脾虚肝旺型抽动障碍中医与现代生物学研究进展

Research Progress on Tic Disorder of Spleen Deficiency and Liver Hyperactivity Pattern in Traditional Chinese Medicine and Modern Biology

摘要: 本文系统梳理了近10年关于脾虚肝旺型儿童抽动障碍的中医理论、临床治疗及现代生物学机制的研究进展。首先，探讨了脾虚肝旺证型在儿童抽动障碍中的高发性和辨证价值，并分析了该证型的病因病机和辨证标准化研究。其次，总结了经典方剂加减应用和中药作用机制推测的研究进展，并介绍了针灸与推拿在该证型中的应用。然后，探讨了神经递质与神经环路异常、脑肠轴与肠道微生物、免疫–炎症机制以及代谢组学与生物标志物等方面的研究进展。最后，通过证治–生物学关联分析和中药复方的多靶点调控证据，强调了从“调和肝脾”入手的中西医结合策略的转化医学潜力，并呼吁进行标准化的证候生物学研究。然而，当前研究存在局限性，包括缺乏大样本、多中心、纵向的证型–生物学随访研究和动物模型的不完善。未来研究方向包括建立基于肠道菌群–代谢组–神经影像的多模态诊断模型和探索饮食调理联合益生菌的辅助治疗价值。

Abstract: This article systematically reviews the research progress on the Chinese medicine theory, clinical treatment, and modern biological mechanisms of Tourette syndrome in children with spleen deficiency and liver hyperactivity over the past decade. Firstly, it explores the high prevalence and diagnostic value of the spleen deficiency and liver hyperactivity syndrome in children with Tourette syndrome, analyzes the etiology and pathogenesis of this syndrome, and discusses the standardization of diagnosis. Secondly, it summarizes the research progress on the application of classic prescriptions, the speculated mechanism of action of Chinese herbal medicines, and the use of acupuncture and massage for this syndrome. Then, it discusses the research progress on abnormal neurotransmitters and neural circuits, the gut-brain axis and gut microbiota, immune-inflammatory mechanisms, and metabolomics and biomarkers. Finally, through the analysis of syndrome-biological correlation and evidence of multi-target regulation by traditional Chinese medicine compound prescriptions, it emphasizes the potential of integrating traditional Chinese and Western medicine strategies starting from “harmonizing the liver and spleen”, and calls for standardized syndrome-biological research. However, current research has limitations, including the lack of large-scale, multi-center, longitudinal syndrome-biological follow-up studies and imperfect animal models. Future research directions include establishing a multimodal diagnostic model based on gut microbiota-metabolomics-neuroimaging and exploring the auxiliary therapeutic value of dietary regulation combined with probiotics.