基于"风动内扰"病机探讨从肝论治原发性震颤OA

Essential tremor(ET)is characterized mainly by action tremor.In traditional Chinese medicine(TCM),its shaking manifestations may be understood within the category of tremor syndrome,but the presence of movement alone does not justify attributing the disorder directly to liver wind."Stirring wind with internal disturbance"is not an independent pattern.Rather,it refers to recognizing internal wind from the tremor manifestation and then examining its source in light of accompanying symptoms,tongue and pulse manifestations,and the overall pattern.The existing studies on the TCM patterns in ET mostly identify the liver and kidney as the disease-location elements and yin deficiency and stirring wind as the disease-nature elements.However,its pattern terminology and classification remain inconsistent,and the available research findings are insufficient to establish a stable ET-specific pattern differentiation system.Dysregulation of liver qi,hyperactivity of liver yang,deficiency of liver blood,and deficiency of liver yin may all be involved in the development of stirring wind,while tremor may also occur with phlegm-heat disturbance,qi and blood deficiency,marrow sea insufficiency,or yang qi exhaustion.The pathogenic role of the liver therefore varies among distinct patterns.When treating ET from the liver,it is imperative to differentiate whether the disturbances of liver qi,blood,yin,or yang directly participate in the development of stirring wind and whether they take on a primary or secondary role in a specific pattern.When the liver-related pathogenesis predominates,its treatment should focus on regulating the liver.When it acts as a secondary cause,it should be addressed as appropriate to the pattern.If the disease is not predominantly caused by the liver-related disturbances,its treatment should target the core pathogenesis.The available clinical evidence for treating ET from the liver is mostly based on small sample observations and empirical reports,while its basic and mechanistic studies remain limited,and a vast space is left for further exploration to clarify the applicable scope of this approach and its clinical value.