小兒功能性便秘之中醫藥治療案例

A Case Report of Functional Constipation in Children Treated by Traditional Chinese Medicine

10.6516/TJTCM.2017.20(1)171

許堯欽(Yao-Chin Hsu)；徐尉芳(Wei-Fang Hsu)；王瑜婷(Yu-Ting Wang)；張仁旭(Ren-Shiu Chang)；王宏銘(Hung-Ming Wang)

小兒便秘 ； 中醫 ； 功能性便秘 ； 甘露飲 ； 小柴胡湯 ； Pediatric constipation ； Traditional Chinese Medicine ； functional constipation ； Gan-Lu-Yin ； Xiao-Chai-Hu-Tang

中醫藥研究論叢

20卷1期（2017 / 03 / 30）

171 - 180

繁體中文

小兒便秘是臨床門診常見的問題，根據研究統計，在台灣，國小兒童的發生率約為32.2%。影響便秘的因素眾多，包括飲食、心理、身理、環境和社會因素。西醫治療小兒便秘一般多使用緩瀉劑或甘油球，然而很容易有依賴性的問題產生，而手術治療亦可能造成大便失禁之風險。許多病患家屬因而紛紛轉向中醫尋求幫助。本案例為一個便秘2-3個月之3歲女童就診中醫之病案。經採用滋陰清熱，通調氣機的治則，以甘露飲與小柴胡湯加減處方，其便秘在服藥一週內明顯改善，不須甘油球通便，第二週起自解便順暢，故開始減量服藥，第三週起諸症平穩，故囑咐家屬逐漸調整小兒飲食，可以漸進式停服中藥。前後三週，依中醫辨證原則，未使用通腑瀉下中藥，順利控制此小兒便秘之案例。

Constipation, which is common among children, is accounting for an estimated 3 to 5 percent of all visits to pediatricians. Among different causes of constipation, functional constipation is particularly common among preschoolage children. Functional constipation describes persistently difficult or seemingly incomplete defecation, without evidence of a primary biochemical or anatomic cause. There are multiple factors that influence constipation, such as dietary, psychological, physical, environmental and social factors. We report a case of a 3-year-old female children with constipation for 2-3 months who is seeking TCM advice. The symptoms was improved after taking Chinese herbal formulae within 3 weeks. This approach seems to offer a effective alternative treatment for funtional constipation children.

1. Health Promotion Board, Singapore. Nutrition for children . Version current 2007. Available at: http://www.hpb.gov.sg/hpb/default.asp?pg_id=865&aid=274&altid=0. Accessed December 31, 2008
2. National Academy of Sciences. Science Academies urge more funding for maternal and child health.Availableat: http://w ww.nasonline.org/site/PageServer. Accessed May 26, 2010.
3. Benninga, MA,Faure, C,Hyman, PE,St James Roberts, I,Schechter, NL,Nurko, S(2016).Childhood Functional Gastrointestinal Disorders: Neonate/Toddler.Gastroenterology,pii,S0016-5085(16)00182-7.
4. Di Lorenzo, C(2001).Pediatric anorectal disorders.Gastroenterol Clin North Am.,30(1),269-87.
5. Fontana, M,Bianchi, C,Cataldo, F,Conti Nibali, S,Cucchiara, S,Gobio, Casali L,Iacono, G,Sanfilippo, M,Torre, G(1989).Bowel frequency in healthy children.Acta Paediatr Scand.,78(5),682-4.
6. Friedmacher, F,Puri, P(2012).Comparison of posterior internal anal sphincter myectomy and intrasphincteric botulinum toxin injection for treatment of internal anal sphincter achalasia: a meta-analysis.Pediatr Surg Int.,28(8),765.
7. Hyams, JS,Di Lorenzo, C,Saps, M,Shulman, RJ,Staiano, A,van Tilburg, M(2016).Functional Disorders: Children and Adolescents.Gastroenterology,pii,S0016-5085(16)00181-5.
8. Hyams, JS,Treem, WR,Etienne, NL,Weinerman, H,MacGilpin, D,Hine, P,Choy, K,Burke, G(1995).Effect of infant formula on stool characteristics of young infants.Pediatrics,95(1),50-4.
9. Loening-Baucke, V(1993).Chronic constipation in children.Gastroenterology,105,1557.
10. Tabbers, MM,DiLorenzo, C,Berger, MY,Faure, C,Langendam, MW,Nurko, S,Staiano, A,Vandenplas, Y,Benninga, MA,European Society for Pediatric Gastroenterology, Hepatology, and Nutrition,North American Society for Pediatric Gastroenterology(2014).Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN.J Pediatr Gastroenterol Nutr.,58(2),258-74.
11. Van Den Berg, MM,Benninga, MA,Di Lorenzo, C(2006).Epidemiology of childhood constipation: a systematic review.Am J Gastroenterol.,101(10),2401-9.
12. Walker, WA,Goulet, O,Kleinman, RE(2004).Pediatric Gastrointestinal Disease.Ontario:BC Decker Inc..
13. WHO(2004).Guiding Principles for Feeding Non-Breastfed Children 6-24 Months of Age.Geneva:WHO.
14. Wyllie, Robert,Hyams, Jeffrey S.,Kay, Marsha(2016).Pediatric Gastrointestinal and Liver Disease.Amsterdam:Elsevier Inc..
15. 呂澤康、朱良春(2014)。國醫大師朱良春教授塞因塞用法辨治小兒便秘。吉林中醫藥，34(6)，577-9。
16. 郝宏文、王素梅、吳力群、崔霞、劉奕(2009)。從脾虛肝旺論治小兒便秘。北京中醫藥大學學報，16(3)，29-30。
17. 郝玲(2012)。鄭家遠主任醫師治療小兒便秘經驗。中醫兒科雜誌，8(6)，3-4。
18. 郝萬山(2008)。郝萬山傷寒論講稿。北京:人民衛生出版社。
19. 楊紹心(2010)。張士卿教授治療小兒便秘經驗。中醫兒科雜誌，6(5)，1-2。

1. 蘇泓文,許堯欽,莊照宇(2023)。小兒慢性便秘之中醫藥治療驗案。中醫藥雜誌，34(2)，98-107。