基于“虚气留滞”探讨小儿功能性便秘的证机与治验

Discussion on the Pathogenesis and Therapeutic Experience of Functional Constipation in Children Based on “Stagnation of Deficient Qi”

摘要: 小儿功能性便秘是儿科临床常见的消化系统疾病，发病率高且易反复发作，严重影响患儿的生活质量。本文基于“虚气留滞”理论，认为“虚为本、气滞为标、津亏为变”是本病的基本病机特征，“虚气”为便秘之本，小儿肺、脾、肾三脏常不足，以脾虚失运为主，肺气不宣、肺经有热为发病诱因，肾常虚是小儿便秘的根本。“留滞”为便秘之标，气机郁滞、痰湿内生、乳食积滞、燥热内结内生，使便秘迁延难愈。临床治疗当以“补虚通滞”为核心，以“健脾补肺益肾”治本，以“消食导滞、清热润下、祛湿化痰、行气布津”治标。

Abstract: Pediatric functional constipation is a common digestive system disease in pediatric clinics, with high incidence and frequent recurrence, seriously affecting the quality of life of affected children. Based on the theory of “stagnation of deficient qi”, this paper considers that “deficiency as the root, qi stagnation as the manifestation, and fluid depletion as the transformation” is the basic pathogenesis of this disease. “Deficient qi” is the root cause of constipation. The lungs, spleen, and kidneys of children are often insufficient, with spleen deficiency leading to impaired transportation regarded as primary, lung qi failing to circulate and lung meridian heat as triggers, and kidney deficiency as the fundamental cause of pediatric constipation. “Stagnation” is the manifestation of constipation, with qi movement stagnation, internal generation of phlegm-damp, accumulation of milk and food, and internal accumulation of dryness-heat causing prolonged and difficult-to-heal constipation. Clinical treatment should focus on “tonifying deficiency and relieving stagnation”, treating the root with “strengthening the spleen, tonifying the lungs, and benefiting the kidneys”, and addressing the manifestation with “digesting food and guiding stagnation, clearing heat and moistening the intestines, removing dampness and resolving phlegm, and regulating qi and promoting fluids”.