摘要
目的和意义：总结小儿再发性腹痛的古今用药特点,推理本病的病因病机及证治规律。对符合纳入标准的79例再发性腹痛患儿进行临床观察,归纳、总结本病的发病特点、病因病机和临床证型。
研究方法：
1.文献部分：整理小儿再发性腹痛的古代文献和近二十年临床文献,通过频数分析、主成分分析,因子分析及聚类分析等统计学方法,从方药的角度,分析研究本病的病因病机及证治规律。
2.临床部分：设计小儿再发性腹痛调查表,在病人就诊时收集临床证候及相关资料。对其发病特点,临床证候特点等进行主成分分析,因子分析,聚类分析及相关性分析等统计分析,得出辨证规律。
结果：
1.文献部分：古代文献研究显示脾胃虚寒证及腹部中寒证较多,现代则以肝脾不和证、气滞血瘀证、湿滞脾胃证、乳食积滞证为主。治疗小儿腹痛的药物中甘草及芍药的使用频率较高。
2.临床部分：小儿再发性腹痛临床常见证型中胃肠结热证所占比例最高(24.05%),其次为腹部受寒证(21.52%)、气滞湿阻证(20.25%)、乳食积滞证(18.99%)、中焦虚弱证最少(15.19%)。临床常见兼夹证候中以湿邪阻滞及气滞为多。临床各证型中,胃肠结热证多出现在疾病早期且有明确的诱因；平素易感冒、腹泻的患儿更易患腹部受寒证；乳食积滞证患儿幽门螺旋杆菌(HP)感染率较高；年龄越大,病程越长的患儿更易出现气滞湿阻证。
结论：
1.小儿再发性腹痛的基本病机为“中焦虚弱,气机失调”,并结合寒凝,气滞,血瘀食积,湿阻等病理变化。临证治疗时以“补中益气,调畅气机”为主。
2.小儿再发性腹痛临床主要分为胃肠结热证、腹部受寒证、气滞湿阻证、乳食积滞证及中焦虚弱证等证型。证候之间是相互兼夹的,在诊疗过程中证候是动态变化的。证候的形成与年龄、病程及素体体质等因素相关。
The purpose and significance:Summing up the treatment experience of the ancient and modern medicine on infantile Recurrent Abdominal Pain (RAP), reasoning the etiology, pathomechanism, and the rule of TCM syndromes. Summing up the pathogenesis,clinical symptoms and physical signs of RAP through 79 cases.
Methods:
1. Literature Parts:Collating the ancient literature and clinical literature of RAP over the past 2 decades, carrying out statistical analysis, drawing treatment experience, reasoning the laws of dialectic.
2. Clinical parts:Collecting the cases of RAP, carrying out statistical analysis, summing up its pathomechanism, clinical symptoms, physical signs.
Results:
1. Literature Parts:Ancient literature research find that the syndrome of abdominal catching cold and the syndrome of deficiency-cold in middle energizer are more common. Modern literature research gives priority to the syndrome of dysfunction of the liver and spleen, qi stagnancy and blood stasis, food dyspepsia, etc. Statistics show that herb Gancao and Shaoyao use most.
2. Clinical parts:The most commonly type of RAP is the retention of heat in the stomach and intestine, which accounting for 24.05%, followed by the syndrome of abdominal catching cold (21.52%), the syndrome of qi stagnancy and water retention(20.25%), the syndrome of food stagnation (18.99%), the weakness of middle energizer at least (15.19%). The common syndrome of RAP is always combining with the stagnant of qi and dampness. The syndrome of the retention of heat in the stomach and intestine is often seen at the early course of the disease and has a clear inducement. Who usually easy to get a cold or diarrhea is more prone to get the syndrome of abdominal catching cold. Who gets the syndrome of food stagnation has higher infection rate of HP. The one whoes age is larger or the duration of the disease is longer is more likely to catch the syndrome of qi stagnancy and water retention.
Conclusions:
1. The basic pathogenesis of RAP is the weakness of the middle energizer, and the failure of qi activity. The pathological changes include the stagnancy of cold and qi, blood stasis, dyspepsia, retention of water and dampness, etc. The treatment rule of RAP is to invigorating qi and strengthening the middle energizer, and regulating qi activity.
2. RAP can be mainly typed into:syndrome of retention of heat in the stomach and intestine, syndrome of abdominal catching cold, syndrome of qi stagnancy and water retention, syndrome of food stagnation, syndrome of the weakness of middle energizer. Syndromes are combined and mutative in the treatment process. The related factors such as age, courses and physique affect the formation of syndromes.
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