自閉症兒童的中西醫觀點文獻探討

Literature Review of Children with Autism Spectrum Disorder in the Perspective of Traditional Chinese Medicine and Western Medicine

10.6516/TJTCM.202309_26(3).0006

廖宇晨(Yu-Chen Liao)；楊舒渝(Su-Yu Yang)

自閉症 ； 語遲 ； 行為治療 ； 補腎填精 ； 豁痰開竅 ； Autism spectrum disorder ； retardation in speaking ； behavioral therapy ； invigorating kidney and nourishing essence ； eliminating phlegm for resuscitation

中醫藥研究論叢

26卷3期（2023 / 09 / 30）

81 - 92

繁體中文;英文

自閉症是一種以社交功能障礙與重複刻板行為為症狀表現的廣泛性發展障礙，根據世界衛生組織（WHO）統計世界上每100個兒童中有1位患有自閉症，隨著診斷標準的確立以及社會對此病的意識提升，發病率有逐年上升的趨勢。目前已知自閉症的病因與環境及遺傳因素有關，而具體病因病機尚未明確，且此病具高度異質性，目前治療方式根據患者多變的症狀而有所不同，其中包括行為治療、藥物以及另類療法，雖能改善部分的症狀，臨床上卻仍未發展出最有效治療核心症狀的方法。中醫認為自閉症屬於「童昏」、「語遲」等範疇，是由於先天不足，後天失養；腎精虧虛，心竅不通，神失所養，肝失調達，升發不利所致；其病位在腦，與心、肝、腎三臟有密切關係。根據不同的臨床症狀，以補腎填精、清心平肝、豁痰開竅，或益氣健脾、養心安神為治則，亦能併用針灸或推拿手法刺激穴位以開竅益智、醒神啟閉，達到標本同治。本文藉由文獻探討中西醫對自閉症病因病機與治療方式的觀點，提供更多治療想法，以期提升整體療效，幫助自閉症兒童之未來發展。

Autism spectrum disorder (ASD) is characterized with persistent deficits in social communication and interaction and restricted, repetitive patterns of behaviors, interests, or activities. According to World Health Organization, about one in 100 children has autism. The prevalence continues to rise because of better clinical diagnostic assessments and increased community concern. Environmental factors and genetical factors are believed to be related to ASD, but the exact etiology still remains unknown. Since ASD is highly heterogeneous, managements can be various and adapted to different patients. Behavioral therapies, medicines and alternative therapies have been widely conducted clinically. However, there has not been an effective way to cure the core symptoms. In theories of Traditional Chinese Medicine, ASD is considered as retardation in speaking. ASD is caused by congenital deficiencies and malnutrition of acquired essence, with different causes such as depletion of kidney essence, heart spirit confused by phlegm or liver depression. Brain, heart, liver and kidney are the associated organs. In order to treat both manifestation and root cause of disease, the principals of treatment can be invigorating kidney and nourishing essence, clearing heart fire and suppressing hyperactive liver, eliminating phlegm for resuscitation, invigorating spleen and replenishing qi or nourishing blood for tranquillization according to different clinical symptoms. Acupuncture or manipulation techniques can also be used for inducing resuscitation and benefiting intelligence by stimulation acupuncture points. In this article, we hope to provide more ideas for treating ASD and help more autistic patients by discussing different viewpoints in TCM and Western medicine.

1. 謝錦城,黃慧珊,陳怡鈞,賴彥廷,黃曉令,曾鈺婷(2020)。泛自閉症障礙兒童與一般兒童身體活動量與睡眠品質之比較。大專體育學刊，22(3)，274-285。
   連結：
2. Bang, M.,Lee, S. H.,Cho, S. H.,Yu, S. A.,Kim, K.,Lu, H. Y.,Chang, G. T.,Min, S. Y.(2017).Herbal Medicine Treatment for Children with Autism Spectrum Disorder: A Systematic Review.Evidence-based complementary and alternative medicine: eCAM,2017,8614680.
3. Cheuk, D. K.,Wong, V.,Chen, W. X.(2011).Acupuncture for autism spectrum disorders (ASD).The Cochrane database of systematic reviews,2011(9),CD007849.
4. Gabriels, R. L.,Pan, Z.,Dechant, B.,Agnew, J. A.,Brim, N.,Mesibov, G.(2015).Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder.Journal of the American Academy of Child andAdolescent Psychiatry,54(7),541-549.
5. Lee, B.,Lee, J.,Cheon, J. H.,Sung, H. K.,Cho, S. H.,Chang, G. T.(2018).The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.Evidence based complementary and alternative medicine: eCAM,2018,1057539.
6. Lee, M. S.,Choi, T. Y.,Shin, B. C.,Ernst, E.(2012).Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials.Journal of autism and developmentaldisorders,42(8),1671-1683.
7. Levy, S. E.,Hyman, S. L.(2015).Complementary and alternative medicine treatments for children with autism spectrum disorders.Child and adolescent psychiatric clinics of North America,24(1),117-143.
8. Liu, C.,Li, T.,Wang, Z.,Zhou, R.,Zhuang, L.(2019).Scalp acupuncture treatment for children's autism spectrum disorders: A systematic review and meta-analysis.Medicine,98(13),e14880.
9. Lofthouse, N.,Hendren, R.,Hurt, E.,Arnold, L. E.,Butter, E.(2012).A review of complementary and alternative treatments for autism spectrum disorders.Autism research and treatment,2012,870391.
10. Maglione, M. A.,Gans, D.,Das, L.,Timbie, J.,Kasari, C.,Technical Expert Panel,HRSA Autism Intervention Research – Behavioral (AIR-B) Network(2012).Nonmedical interventions for children with ASD: recommended guidelines and further research needs.Pediatrics,130(Suppl 2),S169-S178.
11. Matson, Johnny L.,Kozlowski, Alison M.(2011).The increasing prevalence of autism spectrum disorders.Research in Autism Spectrum Disorders,5(1),418-425.
12. Rossignol, D. A.,Frye, R. E.(2011).Melatonin in autism spectrum disorders: a systematic review and meta-analysis.Developmental medicine and child neurology,53(9),783-792.
13. World Health Organization (2022). Autism spectrum disorders: Fact sheets. July 25, 2022, Retrieved from: https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders
14. Zhang, Y.,Zeng, J.,Wu, D.,Li, X.,Chen, Y.,Dai, S.,Wang, B.,Qi, Y.,Lu, J.(2021).Effect and safety of acupuncture for autism spectrum disorders: A protocol for systematic review and meta-analysis.Medicine,100(11),e22269.
15. 丁一蕓,衛利,王素梅(2014)。自閉癥中西醫研究進展及中醫研究思路淺析。世界中醫藥，9(06)，820-823。
16. 王海麗,吳九偉,林學儉(2005)。林學儉運用頭皮針治療部分腦源性疾病經驗。中國針灸，25(10)，729-732。
17. 王雷,丁玉蓉,汪受傳(2018)。汪受傳辨治孤獨癥心脾兩虛證的經驗。中華中醫藥雜志，33(08)，3393-3395。
18. 江曉宇,蔡在欣,張作美,李愛武,成云水,呂英(2016)。引火湯加味結合干預訓練治療兒童自閉癥的療效觀察。中華中醫藥雜志，31(10)，4322-4324。
19. 肖宇碩,盧金清,蔡佩,黃立(2014)。中西醫治療兒童自閉癥的研究概況。湖北中醫雜志，36(09)，80-82。
20. 周念瑩,李永春,江曉宇,呂英(2015)。理中湯加味治療小兒自閉癥臨床觀察。新中醫，47(06)，200-202。
21. 周惠嫦,張盤德(2008)。穴位按摩結合語言訓練對自閉癥兒童語言交流障礙的療效觀察。中國實用醫藥，3(23)，24-26。
22. 袁青,吳至鳳,汪睿超,劉剛,包小娟,郎建英(2009)。靳三針治療兒童自閉癥不同中醫證型療效分析。廣州中醫藥大學學報，26(03)，241-245。
23. 財團法人中華民國自閉症基金會（2021年更新）。關於我們—簡介。民 111 年7 月 25 日，取自：https://www.fact.org.tw/contents/text?id=55。
24. 財團法人台北市自閉兒社會福利基金會（無日期）。何謂自閉症。民 111 年7 月 25 日，取自：http://www.ican.org.tw/content.asp?id=1。
25. 郝宏文,劉奕,衛利,王素梅(2016)。王素梅治療兒童自閉癥經驗。中醫雜志，57(01)，19-21。
26. 馬丙祥,牛曾,黨偉利,李華偉,周榮易,李偉(2021)。孤獨癥譜系障礙的中醫證候規律研究。中華中醫藥雜志，36(07)，4300-4303。
27. 張也,郭亞雄,馬艷芳,陳艷妮,金瑄(2020)。淺談以脾胃為核心的孤獨癥中醫辨證。環球中醫藥，13(08)，1333-1337。
28. 張玲瓏,趙倩,張昕睿,朱徐彤,袁錦虹(2022)。自閉癥譜系障礙的中西醫康復治療研究進展。現代醫藥衛生，38(02)，269-272。
29. 曹建英,曲秀君,王素麗,高鴻,賀莉(2019)。養心抗閉湯聯合干預訓練治療心脾兩虛型兒童自閉症的臨床觀察。河南中醫，39(06)，898-900。
30. 郭曉琳(2010)。中醫對自閉癥的認識及治療現狀。中醫兒科雜誌，6(05)，48-51。
31. 程艷然,熊振芳,盧金清,賀安妮,葉欣(2017)。中西醫結合干預自閉癥的研究現狀。湖北中醫雜誌，39(05)，63-66。
32. 琚瑋,封玉(2009)。針刺、推拿為主治療兒童孤獨癥語言障礙 13 例。中醫研究，22(04)，54-55。
33. 葉兵,張海華,湯琛,于甜甜,熊茜,鄭曉斌,林偉容(2017)。從臨床癥狀學淺析自閉癥兒童的中醫病因病機。中國民族民間醫藥，26(18)，9-11。
34. 賓有富,李佳恒,劉苑犇,韋武濤,黃群,梁明坤,鐘靜,鐘海明,黃金連,韋麗娥(2020)。中藥湯劑治療兒童自閉癥的研究概況。中國民間療法，28(05)，110-112。
35. 趙寧俠,王成(2014)。針刺配合中藥治療孤獨癥療效觀察。實用中醫藥雜志，30(02)，95-96。
36. 趙寧俠,王成(2015)。針刺配合利培酮片改善自閉癥兒童異常行為療效觀察。陜西中醫，36(08)，1070-1071。
37. 趙寧俠,張寧勃,高峰,焦文濤(2014)。參茸健腦膠囊聯合針推治療腎精虧虛型自閉癥 36 例。陜西中醫，35(12)，1635-1636。
38. 劉剛,袁立霞(2007)。兒童孤獨癥中醫病因病機及辨證分型淺析。遼寧中醫雜志，34(09)，1226-1227。
39. 賴德聰,劉文信(2018)。自閉症類群。家庭醫學與基層醫療，33(4)，115-121。