基于“火郁发之”论泻黄散加味治疗儿童功能性便秘

Treating children’s functional constipation with Xiehuang San based on the theory of“relieving fire stagnation”

儿童功能性便秘作为儿科常见消化性疾病之一,是一种以功能性改变为主而排除其他器质性病变,以排便功能障碍为特征,由多种因素引起的小儿胃肠疾病。由于小儿便秘的临床病因复杂多样,其发病机制并无完全准确的标准,至今对其的认识仍不统一,诊断标准缺乏科学性、明确性和规范性。临床上多应用以导泻剂为主的药物进行对症治疗,虽然临床药物的疗效较为显著,但治疗后容易出现不良反应和耐药性,导致疾病的预后不佳。同时,也可能对患儿的心理和生理方面造成严重的影响。中医疗法在治疗方面,通过整体观念和辨证论治可以整体调理气血阴阳,提高各个脏腑功能,在临床治疗方面更具优势。根据患儿特殊的生理和病理特点,小儿以脾脏不足为主,各个脏腑功能发育尚不完善,抵御邪气能力不足而易发病,病机多为内外之邪的侵袭。基于“火郁发之”理论指导,用“发”法祛除壅滞在脏腑的邪气,从而实现固护正气,安和脏腑的作用,泻黄散即为“火郁发之”的代表方。在临床上以脾胃积热型便秘较为多见,王芳副主任根据个人经验,认为治疗便秘在升散脾胃伏火的同时,还应该强调行气消积,顾护脾胃的重要性,选用泻黄散加味治疗儿童功能性便秘,在临床治疗方面具有重要的指导意义,并附验案1则加以佐证。

Functional constipation in children is one of the common digestive diseases in pediatrics.It is a kind of gastrointestinal disease in children characterized by functional changes and excluding other organic lesions,characterized by defecation dysfunction,caused by many factors.Due to the complex and diverse clinical causes of constipation in children,there is no completely accurate standard for its pathogenesis.So far,the understanding is still not uniform,and the diagnostic criteria lack scientificity,clarity and standardization.Clinically,laxative-based drugs are often used for symptomatic treatment.Although the efficacy of clinical drugs is significant,adverse reactions and drug resistance are easy to occur after treatment,resulting in poor prognosis of the disease.At the same time,it may also have a serious impact on the psychological and physiological aspects of the child.In the treatment of traditional Chinese medicine,through the overall concept and syndrome differentiation,it can regulate Qi(气),blood,Yin(阴)and Yang(阳)as a whole to improve the function of various organs,and has more advantages in clinical treatment.Children are mainly characterized by insufficient spleen,imperfect development of various zang-fu organs,insufficient ability to resist evil Qi and easy to develop,and the pathogenesis is mostly the invasion of internal and external evils.According to the special physiological and pathological characteristics of children based on the guidance of the theory of fire stagnation,the method of relieving is used to eliminate the evil Qi in the viscera,so as to realize the role of protecting the vital Qi and harmonizing the viscera.Xiehuang San(泻黄散)is the representative prescription of relieving fire stagnation.Constipation of spleen-stomach heat accumulation type is more common in clinical practice.According to the personal experience,Deputy Director WANG Fang believes that the treatment of constipation should also emphasize the importance of promoting Qi to dissipate accumulation and protecting the spleen and stomach while ascending and dispersing the latent fire of the spleen and stomach.The use of Xiehuang San in the treatment of functional constipation in children has important guiding significance in clinical treatment,and 1 case is attached.