《幼科发挥》论治小儿汗证经验探析

Analysis of the Experience in Treating Pediatric Sweating Syndrome in Youke Fahui (Developments in Pediatric Medicine)

摘要: 本文系统梳理万全《幼科发挥》中有关小儿汗证的诊疗思想，重点围绕健运脾胃、调和营卫、益气固表及慎用止涩等治法展开论述，分析其辨治小儿汗证的学术思路与临证特色。万全立足于小儿“脾常不足、脏腑柔弱、形气未充”的核心病机，以调理脾胃为论治中心，紧扣营卫不和之关键病机，立法强调扶正固本，处方追求清灵平和。在诊治过程中，他力主详辨自汗盗汗之别、虚实寒热之兼，强调“治病必求于本”，反对见汗止汗、滥用敛涩，以防闭门留寇，并善用简便安全之外治法。万全所构建的诊治体系深刻体现了整体审证、辨证求本、顾护元气、药食并用的学术思想，对现代临床全面理解小儿汗证的病机本质及安全有效用药具有重要的指导与借鉴价值。

Abstract: This paper systematically examines the diagnostic and therapeutic ideas concerning pediatric sweating syndrome in Wan Quan’s Youke Fahui (Developments in Pediatric Medicine), with a focus on treatment methods such as strengthening the spleen and stomach, harmonizing nutrient and defense qi, boosting qi to secure the exterior, and cautious use of astringents. It analyzes his academic rationale and clinical characteristics in the pattern identification and treatment of pediatric sweating syndrome. Grounded in the core pathogenesis of children’s “spleen often being insufficient, organs being delicate, and physical form and qi not yet fully developed”, Wan Quan centered his treatment approach on regulating the spleen and stomach, closely addressing the key mechanism of disharmony between nutrient and defense qi. His therapeutic principles emphasized strengthening the body’s resistance and consolidating the root, while his prescriptions aimed to be light, balanced, and gentle. During diagnosis and treatment, he advocated for detailed differentiation between spontaneous sweating and night sweating, as well as the identification of accompanying deficiency, excess, cold, or heat patterns. He stressed that “treatment must seek the root”, opposed indiscriminate use of sweating-reducing and astringent methods to avoid trapping pathogens, and was skilled in applying simple and safe external therapies. The diagnostic and treatment system established by Wan Quan profoundly reflects an academic philosophy that integrates holistic diagnosis, pattern differentiation to address the root, preservation of vital qi, and combined use of herbal medicine and dietary therapy. It holds significant guiding and referential value for modern clinical practice in comprehensively understanding the pathological mechanism of pediatric sweating syndrome and ensuring safe and effective medication.