基于万全“四不足”的儿童体质学说探讨小儿慢性咳嗽的证治规律

Discussion on the Rules Syndrome and Treatment of Chronic Cough in Children Based on Wanquan′s "Four Deficiencies" Theory of Children′s Constitution

"四不足"是万全在钱乙"脏腑虚实辨证"和朱丹溪"阳有余,阴不足"的基础上,提出小儿"肺常不足、脾常不足、肾常虚、阴常不足"的临床特点。基于此观点可知,小儿慢性咳嗽的病因病机应为肺常不足、娇脏易伤;脾常不足,土不生金;肾阴不足,水不制火;阴常不足,肺津耗伤。临证时,若属肺常不足,应治以益气固表,补肺散邪之玉屏风散;若属脾常不足,应治以培土生金、健脾化痰之二陈汤;若属肾常虚,应治以滋阴降火之六味地黄丸合补肾温肺之核桃仁、蛤蚧等;若属阴常不足,应治以益气养阴,生津润燥之沙参麦冬汤。

"Four deficiencies" are all based on Qian Yi′s "syndrome differentiation of deficiency and excess of Zang Fu organs" and Zhu Danxi′s "surplus Yang and deficiency of Yin",and put forward the clinical characteristics of children′s "frequent deficiency of lung, spleen, kidney and yin".Based on this point of view, the etiology and pathogenesis of chronic cough in children should be that the lungs are often insufficient and delicate and vulnerable;the spleen is often insufficient, and the earth does not produce gold;kidney yin deficiency, water does not make fire;yin is often insufficient, and lung fluid is consumed and injured.In case of clinical syndrome, if the lung is often insufficient, it should be treated with Yuping Feng Powder, which can replenish qi and strengthen the surface, supplement the lung and disperse pathogen;if the spleen is often insufficient, it should be treated with Eechen Decoction of cultivating soil and generating gold, strengthening the spleen and resolving phlegm;if the kidney is often deficient, it should be treated with Liuwei Dihuang Pill for nourishing yin and reducing fire combined with Hetaoren(walnut kernel) and Gejie(gecko) for tonifying the kidney and warming the lung;if Yin is often insufficient, Shashen Maidong Decoction should be treated to replenish qi and nourish yin, generate fluid and moisten dryness.