基于万全“亦有诸般不可攻”理论探讨小儿功能性便秘的辨治策略  

Exploring the differentiation and treatment strategies for functional constipation in children based on Wan Quan′s theory of "No Use of Attacking Method in Spite of the Condition"

作　　者：张艺斐 董盈妹 赵霞 潘青云 严花 ZHANG Yifei;DONG Yingmei;ZHAO Xia;PAN Qingyun;YAN Hua(Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学,南京210029 [2]南京中医药大学附属医院儿科,儿童健康与中医药江苏省高校重点实验室

出　　处：《中国中西医结合儿科学》2024年第1期7-11,共5页Chinese Pediatrics of Integrated Traditional and Western Medicine

基　　金：江苏高校优势学科建设工程资助项目(PAPD);江苏省中医院高峰学术人才项目(Y2021rc21)。

摘　　要：功能性便秘是小儿时期常见胃肠道疾患,全球小儿功能性便秘患病率为0.5%~32.2%,严重影响患儿生活质量。万全为我国古代著名儿科医家,其创新性地提出小儿“脾常不足”等五脏有余不足思想,临证注重调理脾胃,对现代小儿疾病的诊疗具有重要指导作用。万全在《育婴家秘·卷之四·大小便病》中提出了小儿便秘的治疗总原则:“大便鞕结须宜下,亦有诸般不可攻。”基于万全“脾常不足”“大便鞕结须宜下,亦有诸般不可攻”的小儿便秘辨治理论,结合近现代研究,认为小儿功能性便秘病因多归于燥热内结、乳食积滞、脾虚不运、气机郁滞和血虚肠燥,病机关键为脾虚食伤。据此提出小儿功能性便秘临证治疗应明辨虚实,将运脾助通贯穿于治疗始终,分别从急下、消导、缓下、顺气、辛润等方面探讨小儿功能性便秘的辨治策略,以期为小儿功能性便秘的临床诊疗及调护提供参考。Functional constipation(FC) is a common gastrointestinal disease in children.The global prevalence of functional constipation in children is about 0.5% to 32.2%,which seriously affects the quality of life of children.Wan Quan is a famous pediatric doctor in ancient China,who innovatively put forward the idea of "spleen insufficiency" in children,and paid attention to regulating the spleen and stomach,which has an important guiding role in the diagnosis and treatment of modern pediatric diseases.Wan Quan put forward the general principle of the treatment for pediatric constipation in "Infant Family Secrets:Volume Ⅳ:Urination and Defecation Diseases":"The stool induration should be attacked,but sometimes is attacking method useless in spite of the condition".Based on Wan Quan′s theory of "spleen insufficiency",and "The stool induration should be attacked,but sometimes attacking method is useless in spite of the condition",and combined with modern research progress,it is proposed that the causes of FC in children are mostly attributed to dryness-heat accumulation,stagnation of milk and food,spleen deficiency leading to transportation failure,qi stagnation,and blood deficiency resulting in intestinal dryness.Spleen deficiency leading to food injury is considered to be the key pathogenesis;therefore,it is recommended that the treatment for FC in children should differentiate deficiency from excess,and carry out the principle of activating spleen to assist the transportation throughout the treatment process.This study explores the differentiation and treatment strategies for FC in children from the aspects of acute purgation,digestion and elimination of accumulated stagnation,slow purgation,regulating qi,and moistening dryness,etc.,in order to provide a reference for the clinical diagnosis,treatment,and care of FC in children.

关 键 词：功能性便秘 脾常不足 脾虚食伤 

分 类 号：R725.7[医药卫生—儿科]