基于“三焦气化”理论辨治食积肺热型小儿便秘经验

Experience in treating pediatric constipation of food accumulation and lung-heat syndrome based on the theory of "Sanjiao Qi transformation"

摘要

便秘是儿科临床常见脾胃系疾病, 随着饮食结构改变与生活方式变迁, 小儿便秘食积肺热证的发病率呈逐年上升趋势, 该病虽位在大肠, 但与三焦气化失常紧密相关。该文总结了段晓征教授立足于“三焦气化”理论, 结合小儿“脏腑娇嫩, 形气未充”的生理特点, 系统阐释小儿便秘与三焦功能失调的密切关联。段教授认为三焦的生理功能涵盖气机运行、水液代谢、水谷运化、防御外邪等多个方面, 总以“通”为用, 以“气化”为核心。基于此提出治疗当充分体现中医整体观, 以“健脾消中、清肺宣上、滋阴润下”为法, 三焦同调, 气血津液并治, 恢复大肠传导之职。并以国医大师王烈教授“当枳通秘汤”为基础, 加减化裁创立“三焦消润汤”, 构成“君药贯通三焦、臣药分治三焦、佐使药沟通上下”的独特配伍体系, 攻补兼施而不偏, 充分体现了对小儿“稚阴稚阳”体质特点的审慎用药原则。文章详述其理论创见、用药规律及特色, 并附典型医案佐证。

Abstract

Constipation is a common clinical spleen-stomach disorder in pediatrics. With changes in dietary structure and living habits, the incidence of pediatric constipation of food accumulation and lung-heat syndrome has increased year by year. Although the disease is located in the large intestine, it is closely correlated with abnormal Qi transformation of the Sanjiao (upper Jiao, middle Jiao and lower Jiao). The paper summarizes Professor Duan Xiaozheng's academic thoughts based on the theory of "Sanjiao Qi transformation", and taking into account children's physiological characteristics of "delicate Zang-fu organs and immature Qi-blood constitution", and systematically expounds the intrinsic relationship between pediatric constipation and Sanjiao dysfunction. Prof. Duan holds that the physiological functions of the Sanjiao include Qi movement, fluid metabolism, food digestion and transportation, and defense against external pathogens, generally with "Qi transformation" as the core and "unblocking" as the principle. On the basis, Prof. Duan proposes that the treatment should fully reflect the holistic concept of traditional Chinese medicine, and adopts the method of "invigorating the spleen to resolve middle Jiao, clearing lung to disseminate upper Jiao, and nourishing Yin to moisten lower Jiao", that is, to regulate Sanjiao comprehensively and manage Qi, blood and body fluids simultaneously, so as to restore the conducting function of the large intestine. Taking "Dangzhi Tongmi decoction" created by National Traditional Chinese Medicine Master Wang Lie as the basic prescription, Professor Duan modifies it and develops "Sanjiao Xiaorun decoction", forming a unique medication compatibility system: to permeate and unblock Sanjiao by monarch drug, to manage each of Sanjiao by minister drug, and to connect the upper and the lower by assistant and envoy drugs, combining attacking with tonifying without bias, which reflects the principle of careful medication based on the constitution characteristics of "immature Yin and immature Yang" in children. The article elaborates on the theoretical insights and medication rules and features of Professor Duan, with typical medical cases attached for verification.

关键词

功能性便秘 / 食积肺热证 / “三焦气化”理论 / 儿童

Key words

Functional constipation / Food accumulation and lung-heat syndrome / "Sanjiao Qi transformation" theory / Child

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