第五章重點整理                                
                                                                      
        【兒科常見疾病之保健】                                        
                                                                      
        〈小兒體質中醫觀〉                                            
        古代早就把小兒科單獨列為一科,隋唐時代太醫暑即專設「少小科」  
        並規定學習五年後,需考試合格後才能做小兒科醫生。              
                                                                      
        由此可見,小兒疾病的預防保健、生理、病理、處方用藥等等均有其  
        獨特之處,所以不能把小兒當做成人的縮影。                      
                                                                      
        §生理特點                                                    
                                                                      
        小兒的生理特點,依據大多數學者專家的共識,認為是「臟腑嬌嫩,  
        形氣未充」、「生機蓬勃,發育迅速」。                          
                                                                      
        1.臟腑嬌嫩,形氣未充:                                        
          嬌,指嬌氣;嫩,指嫩弱;形,指形體結構;氣,指生理功能活動。
                                                                      
        2.生機蓬勃,發育迅速:                                        
          生機蓬勃指小兒在生長發育過程中,從體格、智力以及臟腑功能各  
          方面,均不斷的向完善、成熟方面發展。年齡越小生長發育的速度  
          也越快。                                                    
                                                                      
        §病理特點                                                    
                                                                      
        小兒的病理特點依大陸中醫兒科學者共識,認為是「發病容易,傳變  
        迅速」、「臟氣清靈,易於康復」。                              
                                                                      
        1.發病容易,傳變迅速:                                        
          由於小兒臟腑嬌嫩,形氣未充,體質和功能均屬脆薄,對疾病的抵  
          抗力差,再加上小兒對環境中所有病毒,細菌的接觸多屬第一次,  
          或調護不當,飲食不節,外易為六邪所犯,內易為飲食所傷(發病容 
          易),患病之後,病情容易有變化。                             
                                                                      
        2.臟氣清靈,易於康復:                                        
          即使小兒得病容易,只要經過合理的治療或調養,病情往恢復迅速,
          後遺症少。                                                  
                                                                      
        3.在小兒保健及治療疾病上,特別是注重小兒「脾常不足」的特點。所
          謂「脾常不足」,是指小兒臟腑嬌嫩,脾胃運化功能尚未健全,而生
          長發育所需水穀氣,卻較成人更為迫切。                        
                                                                      
        4.在小兒疾病的發展上,也須特別留意「肝常有餘」的特色;所謂「肝
          常有餘」即指肝陽有餘,肝風易動的病理特點。                  
                                                                      
        【中醫兒科保健概述】                                          
        〈小兒保育觀〉                                                
                                                                      
          小兒保育觀有以下的重點:                                    
          1.注意溫度的變化與衣著:要背暖、要肚暖、要足暖、要頭涼、要心
            胸涼。                                                    
                                                                      
          2.宜適度的戶外運動:主張應有充足的睡眠,並主張在氣候適宜情況
            下,讓小兒到戶外接觸陽光和新鮮空氣。                      
                                                                      
          3.飲食宜清淡易消化並且注重均衡營養:由於小兒臟腑嬌嫩,脾胃脆
            弱,消化機能未趨完善,所以古代醫家都十分注重飲食節度,反對
            乳食太飽。                                                
                                                                      
          4.小兒進補宜慎重:現今台灣民眾生活富足,小兒體質偏虛者少,偏
            實者多,父母如果不辨明小兒當前的體質情況,一昧給小兒進補,
            從維他命到健康食品,甚而各種補養中藥等等,不一而足,常常不
            但無益反而有害。                                          
                                                                      
          5.宜保持精神安靜心情愉快:由於小兒屬於「成而未全、全而未狀」
            的體質,受外界刺激多是第一次,對於外界刺激的應付能力不足,
            所以保持小兒精神安靜,是非常重要的一門課程。              
                                                                      
        〈小兒腸胃保健法〉                                            
        1.傳統中醫認為「脾胃」為「後天之本,為氣血生化之源」。而小兒體
          質特色是「脾常不足」,所謂「脾常不足」,是指小兒臟腑嬌嫩,脾
          胃運化功能尚未健全,而生長發育所需水穀之氣,較成人更為迫切。
                                                                      
        2.中醫的脾胃系統包括現代醫學的消化系統,消化吸收功能以及部份免
          疫抗病功能。由於小兒無時無刻不在成長發育,很多疾病也是第一次
          接觸,所以「脾胃」的強弱與否,關係著成長過程是否順利少病。  
                                                                      
        3.明代徐春圃『養子十法』:一要背暖,二要肚暖,三要足暖,四要頭
          涼,五要心胸涼,六者小兒勿見非常之物或未識之人,七者溫脾胃,
          八者兒哭未定勿使飲乳,九者勿得輕粉硃砂,十者小兒一週之內不可
          輕易頻洗。其中「肚暖」、「溫脾胃」講的就是脾胃保健的基本原則。
                                                                      
        4.『養子十法』簡述如下:                                      
          (1)「肚暖」:也就是穿著腹部要保暖。                         
          (2)「溫脾胃」:飲食上宜溫不宜涼冷,在用藥上宜慎用苦寒,即使不
             得已須用苦寒藥,也應「中病即止」。                       
          (3)「吃熱」:也就是說在飲食上應該選擇溫性而忌涼性,尤忌生冷瓜
             果、冰品等。                                             
          (4)「吃軟」:選擇容易消化的食物〈吃軟不吃硬〉。             
          (5)「吃少」:食勿過飽。                                     
                                                                      
        現代醫學證實:過飽或消化不良造成「食積」狀態會降低身體的免疫抗病
        功能。                                                        
                                                                      
        【兒科常見疾病與保健】                                        
        《感冒》                                                      
                                                                      
        1.感冒是小兒時期最常見的外感疾病。                            
                                                                      
        2.主要症狀:發熱、怕冷、頭痛、咳嗽、打噴嚏、鼻塞流涕。        
                                                                      
        3.臨床上常見證約可分為:風寒感冒、風熱感冒、暑邪感冒三種證候。
                                                                      
        《飲食與藥膳》                                                
                                                                      
        1.風寒感冒:薑糖茶、薑蘇飲、紫蘇粥。                          
                                                                      
        2.風熱感冒:忍冬薄荷飲、菊花茶、桑菊豆豉茶。                  
                                                                      
        3.暑濕感冒:綠豆湯、香蕦飲。                                  
                                                                      
        《飲食禁忌》                                                  
                                                                      
        1.患病期間,宜多休息多飲水,飲食以清淡、易消化為原則。        
                                                                      
        2.忌食油膩、粘滯煎炸食物,魚肉腥葷皆宜不用或少用。尤忌冰品、  
          汽水、生冷瓜果等。                                          
                                                                      
        3.感冒期間一般不宜進補品,以免邪氣戀而不去,反致疾病延綿難癒  
          。若慮其體弱不耐,可稍給蛋、乳、瘦肉之類。                  
                                                                      
        《預防與護理》                                                
                                                                      
        1.「宜時見風日」,平時加強戶外活動,多見陽光,增加體質;提升  
          身體抗病能力。                                              
                                                                      
        2.注意穿著,留意氣候變化,及時增減衣服。經常保持室內空氣新鮮  
          流通。                                                      
                                                                      
        3.在感冒流行期間,避免出入公共場所,或戴口罩,預防傳染。      
                                                                      
        4.藥物預防,生貫眾3~9克水煎服。每日一劑,分三次服,連服三日(  
          須經中醫師診視後方可使用本法)。                             
                                                                      
        5.患病期間,宜多飲水,給易於消化食物,注意清潔衛生與注意病情  
          變化。                                                      
                                                                      
        §附方§                                                      
        1.蔥豉湯   2.杏蘇散   3.荊防敗毒散   4.銀翹散   5.桑菊飲      
                                                                      
        6.近加香蕦飲   7.藿香正氣散                                   
                                                                      
        《咳嗽》                                                      
        1.咳嗽定義,簡而言之,有聲無痰為咳,有痰無聲為嗽,所以有聲有痰
          稱之為咳嗽。                                                
                                                                      
        2.咳嗽是小兒呼吸系統常見疾病。                                
                                                                      
        3.咳嗽的主要病因不外乎「外感」、「內傷」二途。                
                                                                      
        4.臨床上風寒咳嗽、風熱咳嗽二證較為常見。                      
                                                                      
        《預防與保健》                                                
        1.加強鍛鍊身體,宜多戶外運動,增加抗病能力。                  
                                                                      
        2.注意氣候變化與衣服增減,防止受涼。                          
                                                                      
        3.病後適當休息,多喝水,飲食宜清淡易消化,忌油膩難化之食物,以
          免助熱生痰。                                                
                                                                      
        4.「形寒飲冷則傷肺」,不管任何證型之咳嗽,尤忌冰品、汽水、可樂
          等品。                                                      
                                                                      
        5.保持室內環境清潔安靜,空氣新鮮及室內適當溫度、濕度。        
                                                                      
        §附方§                                                      
        1.金沸草散   2.杏蘇散   3.華蓋散   4.麻杏石甘湯   5.桑菊飲    
        6.五虎湯     7.二陳湯   8.蘇子降氣湯   9.六君子湯  10.生脈湯  
        11.紫苑湯   12.百合固金湯   13.沙蔘麥冬湯                     
                                                                      
        《泄瀉》                                                      
        1.泄瀉是以大便次數增多,大便性質稀薄或如水樣為其主證。        
                                                                      
        2.引起小兒泄瀉的原因很多,依中醫辨證約可分為「濕熱」、「傷食瀉」
          、「虛證」與「寒證」等。                                    
                                                                      
        《預防與保健》                                                
        1.注意飲食衛生,鼓勵餵食母乳,增添副食宜單純且漸進,不宜太多太快
                                                                      
        2.餵乳食要做到定時定量,要避免受涼,尤其是腹部要注意保暖。加強戶
          外活動,注意氣候變化與衣服穿著等。                          
                                                                      
        3.一旦出現腹瀉,控制飲食非常重要。                            
                                                                      
        §附方§                                                      
        1.藿香正起散   2.胃苓湯   3.葛根芩連湯   4.消乳丸   5.保和丸  
        6.蔘苓白朮散   7.七味白朮散   8.四神丸    9.附子理中湯        
        10.連梅湯     11.清暑益氣湯   12.四逆湯   13.蔘附龍牡湯       
                                                                      
        《腹痛》                                                      
        1.小兒腹痛是臨床極為常見的證候。                              
                                                                      
        2.中醫認為小兒腹痛產生的原因有:因寒、因熱、因積滯交相侵害而發病
          ,或因氣滯血瘀、臟腑虛冷等因素。                            
                                                                      
        3.臨床常見有:                                                
        (1)食積腹痛   (2)中寒腹痛   (3)熱結腹痛   (4)虛寒腹痛         
        (5)氣滯血瘀腹痛                                               
                                                                      
        《預防與保健》                                                
                                                                      
        1.注意個人和飲食衛生。                                        
        2.宜避免感受風寒,並注意腹部保暖。                            
        3.「頻揉肚」,強化脾胃功能。                                  
                                                                      
        §附方§                                                      
        1.木香檳榔丸   2.保和丸   3.良附丸   4.養臟丸   5.涼膈丸      
        6.麻子仁丸   7.導赤丸   8.小建中湯   9.理中湯   10.少腹逐瘀湯 
        11.使君子散  12.肥兒丸                                        
                                                                      
        《積滯》                                                      
        1.積滯是指小兒因引飲食不當,傷乳過久,積聚不化所形成的一種慢性胃
          腸疾患。                                                    
        2.本病治療時,實證應以消導為主,虛中夾實證則宜和中健脾,消補共施
                                                                      
        辨證論治                    &nbsp

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