Syndrome differentiation of Zang-Fu for Tourette syndrome in children

Zhao Mu, Teng Huang, Zhan-Ling Zhang



Syndrome differentiation of Zang-Fu for Tourette syndrome in children

Zhao Mu1, Teng Huang1, Zhan-Ling Zhang2, *

1College of Traditional Chinese Medicine, Hebei University, Hebei, China.2Department of Paediatrics, Baoding No.1 Hospital of TCM, Hebei, China.

As a kind of psychoneurotic disease, the incidence of Tourette syndrome (TS) is increasing gradually in recent years. Modern medicine for the pathogenesis of this disease has not been clear, in the treatment is mainly symptomatic treatment. Based on syndrome differentiation and treatment, traditional medicine treats the unique system of etiology and pathogenesis of the disease, and achieves remarkable results in treatment. Chinese medicine treatment of children's diseases generally from the viscera dialectical. In this paper, we summarize the clinical experience of the treatment of pediatric TS by syndrome differentiation of viscera in order to provide reference for the clinical treatment and research of pediatric TS.

Tourette syndrome, TCM, syndrome differentiation, Review

Zang-fu syndrome differentiation is one of the principles of TCM syndrome differentiation and treatment, and is also the most commonly used method of TCM pediatrics syndrome differentiation and treatment. TS in children is difficult to treat in the field of western medicine, but under the guidance of TCM Zang-fu syndrome differentiation theory and holistic view, many therapeutic schools have been derived.

Introduction

Tourette syndrome (TS), It is a neuropsychiatric disease clinically characterized by involuntary, aimless, repeated and rapid motor twitch and/or vocal twitch of one or more muscle groups. The specific manifestations include blink of an eye, shrug of nose, grin, shrug of shoulders, shaking hands and feet, strange voice in throat,It can be accompanied by comorbidity of obsessive-compulsive disorder, attention deficit hyperactivity disorder, irritability, etc. [1]. TS is more common in children before the age of 10, the prevalence rate is 0.05%~3%, and has a rising trend year by year in recent years, which can seriously affect children's physical and mental health and life learning [2]. At present, western medicine mostly uses dopamine receptor antagonist orally to treat the disease, such as "tiapride" and "haloperidol", but its side effects are large and numerous, and it is easy to relapse after drug withdrawal. Traditional Chinese medicine mostly treats children's diseases based on zang-fu syndrome differentiation. The theory of treating children's Tourette syndrome based on zang-fu syndrome differentiation in recent years is summarized as follows. From what is said in many ancient books, it can be seen that the symptoms of Tourette's syndrome are mostly consistent with the manifestations of "liver wind". Therefore, the location of the disease in the liver has become the basic consensus in the diagnosis and treatment of the disease in modern Chinese medicine. Various doctors take the principle of coordinating the liver with the treatment of other organs as their principle. Some doctors are listed as follows

Treatment from liver and spleen

Spleen is the acquired foundation. Any dysfunction of viscera is more or less related to dysfunction of spleen. Therefore, the treatment from liver and spleen is also one of the focuses of doctors in treating childhood TS.

Spleen producing phlegm and liver producing wind

Professor Chen Baoyi [3] starts from spleen producing phlegm and liver producing wind. He thinks that children's spleen is delicate, and various factors such as diet and emotion are easy to hurt their temper. Spleen is not healthy, and the body's water is wet and cannot be transported and turned into phlegm. If it is blocked in the airway, there will be abnormal throat sounds. Liver is inherently wind-dirty. If spleen soil is weak, liver wood is relatively stronger and wind is more abundant, twitching of limbs will occur. In the treatment, the decoction for relieving liver and regulating spleen in "Yizong Jinjian" is usually modified, with spleen-invigorating drugs such as dangshen, poria cocos, atractylodes rhizome, licorice, liver-soothing drugs such as bitter orange, white peony root, Bupleurum root, wind-soothing drugs such as Rhizoma ligustici chuanxiong and notopterygium root, and phlegm drugs such as stiff silkworm and Pinellia tuber, which have the functions of relieving liver and regulating spleen, calming wind and eliminating phlegm.

Spleen generates Qi and blood

Professor Wang Sumei in addition to the viewpoint of wind and phlegm agitation, also considered that spleen is the source of qi and blood biochemistry, if spleen deficiency, biochemical qi and blood is not sufficient to nourish muscles and tendons, twitching will also occur [4]. At the same time, due to the accumulation of blood in the liver, the deficiency of blood production will also lead to the deficiency of liver yin. Thus, yin deficiency and hyperactivity of wind combined with blood deficiency and wind production will become the inducement for tic symptoms. Therefore, in addition to the treatment methods of suppressing wood, supporting soil, calming liver and calming wind, Liujunzi Decoction and Xieqing Pills are often added with nourishing yin and enriching blood products, such as Radix Paeoniae Alba, Matrimony vine, Radix Rehmanniae Recens, etc.

Pay attention to the physiological and psychological characteristics of children

Professor Ma Bingxiang [5] combines the physiological characteristics and social psychological factors of children, and thinks that modern children are mostly only children. Doting parents and learning pressure lead to children's willfulness and poor psychological acceptance ability. Children are easily angry and depressed if they are not satisfied. In traditional Chinese medicine, it is liver-Qi stagnation, while children have the physiological characteristics of "surplus liver". At this time, it is easier to turn fire into wind and produce twitch. On the other hand, modern living conditions make children more picky and partial in eating, and eat more fat, sweet and thick, making the spleen, which is already insufficient, even weaker. Spleen also governs meat. Children like watching TV and playing computer. Sedentary sitting with stiff muscles, pain, atrophy, spasm and so on can also lead to twitch symptoms. For the treatment of mild diseases, Sini Powder combined with Ganmai Dazao Decoction is used to soothe liver and relieve depression and harmonize liver and spleen. For those with obvious spleen deficiency, Ramulus Uncariae cum Uncis Yigong Powder is used to invigorate spleen and Qi, relieve wind and relieve spasm.

Treatment from liver and heart

TS is a kind of mental nervous disease in essence, so the heart function of "ruling the gods" is especially concerned by doctors. However, there are also differences between the same and the same. From the point of view that the heart governs the gods, each doctor has different treatment methods.

Both heart and liver are weak

Professor Wang Lie is different from other doctors in that he thinks that although children have "excess liver", their physiological characteristics are juvenile yin and juvenile yang, and the form and qi are not sufficient, so children's liver qi is also insufficient [6]. Main muscle of liver, if liver qi is not solid and liver yin is insufficient, it cannot nourish the muscle. The chief heart god, if the heart qi is not sufficient and the heart yang is not warm, the mind is weak, the liver qi and the heart qi are deficient, and the liver yin and the heart yang are out of balance, it will be manifested as twitch on the limbs and neuropsychiatric symptoms. The self-created "Tiaoshen Decoction" is used to regulate liver and heart. The prescription mainly includes Angelica sinensis, Poria, Cortex et Radix Polygalae, Caulis Polygoni Multiflori, Radix Curcumae for nourishing heart qi and warming heart yang, Carapax Trionycis, Carapax et Plastrum Testudinis, Radix Paeoniae Alba, and Xu Changqing for nourishing liver Qi and nourishing liver yin, so that the baby's heart and liver are nourished and yin and yang are harmonized.

Relationship between emotion and mind

Professor Han Fei [7] observed the development process of the disease from the children's personality characteristics, and found that the vast majority of the children will have a series of abnormal emotional manifestations, thus thinking that emotional factors are the main factors of the disease. Emotional diseases are primarily caused by the mind. Abnormal emotions and many symptoms of children, such as blinking and foul language, are all caused by disorders of the mind. Therefore, its treatment is mainly to regulate the mind, and due to the delicate constitution of children, it advocates peace and regulation of the mind. The self-made formula for calming the mind and stopping the mind is composed of keel, oyster and mother of pearl. The spina date seed and platycladi seed nourish the heart and calm the mind. The bitter orange and bupleurum root promote the circulation of qi and smooth the emotions. The white peony root promotes liver blood to eliminate the wind, and the radix isatidis, magnolia flower, stiff silkworm and tribulus terrestris are added to regulate the mind, calm the liver and extinguish the wind.

Heart and brain govern the spirit

Professor Liu Yushu [8] also pays attention to the gods, but he thinks that although the heart is the Lord god, it also depends on the physiological function of the brain governing mental activities. All kinds of thinking, consciousness and emotional activities are the results of mind reflected by the brain. If wind and fire blinds the heart and brain with phlegm, emotional disorders and mental abnormalities, such as foul language in mouth, limb twitch and irritability, will appear.For this reason, Professor Liu pays special attention to the nurturing of fetuses. He thinks that the heart development in the fifth week of pregnancy and the brain development in the ninth week of pregnancy will affect the heart and brain development of fetuses and induce the disease if they are frightened during pregnancy. The treatment includes nourishing heart and regulating mind from various aspects, reinforcing kidney and nourishing heart with tortoise shell, calming liver and clearing heart fire with Rhizoma Gastrodiae, Ramulus Uncariae cum Uncis, Radix Curcumae, Cortex et Radix Polygalae, Rhizoma Acori Graminei, Os Draconis, and Concha Ostreae. All the drugs are combined to nourish heart and brain, and the mind is treated by the spirit.

Treatment from Liver and Kidney

Kidney is the foundation of nature, and the quality of kidney function determines to a great extent whether the overall body function of children is normal or not. The following are some viewpoints put forward by some doctors focusing on the treatment of liver and kidney.

Liver and kidney are homologous

Professor Zhu Xiankang [9] thinks that the most common pathogenesis of this disease is kidney deficiency and liver hyperactivity, wind and phlegm blocking collaterals. The deficiency of kidney yin and the homology of liver and kidney in children lead to deficiency of liver yin and deficiency of wind, which leads to limb shaking and other symptoms, while liver yang transforming wind leads to the occurrence of head and face twitch symptoms. The self-created prescription "Dingchou Prescription" is basically composed of Rhizoma Gastrodiae, Ramulus Uncariae Cum Uncis, Radix Bupleuri, Flos Chrysanthemi，Radix Paeoniae Alba, Radix Rehmanniae Recens, Rhizoma Arisaematis Cum Bile, Rhizoma Acori Tatarinowii, Radix Curcumae, Radix Polygalae. The general formula not only nourishes yin and nourishes yang, but also expels wind and eliminates phlegm, which is suitable for the pathogenesis of this disease.

The theory of kindey

Professor Yan Zhaojun [10] took a new approach to analyze the disease from the perspective of "kidney manifestation". He believed that the involuntary and unconscious twitch of children with Tourette's syndrome was caused by deficiency of kidney manifestation, insufficient control of kidney essence and mind, insufficient absorption of liver soul and lung spirit, and dysfunction of viscera, emotions, meridians and limbs. Children with TS often have stiff, repetitive and clumsy movements, and often have difficulties in life and study. This is precisely the manifestation of renal insufficiency, abnormal function of "strong acting" and "skillful acting" of the kidney, thus showing the influence of renal insufficiency on TS. The treatment is based on the principle of tonifying the kidney and strengthening the mind. Radix Morindae Officinalis is used for kidney and liver meridians, kidney and bones are strengthened, Polygala tenuifolia is used for heart, lung and kidney meridians, heart and kidney are communicated, Tuckahoe with pine is used for heart, lung, spleen and kidney meridians, nerves are tranquilized, Rhizoma Pinelliae is used for eliminating dampness and phlegm, Rhizoma dioscoreae is used for kidney, spleen and lung, jujube is used for heart nourishing and nerves calming, this six drugs are used for five internal organs and the focus is on kidney strengthening the mind, and the curative effect is good.

Treatment from liver and lung

Mr. Liu Bichen, a great master of pediatrics in China and the third generation successor of "Chen Men", pays special attention to visceral transmission. Therefore, he often starts with the lung, the initial stage of the disease, and becomes a major system for the diagnosis and treatment of pediatric diseases. Many doctors have inherited and developed their theory of treating lung diseases, which makes this treatment system develop gradually.

Treat lung to prevent transmission

Professor Liu Bichen [11] advocated treating from the liver and lung and attached importance to the physiological and pathological connections between the viscera. Because the lung is the highest and is the "canopy", the invasion of pathogens first invades the lung, which can then cause pathological changes of other viscera. Therefore, Mr. Liu started from the root causes of the disease, drawing firewood from the bottom of the kettle to prevent the disease from spreading, and started from the lungs to treat other visceral diseases. The change of medication is flexible, but it is always based on the principle of simultaneous treatment of liver and lung.

Allergic constitution is closely related to this disease

Professor Zhang Zhanling [12] paid special attention to the physical factors of children. In clinical treatment, he observed that most children with this disease have allergic diseases or family history such as eczema, urticaria, allergic rhinitis, etc. Therefore, he proposed that this disease is closely related to allergic constitution. No matter which part has the closest contact with the outside world, therefore the special pathogenic factor of the outside world-allergen substance is also easy to cause twitch symptoms by invading the lung. She is good at flexible application of various wind drugs in treatment, with obvious curative effect and is highly respected by parents of children.`

Wind inside and outside the human body

Professor Gao Shubin [13] paid more attention to the pathogenic factor of "wind". He divided the wind into external pathogenic wind and endogenous wind. He believed that the lung was susceptible to external pathogenic wind. He believed that "skin, pulse, flesh, bones and muscles" should be located in the five internal organs respectively, thus inducing internal wind. The internal and external wind combined and developed into TS. The self-made "Tiaofei Decoction" uses Herba Schizonepetae and Radix Saposhnikoviae as monarch to expel wind and relieve exterior syndrome, Bombyx Batryticatus, Periostracum Cicadae, Radix et Rhizoma Rhei, and Curcuma Rhizome as ministers. It is supplemented with Cortex Dictamni Radicis, Rhizoma Chuanxiong, Radix Angelicae Sinensis, Radix Rehmanniae, Radix Paeoniae Alba, Radix Paeoniae Rubra, Carthami Flos, Rhizoma Smilacis Glabrae to nourish blood and promote blood circulation.

Apart from syndrome differentiation and treatment based on the five zang-organs, many other doctors now have another way to treat childhood TS from gallbladder, brain, triple energizer, or five zang-organs. The following is a brief introduction.

Treating from gallbladder

Professor Xu Rongqian [14] observed children with Tourette's syndrome, and found that many children have timid personality characteristics, and the symptoms will worsen or appear repeatedly when mental pressure is high, thus proposing gallbladder as the main damaged viscera of the disease. Gallbladder is the home organ of Shaoyang and the pivot of Qi movement. Damage to gallbladder Qi will affect other organs in the form of imbalance of Qi movement. Liver Qi will stagnate and turn fire into wind, resulting in limb twitching. Qi deficiency of the heart leads to loss of nourishment of the mind and mental consciousness. Infringement of the spleen due to horizontal and vertical inversions leads to phlegm generation and deficiency of the body. Impaired lung spirit or lung disease produces phlegm and produces vocal twitch. The kidney Qi was broken, showing signs of delayed development and voiding. In the treatment, Wendan Decoction is mostly used to modify and calm gallbladder Qi, so as to smooth the movement of Qi and regulate the five internal organs.

Treating from brain

Professor Zhang Biao [15] believes that "the brain is the house of the spirit". The limb shake, foul language in mouth and abnormal mind of children with TS are all caused by interference of the spirit in the brain. He thinks that the brain is at the top of the body, and the liver wind is most likely to disturb the height, or generate liver fire and inflammation, or entrap phlegm and turbidity, etc. Wind, fire, phlegm and blood stasis invade the brain and block clear orifices, which is the most important reason for the onset of this disease. Professor Zhang developed Jing' an oral liquid, a TCM for special diseases, through clinical trials. According to the theory of kidney storing essence and essence producing marrow, he used Radix Rehmanniae and Radix Paeoniae Alba to nourish liver and kidney, Rhizoma Gastrodiae and Ramulus Uncariae cum Uncis to attack brain orifices directly, and used Scorpio, Pheretima, Bombyx Batryticatus, etc. to expel wind, eliminate phlegm and remove blood stasis, so that the drug effect quickly reached the brain mansion. Finally, Radix Curcumae was added to tranquilize the mind, with good therapeutic effect.

Treating from Sanjiao

Professor Ma Rong [16] takes liver as the core, and the Sanjiao is divided to treat TS. The treatment of Shangjiao mainly depends on the twitch symptoms of the five facial features of the head and face, mostly due to the external wind inducing liver wind in the lung. The treatment is mainly to disperse wind evil, with Yinqiao Powder added and subtracted. The treatment of the Zhongjiao mainly depends on the twitch symptoms of limbs and muscles. This is because the tendons and limbs are not nourished by Qi, blood and body fluid. It is necessary to calm the liver and strengthen the spleen at the same time. Erchen decoction and Tianmagouteng decoction are added and subtracted. The treatment of Xiajiao mainly depends on the manifestation of mental nerve, mostly due to deficiency of kidney yin and loss of nourishment of brain marrow. The key is to nourish water and wood, to nourish the mind and clear the mind, and to add and subtract Liuweidihuang pill and Xieqing pill.

Treating from five organs

From ancient literature on the disease

Professor Zhao Shiyu [17] demonstrated from the five zang-organs and attached importance to syndrome differentiation and treatment. Starting from ancient classics, she believed that all the wind and dizziness belong to the liver. Children's tendons and arteries are cramped, quick-tempered and irritable, mostly due to the weathering of liver fire. When soothing the liver and relieving depression, add or subtract by Sini decoction; on the basis of liver fire, if the heart is hot and generates heart fire, if liver fire is strong and heart fire is strong, foul language and impulsion will appear, which should be treated as clearing heart fire and liver fire. The heart also governs the mind, twitching means that the mind is damaged, so at the same time, the heart must be nourishing and tranquilizing, and LongdanXiegan Decoction should be added or subtracted; the liver wood should be restrained by lung gold. When liver fire is strong, the liver wood will counter-attack the lung gold, resulting in abnormal aureole and laryngeal vocalization. Moreover, the lung and liver are associated with the ascending and descending of Qi activity. Therefore, "do not forget to regulate the lung when treating the liver" is mainly used to expel wind and clear fire.

Five zang-organs store the spirit

Professor Jinxi Zhao [18] thinks that the five zang-organs all store spirit, and the dysfunction of the five zang-organs will affect mental consciousness activities. Modern children like watching TV, computers and mobile phones too much. Their lifestyle is monotonous, outdoor sports are insufficient, easy due to the emotional disorders, liver Qi is depressed, and excessive and greasy food impairs the spleen and stomach. It is better to harmonize the liver and spleen. Os Draconis, Concha Ostreae, Ramulus Uncariae Cum Uncis, Flos Chrysanthemi, Herba Menthae Heplocalycis are used to calm the liver and purge the fire. The wind in the liver is already present. At this time, we should prevent the external wind from further attacking the lungs and causing obvious head twitch symptoms. We should harmonize the liver and lungs. Using Periostracum Cicadae, Folium Mori, Flos Chrysanthemi and other drugs can not only calm the liver and extinguish the wind, but also relieve the exterior and expel the wind. It can be treated both internally and externally; some children suffer from congenital deficiency, kidney essence deficiency and marrow insufficiency, which are manifested as abnormal living and learning abilities. At this time, they should replenish essence and marrow to replenish yin of liver and kidney with Radix Rehmanniae, Radix Paeoniae Alba, Radix Angelicae Sinensis, etc. Only when the heart and kidney intersect could balance the yin and yang, otherwise children will be easily frightened and agitated, with hyperactivity, poor sleep and mental consciousness. At this time, Fructus Gardeniae, Rhizoma Coptidis and other herbs are used to clear heart fire, while Radix Paeoniae Alba nourishes kidney yin, so that the heart and kidney intersect and yin and yang are reconciled before the syndrome is verified.

Sanyin is the outline, five zang-organs is the entry

Professor yuan xiaofeng [19] holds the view of " Sanyin is the outline, five zang-organs is the entry ". Sanyin is the nature, nurture and external senses. In the treatment of the five zang-organs, the five zang-organs are divided into three levels. Fire of heart and liver is the main pathogenesis of this disease. Liver fire burns yin fluid, which prevents liver yin from playing the role of nourishing fascia. Heart fire disturbs the gods, causing mental disorder and personality change. In addition, if exogenous pathogenic fire intensifies the fire in the body's inner liver, twitching symptoms will be more serious. Spleen deficiency and liver meridian syndrome, one of which is spleen deficiency producing phlegm, phlegm evil is a disease causing twitch, the other is food stagnation in spleen and stomach due to spleen deficiency transport and transformation disorder, and heat generation due to long time, which is also one of the causes of Tourette's syndrome. Lung and kidney are born together. Kidney water can cool and moisten heart fire and liver fire. Lung and kidney can resist invasion of external pathogens. Whether these two dirty functions are normal or not can directly affect the main pathogenesis of this disease, which is a point requiring special attention during treatment. Professor Yuan summed up decades of clinical experience and established Diguiyisui decoction as the basic prescription for the treatment of this disease. Based on the principle of tonifying liver and kidney, the monarch drug Radix Rehmanniae Preparata and Tortoise Plastron nourish kidney essence, the ministerial drug Fructus Schisandrae Chinensis and Fructus Lycii nourish liver yin, plus Ramulus Uncariae cum Uncis, Concha Margaritifera, Os Draconis and Concha Ostreae to remove liver wind, Rhizoma Acori Graminei to eliminate heart fire, treat both symptoms and root causes, and the clinical effect is significant.

Discussion

Zang-fu syndrome differentiation is one of the principles of TCM syndrome differentiation and treatment, and is also the most commonly used method of TCM pediatrics syndrome differentiation and treatment. TS in children is difficult to treat in the field of western medicine, but under the guidance of TCM Zang-fu syndrome differentiation theory and holistic view, many therapeutic schools have been derived. Each family has obvious advantages in terms of curative effect and safety over western medicine in terms of regulating liver as its core, pushing other organs, penetrating the triple energizer, integrating the five internal organs, or self-made prescriptions, or combining other therapies. This article sorts out the theories of viscera syndrome differentiation, hoping to provide reference for clinical treatment and research of childhood TS.

1. Robertson MM, Eapen V, Cavanna AE. The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective. Psychosomatic Res 2009, 67: 475-483.

2. Zhang HH, Yang S, Li ZX,. Research progress in TCM treatment of children's convulsion disorder. Chinese J Tradit Chin Med 2018, 33: 5061-5065.

3. Wei JP, Hu SY, Liu H,Professor Chen baoyi's experience in treating tourette's syndrome. New J Tradit Chin Med 2012, 44: 158-159.

4. Zheng H, Wang SM. Wang sumei's experience in treating multiple convulsions in children from liver and spleen. Liaoning J TCM 2017, 44: 2284-2285.

5. Ma BX, Yang YL. From the liver and spleen to treat multiple convulsions in children. Chin Pediatrics Integrated Tradit Chin Western Med 2013, 5: 116-117.

6. Li XY, Zhang H, Wang L. The case analysis of professor wang lie's treatment of pediatric heart and liver diseases with tiaoshen decoction. J Tradi Chin Med 2016, 31: 773-774.

7. Nan YW, Han W. Han fei from the heart of the treatment of children convulsive disorder experience summary. Chin J Information Tradit Chin Med 2015, 22: 113-115.

8. Zhao HY, Jiang K, Liu RQ. Professor yu-shu liu's clinical experience in the treatment of multiple convulsions in Children. Guide China Medicine 2017, 15: 211-212.

9. Zhao Y, Zhu XK. Zhu xiankang's experience in treating children with multiple convulsion. J Zhejiang Univer Tradit Chin Med 2014, 38: 58-60.

10. Li YQ, Yan ZJ, Jin Z. Discussion on the treatment of multiple convulsions from nephrology. Modern Distance Education Chin Tradit Med 2016, 14: 37-38.

11. Yu ZY. Liu BC. Experience in treating tourette's syndrome in children from lung. Chin J Information Tradit Chin Med 2006, 4: 81.

12. Chen YJ, Liu B, Huang H,Professor Zhang Zhanling's experience in treating children with tic disorder. J Pediatrics Tradit Chin Med 2019, 15: 24-26.

13. Lin MH. Professor Gao Shupin summarized the clinical experience of pulmonary therapy for pediatric convulsion disorder. Fujian University of Traditional Chinese Medicine, 2014.

14. Feng HY, Xu YQ. From the experience of treating multiple convulsions with gallbladder. J Tradit Chin Med 2013, 54: 1511-1513.

15. Long HY, Zhang P. To understand the key pathogenesis of infantile tourette's disease from the perspective of "brain mechanism disorder". Liaoning J TCM 2012, 39: 73-75.

16. Rong P, Zhang XL, Li YP,Ma rong's experience in the treatment of multiple convulsions in children with the three-jiao method. J Tradit Chin Med 2016, 57: 734-736.

17. Song RH. Professor zhao shiyu introduced the experience of treating multiple convulsions in children from five internal organs. New J Tradit Chin Med 2011, 43: 148-149.

18. Wu XA, Yao S, Jia M,Professor zhao jinxi discussed the experience of treating multiple convulsions in children from five internal organs. J Liaoning Univer Tradit Chin Med 2012, 14: 156-157.

19. Cui HT, Yuan XF. Professor Xiaofeng Yuan"three because of the outline, five zang as the eye" to distinguish and treat children with multiple twit

20. ches. Jilin J Tradit Chin Med 2018, 38: 775-778.

*Correspondence:Zhan-Ling Zhang, Department of Paediatrics, Baoding No.1 Hospital of TCM, Hebei, China. Email: 743350770@qq.com

The authors declare that there is no conflict of interests regarding the publication of this paper.

Chang Liu

10.12032/TMRIM201903013

Mu Z, Huang T, Zhang ZL. Syndrome differentiation of Zang-Fu for Tourette syndrome in children. TMR Integrative Medicine 2019, 3: e19013.