清熱生津潤腸法治療小兒便秘病例報告

Intestines Moistening through Heat Clearing and Fluid Production Promoting for the Child's Constipation

這是一位腦性麻痺的8歲女童，自幼罹患便祕，大便硬而粗大，常臍腹痛，排便2-3日一行。未 服藥物控制。望之兩頰稍紅，嘴唇紅，步行時手足擺動較僵硬不自然。問之出生時早產，體重僅 1,470 g且缺氧，合併先天性大腦白質空洞化、視力與聽力障礙，有肢體功能障礙與語言功能障礙， 且合併腎臟水腫、二便不能自通；嬰兒期餵食母奶，就容易脹氣。四歲時有熱痙孿病史，就診時意 識清楚但情緒不穩定，上課常走動、大叫、或隨意躺下，需家長伴讀。平時易口糜。眠中易磨牙， 睡眠中會說夢話。觸之手心熱。按之腹不痛。脈細弦數，左脈沈細無力。中醫辨證屬鬱熱傷津便 秘。治則採清熱生津潤腸。處方以小柴胡湯合甘露飲加減。服藥十日後回診反應腹痛、皮膚紅癢疹與夜眠磨牙均有改善。第二次回診時反應已經可以每日自己排便順暢，腹痛已少。口內糜已無，夜 眠磨牙減少，皮膚小紅疹搔癢已無。熱邪得清，津液得潤，大腸傳導功能得以恢復。此後均在此大 原則之下臨症加減，至今仍在中醫門診追蹤。不用硝黃等瀉下之劑，多年的習慣性便祕獲得良好的改善，此乃清熱生津潤腸之功也。

The cerebral palsy girl aged 8 had constipation since birth. The hard and thick stools came out once in 2-3 days, and perinavel pain was frequent; nonetheless, no medicine was taken. In our inspection, the slightly red cheeks and red lips were seeable; the arms and legs during walking, moved slightly rigidly rather than naturally. In the inquiry, the premature hypoxic case weighed 1,470 g, with: congential syringomylia; visual and hearing impairments; physical and language disorders with renal edema and difficulties in urinating and stooling. Besides, breastfeeding her induced distention easily. Her consciousness was clear, despite dysthymia. She usually walked, shouted, or randomly lay down in calss, asides from requiring the reading partner, the parent. At the age of 4, the febrile convulsion occurred. Ordinarily, the touching-mucosa erosion chanced; so did tooth grinding during nighttime sleep when talking sometimes befell. The touching-perceived palms were feverish; the pressing-comprehended abdomen was painless. The string-like pulses were thin; the left pulse was deep, thready and feeble. In the Chinese Medicine differential was through heat clearing and fluid production promoting. In the prescription, small Chaihu soup was with Ganlu tea increased or decreased. In the return visit 10 days after medication, the abdominal pain, red itchy rash, and tooth grinding were ameliorated. In her 3rd visit, smoothly defecating daily, less abdominal pain, no oral mucosa erosion, less tooth grinding, no red itchy rash, eliminated heat evil, body fluid moistening dryness, and reinstated bowel conduction appeared. Afterwards, the prescription was based for adding or subtracting the medicine with the changes of the clinic symptoms which have been followed up by the Chinese outpatient department. No laxatives like yellow saltpeter were applied, notwithstanding the habitual constipation for all those years amended greatly, attributed to intestines moistening through heat clearing and fluid production promoting.