《幼科发挥》关于小儿水肿的诊治

Diagnosis and treatment of infantile edema in An Expounding of Pediatrics

万全认为水肿的基本病机为脾虚湿蕴,其本在脾,其标为湿,治疗时攻补兼施,以健脾祛湿、利水消肿为基本治法,并以胃苓丸治水肿。同时将水肿分为风肿和湿肿,因势利导,以发汗和利小便作为祛邪的基本通路,不拘泥于家传秘方,亦选择五皮汤和五苓散分别进行加减治疗,必要时酌加峻下逐水之品以治标,但中病即止,反对纯用攻伐,以免伤及正气,恐邪去而正亦不存。

WAN Quan held that the basic pathogenesis of infantile edema was accumulation of dampness due to spleen-asthenia,whose root lied in the spleen and whose manifestation lied in dampness.The treatment was simultaneous application of purging and nourishing therapeutics,with strengthening spleen to eliminate dampness and promoting urination to alleviate edema as the basic therapeutic method,and using Weilingwan(胃苓丸)to treat edema.Meanwhile,he divided edema into wind edema and damp edema,with treatment in accordance with tendency of pathological changes,taking diaphoresis and promoting urination as the basic passage to expel pathogenic factors.Not sticking to the secret prescription of family,he also selected Wupi Tang(五皮汤)and Wuling San(五苓散)for the modified treatment respectively.If necessary,he deliberated upon adding the drugs with drastic elimination of fluid retention,however,no sooner was the disease relieved than the drug was withdrawn.He opposed purely using offensive and suppressing drugs in case of damage to healthy qi,for fearing that the pathogenic factors were removed while healthy qi never remained.