基于“脑-肠轴”理论从脾虚论治儿童功能性便秘的小儿推拿应用体会

Experience in the application of pediatric Tuina to the treatment of functional constipation in children from the perspective of spleen deficiency based on the "brain-gut axis"

摘要

基于“脾虚为本, 滞热为标”的核心病机, 结合“脑-肠轴”理论, 探讨儿童功能性便秘的中医辨证思路及小儿推拿的临床应用价值。儿童功能性便秘病位在大肠, 与脾、肝、肺、肾及“脑神”功能密切相关, 核心病机为脾虚失运、气机郁滞, 日久兼夹食积、燥热, 形成本虚标实之证。小儿推拿以“运脾通腑、调神解郁”为治则, 采用补脾经、清大肠、摩腹、揉天枢、推下七节骨、捏脊等核心手法, 从物理刺激、神经调节、神经-内分泌调节及心理调节4个层面发挥综合治疗效应。该法能降低远期复发率, 调节患儿情志状态。基于整体观念和“脑肠同调”的辨治思路, 小儿推拿具有安全、有效、依从性好等优势, 是儿童功能性便秘综合治疗体系中的重要手段, 值得临床推广应用。

Abstract

Based on the core pathogenesis of "spleen deficiency as the root, stagnant heat as the manifestation", and in combination with the "brain-gut axis" theory, the paper explores the traditional Chinese medicine (TCM) syndrome-differentiated approach to pediatric functional constipation (FC) and the clinical application value of pediatric Tuina. The disease location of pediatric FC is in the large intestine and is closely related to the functions of the spleen, liver, lung, kidney, and "brain spirit". The core pathogenesis involves spleen deficiency with impaired transportation and stagnation of Qi flow, which, over time, may be accompanied by the accumulation of food and internal heat, forming a syndrome characterized by deficiency in root and excess in manifestation. Pediatric Tuina follows the principle of activating spleen and unblocking Fu-organs, regulating the mind and relieving stagnation, employing core manipulations such as tonifying spleen-meridian, clearing large intestine, rubbing abdomen, massaging Tianshu, pushing downward on Qijiegu (the seven-bone line), and pinching spine, which exerts a comprehensive therapeutic effect through four aspects: physical stimulation, neural regulation, neuro-endocrine regulation, and psychological regulation. The method can reduce long-term recurrence rates and regulate the emotional state of affected children. Based on the holistic concept and the syndrome-differentiated approach of "synchronous brain-gut regulation", pediatric Tuina has the advantages of safety, effectiveness, and good compliance, making it an important means in the comprehensive treatment system for pediatric functional constipation, which is worthy of clinical promotion and application.

关键词

功能性便秘 / 中医辨证 / 小儿推拿 / 脾虚 / 脑-肠轴

Key words

Functional constipation / Traditional Chinese medicine syndrome differentiation / Pediatric Tuina / Spleen deficiency / Brain-gut axis

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基金资助

2024年度江苏省中医药科技发展计划项目(NS2024022)