探析“通因通用”法治疗小儿热结旁流证  

Exploration on the treatment of pediatric heat-bound constipation with concurrent diarrhea by“treating obstruction with purgation”method

作　　者：孔维祎 郝欧美[2] KONG Weiyi;HAO Oumei(No.1 Clinical College,Liaoning University of Traditional Chinese Medicine,Shenyang,Liaoning,110847,China;Department of Pediatrics,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang,Liaoning,110000,China)

机构地区：[1]辽宁中医药大学第一临床学院,辽宁沈阳110847 [2]辽宁中医药大学附属医院儿科,辽宁沈阳110000

出　　处：《中医儿科杂志》2024年第6期4-7,共4页Journal of Pediatrics of Traditional Chinese Medicine

基　　金：沈阳市科技局项目(21-174-9-07)。

摘　　要：热结旁流,热聚肠腑,大肠燥屎内结而致时泄臭水之证,其病因多归咎于外感时邪、药食不慎、便秘日久等。小儿为稚阴稚阳之体,气血津液均不足,如燥热伤阴,胃肠积热,传导失常,则燥屎结于肠道,刺激肠黏膜,导致分泌物增多,体内津液外渗,临床表现为脐腹胀满,疼痛拒按,时有臭秽粪水从肛门溢出。病因不同,病机相同,结者自结,下者自下,“旁流”是其表象,“热结”方为本质。热结旁流证须与泄泻、便秘及兼症鉴别,提出诊断的“金标准”为切诊触及粪块,应运用“通因通用”法进行治疗,采用张仲景所创立的三承气汤,视患儿的病情特点辨证加减用药,量味宜少而精,切忌攻下太过,须中病即止,注意善后。预防应保持肠道通畅,合理饮食,避免久坐少动,谨防他病。Heat-bound constipation with concurrent diarrhea,a condition characterized by the accumulation of heat in the intestines,causing dry feces to accumulate and leading to the intermittent excretion of foul water,is often attributed to external pathogenic factors,inappropriate diet or medication,and chronic constipation.Infants and young children,with their delicate constitution of both yin and yang,are prone to deficiencies in qi,blood,and body fluids.When heat dries up yin and accumulates in the gastrointestinal tract,disrupting normal conduction,dry feces accumulate in the intestines,stimulating the intestinal mucosa,resulting in increased secretions and the exudation of body fluids.Clinically,this manifests as abdominal distension and pain around the umbilicus that is aggravated by touch,accompanied by intermittent expulsion of foul-smelling water from the anus.Although the causes may vary,the pathogenesis is the same:obstruction occurs where there is obstruction,and diarrhea occurs where there is diarrhea.The“concurrent diarrhea”is a superficial manifestation,whereas the“heat-bound constipation”is the essence.It is crucial to differentiate heat-bound constipation with concurrent diarrhea from diarrhea,constipation,and their comorbid conditions.The“golden standard”for diagnosis is palpation to detect fecal masses.The treatment approach should adhere to the principle of“treating obstruction with purgation,”employing the San Chengqi Decoctions(三承气汤)formulated by ZHANG Zhongjing,with modifications based on the specific condition of the child.Medication should be administered in small but precise doses,avoiding excessive purgation,and treatment should be discontinued once the disease is alleviated,with attention paid to post-treatment care.Prevention strategies should focus on maintaining intestinal patency,maintaining a balanced diet,avoiding prolonged sitting and sedentary lifestyles,and guarding against other illnesses.

关 键 词：热结旁流 小儿 通因通用 辨证论治 

分 类 号：R272.6[医药卫生—中医儿科学]