从"治中焦如衡"推拿法辨治儿童抽动障碍OA

Pediatric tic disorder is a common neurodevelopmental and neuropsychiatric disorder in children with a prolonged course and frequent recurrence.In Chinese medicine,previous pattern differentiation and treatment have often been based on internal stirring of liver wind.Although this perspective can explain wind-movement symptoms such as tic,head shaking,eye blinking,and throat clearing,it cannot fully elaborate the clinical characteristics of recurrent onset,intermingled phlegm-dampness,emotional disturbances,and spleen and stomach symptoms.The therapeutic principle of"Treating the Middle Jiao as a Balance"originates from Wen Bing Tiao Bian(Treatise on Differentiation of Warm Diseases)by WU Jutong.Although it was initially formulated as a therapeutic rule for middle-jiao patterns in warm diseases,its core implication is not confined to the category of warm diseases.Rather,it emphasizes the dynamic regulation of cold and heat,deficiency and excess,dryness and dampness,and ascending and descending movements,thereby restoring the pivotal balance of the middle jiao.In children,the spleen is often constitutionally insufficient.When the transformation and transportation functions of the middle jiao are impaired,phlegm-dampness may arise internally.The obstruction caused by phlegm-dampness further disrupts the ascending and descending movements of qi,while disordered qi movement may in turn stir liver wind.Consequently,it forms a pathological evolution chain:middle-jiao imbalance-latent phlegm-dampness-adverse qi movement-internal stirring of liver wind-tic attack."On this basis,the article discusses the theoretical rationale and clinical approach of applying"Treating the Middle Jiao as a Balance"to the pattern-based management of pediatric tic disorder,focusing on the evolution of pathogenesis,therapeutic principles of pediatric tuina,and the application of manual techniques.It proposes that cases characterized by spleen deficiency with latent phlegm should be treated by combining supplementation with unblocking methods to resolve phlegm and free the collaterals;cases with middle jiao stagnation should be managed by regulating qi movement and restoring the proper ascent and descent of qi;and cases with liver-spleen disharmony should be treated by simultaneously moistening dryness and harmonizing the liver and spleen.A representative clinical case is further presented to illustrate the practical application of this approach,with the aim of providing a clinical reference for the external treatment of pediatric tic disorder from the perspective of Chinese medicine.