| 引用本文: |
陈月月,李瑞本,陆艳泓,蔡秋晗,郑子琦,胡思源.历代医家对小儿便秘的认知探讨[J].湖南中医药大学学报,2023,43(11):2117-2122[点击复制] |
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| 历代医家对小儿便秘的认知探讨 |
| 陈月月,李瑞本,陆艳泓,蔡秋晗,郑子琦,胡思源 |
| (天津中医药大学第一附属医院, 天津 300381) |
| 摘要: |
| 总结隋唐以来历代医家对小儿便秘病因病机及辨证论治的认识。历代医家认为小儿便秘的发生以脏腑热盛为主因。对于小儿便秘的治疗,各医家注重内外结合,以内为主。内治法主要为泻热通腑、消积除满和养血润肠等;外治法主要为灸法、坐浴、摩法和贴敷法等。各时期侧重略有不同,隋唐时期的医家大多认为小儿便秘与腑热、气滞和食积有关,治疗以荡涤肠腑、消积除满为主;宋金元时期医家对小儿便秘的病因及特点有了更具体的认识,其认为主要是三焦热壅,下攻大肠,治疗多用清热泻下之品,兼顾护中与调气;明清医家丰富了热移大肠、气机壅滞、食滞胃肠的内涵,另增加血虚亦可致便秘的机制,治疗注重辨证论治:属热结者以泻热通腑、气滞者以理气调中、食积者宜健脾消食、血虚者宜养血润燥。通过梳理隋唐至明清时期各医家对小儿便秘病因病机及临床诊治的认识,探究小儿便秘的溯源和发展脉络,以期为小儿便秘的现代中医药辨治提供借鉴。 |
| 关键词: 小儿便秘 病名 病因病机 辨证治疗 各家学说 |
| DOI：10.3969/j.issn.1674-070X.2023.11.026 |
| 投稿时间：2023-07-12 |
| 基金项目:国家科技重大专项（民口）课题——儿童中药新药临床评价技术示范性平台建设项目（2020ZX09201-008）。 |
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| Discussion on cognition of pediatric constipation by ancient Chinese medicine doctors |
| CHEN Yueyue,LI Ruiben,LU Yanhong,CAI Qiuhan,ZHENG Ziqi,HU Siyuan |
| (The First Teaching Hospital of Tianjin University of Chinese Medicine, Tianjin 300381, China) |
| Abstract: |
| This paper has summarized the understandings of the etiology, pathogenesis, and treatment based on pattern identification of pediatric constipation by doctors since the Sui and Tang Dynasties. They believed that pediatric constipation was mainly due to excessive heat in zang-fu organs. Consequently, for the treatment of pediatric constipation, they focused on the internal and external combination, but mainly the former. Specifically, the internal treatment methods are mainly clearing heat and promoting bowel movements, eliminating accumulation and relieving fullness, nourishing blood and moistening the intestines, and so on; while the external treatment includes moxibustion, sitz bath, massage, and application therapy, with slightly different emphasis in different periods. Most doctors in the Sui and Tang Dynasties thought that pediatric constipation was associated with symptoms of excessive heat in fu-organs, qi impediment, and food stagnation, thus, the treatment was mainly to cleanse the intestines, eliminate accumulation, and relieve fullness. Later, in the Song, Jin, and Yuan Dynasties, the doctors had a more specific understanding of the etiology and characteristics of pediatric constipation. They believed that it was mainly due to excess heat accumulated in the sanjiao attacking the large intestine downward and the medicines with effects of clearing heat and promoting bowel movement were mainly used, taking into account the protection of the spleen and stomach and regulating qi. Then, the doctors in the Ming and Qing Dynasties enriched the connotation of heat transmitting to the large intestine, qi impediment, and food stagnation in the stomach and intestines, and proposed the mechanism that blood deficiency could also cause constipation. Therefore, the treatment based on pattern identification was emphasized, that is, patients with heat stagnation should be treated by clearing heat and promoting bowel movements, patients with qi impediment should be treated by regulating qi and harmonizing middle jiao, patients with food stagnation should be treated by fortifying the spleen and promoting digestion, and patients with blood deficiency should be treated by nourishing blood and moistening dryness. Finally, by combing the knowledge of the etiology, pathogenesis, and clinical diagnosis and treatment of pediatric constipation by various doctors from the Sui and Tang Dynasties to Ming and Qing Dynasties, the origin and development of pediatric constipation were explored in order to provide reference for treating pediatric constipation based on pattern identification of modern Chinese medicine. |
| Key words: pediatric constipation disease name etiology and pathogenesis treatment based on pattern identification doctrines of various TCM schools |
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