从“土枢四象,一气周流”探析儿童肠系膜淋巴结炎的辨治  

Discussion on the differentiation and treatment of mesenteric lymphadenitis in children based on the theory of"earth pivot four organs and whole qi circulating"

作　　者：胡忠杉 孙洮玉[1] 马桢 HU Zhongshan;SUN Taoyu;MA Zhen(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《北京中医药大学学报》2024年第5期679-685,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：北京市自然科学基金资助项目(No.7212179);全国第七批名老中医药专家经验传承项目。

摘　　要：肠系膜淋巴结炎是儿科常见的消化系统疾病,亦是儿童急性腹痛的常见病因,因其具有易反复发作的特点,病程迁延可影响患儿生长发育。西医学多采用止痛、抗炎等相应的对症治疗,中医药治疗本病疗效明确,且具有独特优势。黄元御“土枢四象,一气周流”理论是关于人体气机周流的学说,尤其强调中焦气机通畅的重要性,中焦脾胃为气机升降之枢纽,脾胃之气左升而为心、肝,右降而为肺、肾,气机升降,如环无端。脑-肠轴是消化系统和神经系统之间的复杂信息交流网络的统称,该轴功能在一定程度上与“土枢四象,一气周流”有相通之处。肠系膜淋巴结炎的病因病机与该理论阴盛阳衰、湿阻中焦而致中焦失健、气之循环运动受阻的发病过程相契合,同时,其发病及病情进展亦受脑-肠轴的调控。故本病以脾虚湿阻为主要证候类型,肝脾气滞、脾肾阳衰亦不少见。在该理论的指导下,通过温阳和中、燥湿行气、化痰散结之法,结合脑-肠轴相关理论治疗本病可取得明显的临床疗效。Mesenteric lymphadenitis(ML)is a common digestive system disease in pediatrics.It is a common cause of acute abdominal pain in children,which is characterised by recurrent attacks.If not treated properly with protracted duration,children's growth and development will be affected.Western medicine focuses on relieving pain and resisting inflammation,traditional Chinese medicine(TCM)has unique advantages in the treatment of ML.HUANG Yuanyu's"earth pivot four organs and whole qi circulating"is a theory about the circulation of qi in the body,which emphasizes in particular the importance of the middle-jiao.The spleen and stomach in middle-jiao is the core of the ascending and descending of qi in this theoretical system.The qi of spleen and stomach rises on the left to form the heart and liver,and falls on the right to form the lungs and kidneys.This process,just like a ring,is in an infinite loop.The brain-gut axis is a collective term for the complex information exchange network between the digestive system and the nervous system,which has some similarities with the theory of"earth pivot four organs and whole qi circulating".The etiology and pathogenesis of ML are consistent with the viewpiont of yang deficiency and yin excessiveness,and dampness obstructs the middle-jiao,causing the middle-jiao losing its vitality,resulting in stagnation of qi circulating in this theory.At the same time,the occurrence and development of ML is also regulated by the brain-gut axis.Therefore,the main pattern of this disease is spleen deficiency and dampness obstruction.Liver-spleen qi stagnation and spleen-kidney yang deficiency are common causes,too.Based on the theory of"earth pivot four organs and whole qi circulating",significant clinical effects can be achieved in the treatment of ML by warming yang and regulating middle-jiao,drying dampness and activating qi,dissipating phlegm and resolving masses,combined with the theory of the brain-gut axis.

关 键 词：土枢四象 一气周流 黄元御 肠系膜淋巴结炎 温中燥湿行气 

分 类 号：R272[医药卫生—中医儿科学]