李新民教授辨治小儿痫病思路与经验采撷

Professor LI Xinmin's Ideas and Experience in the Treatment of Pediatric Epilepsy

[目的]介绍与总结李新民教授从枢机论治小儿痫病的经验。[方法]通过门诊跟师抄方,收集、整理和分析来自天津中医药大学第一附属医院门诊的小儿痫病患者的初诊和随诊病历资料,并查阅中医古籍和现代小儿痫病临床研究,从几个方面总结分析李师从枢机论治小儿痫病的经验,另附一则医案例证。[结果]李师以痰浊内伏为该病基本始动因素,痰气逆乱为核心病机,结合小儿特性,发挥中医特色,以枢为核心,治以豁痰顺气,辅以和解少阳枢机,复脾胃升降之运,双管齐下,使小儿全身气机调畅,脏腑功能协调,从而改善癫痫患儿病情,减少发作频次。李师还注重个体化治疗,审证求因,根据不同发作类型加减药物。同时强调动态辨证,根据患儿的病情变化遣方用药,在癫痫的治疗和预防上取得良好效果。所附验案首诊属少阳枢机不利、肝风夹痰证,治以疏利少阳、平肝熄风,予柴胡龙骨牡蛎汤合涤痰汤加减,随后予泻青丸清肝经郁热获效。[结论]李师从枢机论治小儿痫病临床疗效肯定,丰富了小儿痫病的辨治体系,值得学习借鉴。

[Objective]To introduce and summarize Professor LI Xinmin's experience in treating pediatric epilepsy from the perspective of pivot.[Methods]By following the clinical work,it collected,organized and analyzed initial and follow-up medical records of pediatric epilepsy patients from the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and consulted ancient Chinese medicine books and modern clinical research on pediatric epilepsy,and analyzed Professor LI's experience in treating pediatric epilepsy from several aspects.Additionally,it attached a medical case for verification.[Results]Professor LI identifies phlegm turbidity and retention as the basic initiating factor of the disease,and phlegm Qi disorder as the core pathogenesis.Combining with the characteristics of children,he utilizes the characteristics of Chinese medicine,using the pivot as the core to treat phlegm and promote Qi flow,supplemented by reconciling the Shaoyang pivot,restoring the circulation of spleen and stomach,and using a dual approach to regulate the overall Qi and coordinate the functions of organs,thereby improving the condition of children with epilepsy and reducing the frequency of seizures.Professor LI also pays attention to individualized treatment,examines the evidence to determine the cause,and adds or subtracts medication according to different types of seizures.At the same time,emphasis is placed on dynamic syndrome differentiation,and medication is prescribed according to the changes in the patient's condition,achieving good therapeutic effects in the treatment and prevention of epilepsy.The attached case was diagnosed as disadvantageous of Shaoyang pivot syndrome at first visit,the treatment was to dredge and benefit Shaoyang,calm the liver and extinguish wind.Chaihu Longgu Muli Decoction and Ditan Decoction were added and subtracted,and then Xieqing Pill was given to clear the liver meridian and remove the heat.[Conclusion]Professor LI's clinical efficacy in treating pediatric epilepsy from the perspective of pivot theory is affirmed,which enriches the diagnosis and treatment system of pediatric epilepsy and is worthy of learning and reference.