristics and syndrome distribution law of the disease.The effective prescriptions were analyzed using the Traditional Chinese Medicine Inheritance assistance platform(V2.5),and medication experience was summarized through drug frequency statistics,rule analysis,entropy clustering and other methods.Results1.General Information:(1)Age,sex,BMI and educational level of parents: 144 boys(78.7%)and 39 girls(21.3%);63 patients(34.4%)were aged 3-6 years,109 patients(59.6%)were aged 7-12 years,and 11 patients(6.0%)were aged 13-16 years,mainly school-age children.There were 114cases(62.3%)in 1-6 years old,67 cases(36.6%)in 7-12 years old,and 2 cases(1.0%)in13-14 years old,mainly in preschool children.74 children(40.4%)had a BMI within the range of overweight and obesity.Both parents have undergraduate education.(2)Course of disease: The average course of disease was 3.3 years,with 79 cases(43.2%)of 1-2 years,59 years(32.3%)of 3-4 years,30 cases(16.3)of 5-6 years,and 15cases(8.2%)of more than 7 years.(3)Fetal and personal conditions: In the investigation of fetal conditions,169 cases(92.3%)were full-term,9 cases(4.9%)were premature,and 5 cases(2.7%)were overdue;14cases(6.7%)had abnormal health condition at birth and 58 cases(31.7%)had abnormal perinatal condition.There were 129 cases(70.5%)of cesarean section and 54 cases(29.5%)of natural delivery.In the personal investigation,42 children(23.9%)had a history of allergy,25 children(13.7%)had a family history,26 children(14.2%)had a history of allergic diseases,12 children had a history of neurological diseases,10 children(5.5%)had a history of surgical trauma,and 1 child had a history of recurrent respiratory infections.(4)Drug use: The longest time of drug use was 6 years,of which 124 cases(67.7%)took1 to 2 years,36 cases(19.7%)took 2 to 3 years,12 cases(6.6%)took 3 to 4 years,6 cases(3.3%)took 4 to 5 years,and 5 cases(2.7%)took more than 5 years.In the use of western medicine,There were 140(76.5%)thiapride patients,62(33.9%)aripiprazole patients,32(17.5%)haloperidol patients,15(8.2%)clonidine patients,10(5.5%)topiramate patients,8(4.4%)sertraline patients,4(2.2%)debakine patients,2(1.1%)tomoxetine patients,1(0)levetiracetam patients.5%),magnesium valproate 1(0.5%),phenytoin 1(0.5%),clonazepam1(0.5%),risperidone 1(0.5%);In the survey of combined drug use,52 cases(28.4%)had used 2 kinds of western medicine,14 cases(7.7%)had used 3 kinds of western medicine,and6 cases(3.3%)had used 4 kinds of western medicine.(5)Inducing factors: In the investigation of inducing factors,upper respiratory tract infection,strict family discipline,emotional tension and excitement,learning pressure,fatigue,the use of electronic products become the main factors of the onset or aggravation of the disease.(6)Clinical classification: 44 cases(24.0%)of chronic tic disorder and 139 cases(76.0%)of Tourette syndrome were found in this study.(7)Convulsive symptoms: in sports convulsions,blinking has become the most important symptoms of children,followed by neck twisting,tongue,shrug,trunk convulsions,upper limb convulsions,lower limb convulsions,wrist convulsions,frown,clench teeth,finger twitching,ankle twitching,toe twitching less;In vocal convulsions,throat clearing was the main symptom,followed by profanity,mumble,hum,roar,animal bark,repeated language,exhalation was less.2.The distribution of syndromes: through statistical,were included in the high frequency syndrome,49,a frequency of 30% or more syndromes including head face twitched,timid easily frightened,neck shoulder twitch,quick temper,obesity,throat,inattention,limbs twitch,more dynamic to static,pharynx,through the analysis of the refractory tic disorders of preliminary summarized five TCM syndrome type: The syndrome of spleen deficiency and liver swelling combined with dampness(27.3%),phlegm and fire disturbing the spirit(21.3%),wind-heat and wind movement(18.0%),phlegm and gas obstructing(17.5%)and Yin deficiency combined with dampness(15.8%).3.Medication rules:(1)drug frequency: in 214 the first effective prescription of the communist party of China 20 flavour frequency of 60 or more drugs,order from more to less is respectively scorpion,liquorice,rhizoma gastrodiae,rhizoma belamcandae,tinospora,radix scutellariae,chrysanthemum,radix puerariae,radix scrophulariae,keel,oysters,uncaria,feather cockscomb seed,bitter orange,pinellia,radix bupleuri,stone calamus,batryticated silkworm,wheat,jujube.(2)Four qi and five tastes,and meridian return: According to the statistics of five tastes,it was found that sweet medicine accounted for the largest proportion of five tastes,followed by bitter medicine,spicy medicine,salty medicine,sour medicine and astringency medicine;In the statistics of the four qi,cold drugs accounted for the largest proportion,followed by flat drugs,warm drugs,cold drugs,hot drugs;In the statistics,drugs belonging to the liver,lung,stomach and spleen occupy the main body.(4)Drug category statistics: Among all kinds of drugs,heat-clearing drugs were most frequently used(654 times),followed by drugs for calming liver and calming wind(622times),relieving surface(524 times),reducing phlegm,relieving cough and antiasthmatic drugs(437 times),tonifying deficiency drugs(351 times),regulating qi(229 times),tranquilizing drugs(203 times)and dispelling wind and dampness(168 times).Drugs for promoting blood circulation and removing blood stasis(108 times),improving water infiltration and dampness(93 times)and eliminating food(31 times)were rarely used.(5)Usage of prescription: In the frequency of prescription use,the decoction for relieving wind and Stopping vitality reached 48 times(22.4%),accounting for the largest proportion,followed by 46 times(21.5%)for Ditan Decoction,42 times(19.6%)for Yinqiao Powder,and 28 times(13.1%)for Chaihu plus Longbone oyster Decoction.The prescriptions such as Liuwei Dihuang Decoction,Banxia Xiexin Decoction and Zhibai Dihuang Decoction were rarely used.(6)Three pairs of commonly used drug combinations with strong correlation and clinical significance were obtained by association rule drug combination analysis: Gastrodia elata-Scorpion,keel-oyster,Celosia argentea seed-chrysanthemum.Six new prescriptions were obtained by unsupervised entropy hierarchical clustering,and four of them had clinical significance.Conclusion(1)Refractory tic disorder is more common in boys,the onset of pre-school age is more,the average course of disease reached 3.3 years,overweight and obese children accounted for a large proportion of the disease,cesarean section,umbilical cord around the neck,old maternal age and other factors may lead to the disease,Severe discipline for children,parents quarrel,emotional tension or excitement,upper respiratory tract infection,use of electronic products and other factors may be the occurrence or aggravation of refractory tic disorder.(2)The average duration of taking western medicine was 1.7 years,among which tiapride was the most frequently used,and most of the children did not take combination drugs.(3)This study found that the clinical manifestations of refractory tic disorder in children are complex,and Tourette syndrome is the most common.The symptoms include head and face twitching,neck and shoulder twitching,throat clearing,timid and easily frightened,irritable temper,inattention,hyperactivity and difficulty in stillness,etc.(4)Through preliminary analysis,5 common syndromes were found: spleen deficiency and liver heat combined with dampness,phlegm and fire disturbing the spirit,wind-heat moving wind,spittoon and gas obstructing and Yin deficiency combined with dampness.Among them,spleen deficiency and liver heat combined with dampness was the most common,while Yin deficiency combined with dampness was less.(5)The outpatient department of pediatric encephalopathy in our hospital treats the disease mainly from the lung,liver and spleen,and makes good use of the methods of calming the liver and calming the wind,invigorating the spleen and eliminating phlegm,dissipating wind and clearing heat.Besides,the drug is used to regulate qi,tonify deficiency and open stagnation,so the good effect is obtained.