基于“阴静阳躁”理论探讨补肾填髓中药调控注意缺陷多动障碍“皮质成熟延迟”新模式

倪新强; 胥丹桂; 杨萌; 袁海霞; 郑敏; 韩新民

doi:10.13422/j.cnki.syfjx.20191821

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基于“阴静阳躁”理论探讨补肾填髓中药调控注意缺陷多动障碍“皮质成熟延迟”新模式

学术探讨 | 更新时间：2021-02-09

- 基于“阴静阳躁”理论探讨补肾填髓中药调控注意缺陷多动障碍“皮质成熟延迟”新模式
- New Model of Traditional Chinese Medicine with Effect of Invigorating Kidney and Filling Sea of Marrow in Regulating Delay in Cortical Maturation of ADHD Based on Theory of Steady Yin and Vexed Yang
- 中国实验方剂学杂志 2020年26卷第1期页码：184-190
- 作者机构：
  
  1.深圳市中医院，深圳　 518035
  2.南京中医药大学，南京　 210029
- 作者简介：
  
  [第一作者]　倪新强，博士，助理研究员，从事中医药防治儿童精神神经系统疾病研究，E-mail: nxq13ek@163.com
  *郑敏，副主任医师，从事儿童精神、神经系统疾病研究，E-mail: zhengmin1sz@163.com
- 基金信息：
  
  国家自然科学基金面上项目(81873341);国家自然科学基金青年基金项目(81503616);广东省自然科学基金面上项目(2017A030313749);深圳市科技创新委员会项目(JCYJ20160428105935612);江苏省高等学校自然科学研究项目(17KJB360004);深圳市医疗卫生三名工程项目(SZSM201812064)
- DOI：10.13422/j.cnki.syfjx.20191821
  中图分类号： R22; R242; R2-031; R285.5; R287
- 收稿日期：2018-12-27，
  
  网络出版日期：2019-06-05，
  
  纸质出版日期：2020-01-05
- 稿件说明：
移动端阅览
倪新强, 胥丹桂, 杨萌, 等. 基于“阴静阳躁”理论探讨补肾填髓中药调控注意缺陷多动障碍“皮质成熟延迟”新模式[J]. 中国实验方剂学杂志, 2020,26(1):184-190.

Xin-qiang NI, Dan-gui XU, Meng YANG, et al. New Model of Traditional Chinese Medicine with Effect of Invigorating Kidney and Filling Sea of Marrow in Regulating Delay in Cortical Maturation of ADHD Based on Theory of Steady Yin and Vexed Yang[J]. Chinese journal of experimental traditional medical formulae, 2020, 26(1): 184-190.
倪新强, 胥丹桂, 杨萌, 等. 基于“阴静阳躁”理论探讨补肾填髓中药调控注意缺陷多动障碍“皮质成熟延迟”新模式[J]. 中国实验方剂学杂志, 2020,26(1):184-190. DOI： 10.13422/j.cnki.syfjx.20191821.

Xin-qiang NI, Dan-gui XU, Meng YANG, et al. New Model of Traditional Chinese Medicine with Effect of Invigorating Kidney and Filling Sea of Marrow in Regulating Delay in Cortical Maturation of ADHD Based on Theory of Steady Yin and Vexed Yang[J]. Chinese journal of experimental traditional medical formulae, 2020, 26(1): 184-190. DOI： 10.13422/j.cnki.syfjx.20191821.

摘要

注意缺陷多动障碍(ADHD)为儿童期最常见的神经发育障碍性疾病，依其临床表现，属于中医“脏躁”“躁动”“失聪”等范畴，中医药对其优势病种ADHD的研究已形成独特的理论和临床体系，但目前中药对ADHD的药效学研究多集中于神经递质代谢系统及其信号转导通路角度而体现其多成分多靶点的作用优势，未能充分体现中医“肾脑相关”及“阴静阳躁”等特色理论的科学内涵，也忽视了ADHD患儿“皮质成熟延迟”的核心病理特征。ADHD“阳动有余”的症状，责之于阴静不足而无以制妄动阳气，肾阴不足、肝阳偏旺证为ADHD最多见证型，补肾填髓中药为治疗ADHD最常用药物。笔者基于ADHD神经元发育障碍的解剖学基础，“能量代谢障碍”新理论，中医“髓海发育迟缓”病机假说及相关临床、实验研究，“补肾填髓”治法物质基础研究，结合前期熟地黄调控ADHD药效学研究，认为ADHD“阴亏阳躁，阳动有余”病机特点在于由能量代谢障碍、神经元发育障碍等因素参与的皮质成熟延迟而导致的执行功能受损，进一步提出补肾填髓中药可能通过调控神经元发育及能量代谢障碍而改善“皮质成熟延迟(髓海不充/阴亏)”，进而缓解ADHD核心症状(阳躁)。补肾填髓中药调控ADHD机制研究新模式的提出，将为提高中医药治疗ADHD的临床疗效提供理论基础。

Abstract

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder among children. The theory of traditional Chinese medicine (TCM) does not have a special term of this disease

and classifies ADHD to the category of " forgetfulness" " dysphoria" " injudiciousness" according to its clinical manifestations. TCM theoretic and clinical systems for treating ADHD have been developed

but current pharmacodynamics studies of TCM on ADHD have mostly focused on neurotransmitter metabolic system and its receptor signaling pathway to reflect the advantages of multi-component and multi-target effect of TCM

but failed to demonstrate the scientific connotations of TCM theory

such as " coordination between kidney and brain" and " steady Yin and vexed Yang"

and ignored the delay in cortical maturation as the core neuropathology of ADHD. The symptoms relating to " restlessness of Yang" due to Yin deficiency that cannot inhibit hyperactivity of Yang

kidney-Yin deficiency and liver-Yang excess syndrome is the most common syndrome of ADHD

and TCMs with effect of invigorating kidney and filling sea of marrow are mostly used by TCM practitioners. According to anatomy basis of neuronal development disorder

the new theory of " energy metabolism dysfunction"

the pathogenesis hypothesis of sea of marrow development disorder and its relevant clinical practices and experimental studies

substantial basis studies of the therapy for " invigorating kidney and filling sea of marrow"

as well as pharmacodynamics study of

Rehmannia glutinosa

(Shudihuang) for treating ADHD

we put forward ADHD pathogenesis that " restlessness of Yang due to Yin deficiency" is related to the disorder of executive function due to the delay in cortical maturation

energy metabolism dysfunction and neurodevelopmental disorder

and regarded that TCMs with effect of invigorating kidney and filling sea of marrow are the most commonly used to treat ADHD

and improve delay in cortical maturation corresponding to sea of marrow insufficiency by regulating dysfunction of neurodevelopment and energy metabolism

so as to relieve the core symptoms of ADHD. The new treatment model of TCM with effect of invigorating kidney and filling sea of marrow for treating ADHD will provide a theoretical basis for improving the clinical efficacy of ADHD.

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references

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