基于“以补开塞”辨治儿童功能性便秘气阴两虚证

Treating pediatric functional constipation of Qi-Yin deficiency syndrome based on the theory of "tonifying to relieve obstruction"

摘要

儿童功能性便秘为儿科常见病, 现代治疗虽可短期缓解症状, 但停药后易复发, 长期应用泻剂亦损伤肠道功能。既往中医多从“腑气不通”论治, 偏重攻下通导, 而对小儿“稚阴稚阳、气阴易伤”体质特点及“因虚致秘”病机关注不足。李蕙主任基于“塞因塞用”理论, 结合儿童生理病理特点, 提出“以补开塞”法辨治儿童功能性便秘气阴两虚证, 认为其核心病机为“因实致虚、气阴两伤、因虚致实”, 强调“补益气阴”不仅为治本之法, 亦为恢复肠腑传导功能之关键。临证确立“益气养阴以培其本、通补兼施以调其标、阳中求阴以固其枢”之治则, 并创制经验方“参地儿便舒”。文章从病机演变、理论内涵、组方配伍及验案等方面系统阐释其学术思想, 以期为儿童功能性便秘气阴两虚证的中医辨治提供新的临床思路。

Abstract

Pediatric functional constipation (FC) is a common disease in children. Although modern treatments can relieve symptoms in the short term, relapse often occurs after drug withdrawal, and long-term use of laxatives will impair intestinal function. In previous traditional Chinese medicine (TCM) practice, FC was mostly managed from the perspective of "intestinal Qi obstruction", with emphasis on attacking the lower to unblock, while insufficient attention was paid to the pediatric physiological characteristics of "tender Yin and tender Yang and being susceptible to Qi and Yin damage" and the pathogenesis of "constipation due to deficiency". Based on the theory of "treating obstruction with tonification" and taking the physiological and pathological characteristics of children into account, Chief Physician Li Hui proposes the method of "tonifying to relieve obstruction" for the treatment of pediatric FC of Qi-Yin deficiency syndrome. She holds that the core pathogenesis follows the evolution of "excess leading to deficiency--injury of Qi and Yin--deficiency leading to excess", and emphasizes that "replenishing Qi and Yin" is not only the fundamental treatment but also the key to restoring intestinal function of conduction. The therapeutic principles established in clinical practice are "replenishing Qi and nourishing Yin to consolidate the root, combining tonification with unblocking to regulate the manifestation, and seeking Yin within Yang to stabilize the pivot"; hence, the empirical formula "Shendi Erbian Shu" has been developed. The paper systematically expounds her academic thoughts from the aspects of pathogenesis evolution, theoretical connotation, prescription compatibility and typical cases, aiming to provide new clinical ideas for the TCM treatment of pediatric FC of Qi-Yin deficiency syndrome.

关键词

功能性便秘 / 以补开塞 / 益气养阴法 / 气阴两虚证 / 参地儿便舒 / 儿童

Key words

Functional constipation / Tonifying to relieve obstruction / Supplementing Qi and nourishing Yin / Qi-Yin deficiency syndrome / Shendi Erbian Shu / Child

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基金资助

福建省卫生健康委科技计划项目(2025ZYRK0010012)

2025年度中医药监测统计研究课题(2025JCTJC164)