从“脾主困”论治儿童功能性消化不良

Treatment for functional dyspepsia in children based on the theory of"spleen dominating tiredness and spleepiness"

儿童功能性消化不良是儿童时期常见病,根据主症不同辨病当属中医学“厌食”“积滞”“呕吐”“腹痛”范畴,运用中医药辨证论治具有独特优势。王靖主任中医师擅长治疗儿童脾胃病,以钱乙五脏辨证体系中“脾主困”学术思想指导功能性消化不良临床诊治,从疾病发病因素的改变着手,认为现代儿童功能性消化不良病因中外感邪气致病较前有所减少,手足口病、水痘等时行疫疠之邪致病相对较多,而过食肥甘厚腻生冷之品、情志饮食致病者明显增多,故现代儿童功能性消化不良临床以脾健失运、肝郁犯脾、肺脾同病三证最为多见,治疗当以疏肝健脾为治疗大法,临证以其经验方制成的院内制剂消化合剂健脾助运为主方加减,消化合剂方中陈皮健脾行气,茯苓健脾利湿,谷芽和麦芽健脾开胃,消食和中,肝郁者加用石菖蒲、郁金等疏肝解郁之品,感染手足口病等邪气肺脾同病时急性期宣肺同时兼顾脾胃,以其父治麻疹经验方合消化合剂加减,缓解期当补肺健脾,消化合剂加黄芪、白术等治之。

Functional dyspepsia is a common disease in childhood,which belongs to the category of"anorexia","stagnation","vomitting"and"abdominal pain"in traditional Chinese medicine(TCM)according to the differentiation of main symptoms,and the TCM differential treatment has its unique advantages.Director Wang Jing is good at dealing with spleen and stomach diseases in children and performs clinical diagnosis and treatment of functional dyspepsia based on the theory of"spleen-dominating tiredness and sleepiness"from the syndrome differentiation system of Qian Yi Wu Zang.Considering the changes in the pathogenic factors of the diseases,Director Wang Jing thinks that the pathogenic factors of exogenous evil causing functional dyspepsia in children have been reduced nowadays,while the pathogenic factors such as hand-foot-mouth disease and chicken pox have increased,and such disease causes as having too much greasy and raw food and emotional diet have increased significantly.As a result,the 3 most common clinical syndromes of functional dyspepsia in modern children are dysfunction of spleen in transportation,stagnation of liver invading spleen and comorbidity of lung and spleen.The treatment principle should be to soothing liver and strengthening spleen.Based on the Director's experience,a self-made digestive mixture has been developed in the hospital to strengthen spleen and assisting the transportation.In the digestive mixture,dried tangerine peel is used to strengthen spleen and promote transportation;Poriacocos is used to strengthen spleen and removing dampness;rice sprout,and malt are used to strengthen spleen and stimulate appetite,and promote digestion and regulate stomach.For the children with liver stagnation,Shichangpu and Yujing can be added to soothe liver and relieve stagnation.If there is comorbidity of hand-foot-mouth disease,while the lung qi is being dispersed during acute stage,spleen and stomach should also be dealt with,and the empirical formula of the Director's father for measles is used in combination with the digestive mixture with modification.During the relief period,it is necessary to nourish lung and strengthen spleen,and Huangqi(Astragalus)and Baizhu(Atractylodes)are added to the mixture for treatment.