关键词: 强迫样抽动障碍, 五神理论, 病机, 临证经验

Abstract:

Obsessive-compulsive tic disorder, as a special clinical phenotype of tic disorders, has not received sufficient attention regarding its unique pathogenic characteristics and treatment difficulties. Based on the theory of the Five Spirits in traditional Chinese medicine(TCM), this article primarily explains the TCM pathogenesis of this disease and proposes a treatment strategy centered on regulating the spirit. The Five Spirits in humans are responsible for consciousness control, decision-making, memory and thinking, instinctive sensations and habitual actions, and willpower and determination, jointly maintaining the overall balance of "spirit-body-movement-thought". The pathogenesis of obsessive-compulsive tic disorder begins with the disturbance of heart and mind and obscured heart monarch; subsequently, the liver Hun loses its control, resulting in abnormal movement and wind generation, manifested as involuntary tics; as the condition progresses, the lung Po fails to govern, leading to abnormal regulation of actions and habits, forming stereotyped behaviors; its root cause lies in the failure of the spleen Yi to be stored and the retention of thoughts unable to dissipate, and that the kidney Zhi is not firm and lacks a foundation, causing persistent obsessive thoughts and making the condition difficult to heal. Therefore, the core pathogenesis of this disease lies in the disorder of the Five Spirits. Treatment should be based on regulating the spirit as the cardinal principle, coordinating body and spirit, and taking both the symptoms and the root causes into account. Through methods such as calming the spirit to stabilize Zhi, soothing the liver to extinguish wind, consolidating the lungs to settle Po, strengthening the spleen to store Yi, and filling the essence to solidify Zhi, the normal state can be restored where the Five Spirits perform their respective functions and are coordinated in an orderly manner. This article also presents a case of treatment for obsessive-compulsive tic disorder by Professor Chen Yuyan, in which the diagnosis and treatment process based on the Five Spirits syndrome-differentiation is described in detail, aiming to provide a new theoretical perspective and practical reference for the differentiated treatment of this disease with traditional Chinese medicine in clinical practice.

Key words: Obsessive-compulsive tic disorder, Five Spirits theory, Pathogenesis, Clinical experience