Pediatric Tui Na for the Treatment of Constipation

Xingui Yang and Sen Lin

Abstract:This article focuses on discussing pediatric constipation. In pediatric tui na for the treatment of constipation it seems life the disease is in the large intestine, yet, the key to the pathology is actually disharmony in the functions of the child’s organs, such as the spleen, stomach, lung, and liver, and a breakdown of large intestinal conveyance. These factors, in combination with children’s typically low intake of green vegetables, fruit, and water, this causes pediatric constipation, which is primarily treated clinically using simultaneous supplementation and drainage tui na manipulation techniques. The main treatment principles employed are fortifying the spleen, harmonizing the stomach, moving qi, and freeing the stool, along with appropriate point prescriptions. These are the main treatment methods for treating pediatric constipation by solving the root cause of the problem.

Keywords:pediatric constipation, lung, spleen, liver, large intestine, pediatric tui na

Constipation is a common and frequently occurring pediatric illness. As living standards have improved, diets and lifestyles have changed, and there has been a gradual upward trend in the number of children with constipation. Pediatric constipation is a complex of symptoms that include loss of appetite, abdominal distention and pain, umbilical pain, restless sleep, and in severe cases possibly anal prolapse or anal fissure. It may cause the child to be afraid of passing stool, which will increase the abdominal distention and pain, and lead to emotional upset. It can have a negative impact on the child’s physical and mental health, growth, and development.

Children have unique physiological and pathological characteristics, therefore, tui na treatment for pediatric constipation is different from that used for adults. In adults one simply uses heat-clearing techniques, but this will often backfire with children. The author’s realizations, which are based on many years of clinical experience treating pediatric constipation, are as follows.

The causes and pathologies of pediatric constipation have been discussed extensively since ancient times by various experts. For instance, Youke Tiejing ［The Iron Mirror of Pediatrics］states: “The lung and large intestine contain heat; heat leads to a lack of fluids and blockage of stool”. Bai Wen ［One Hundred Questions］says: “Constipation is when there is heat in the interior of the lung, which flows into the large intestine to cause constipation and blockage; this is excess heat”. Chaoshi Bingyuan ［Chao’s Origins of Disease］ states: “In children with constipation, the cause is heat in the organs that overwhelms the large intestine. The stomach is the sea of water and grain; the essence of water and grain transforms into blood and qi, while the waste matter moves along the large intestine. If the triple burner and five viscera are not harmonized, hot qi will return to the large intestine. If the heat is in excess, then there will be constipation”.

In the field of modern TCM, it is believed that pediatric constipation is closely related to improper diet because children tend to dislike drinking water as well as eating green vegetables and fruit, in addition to other dietary irregularities. Since the spleen is the source of engendering transformation of qi and blood, it is the “root of later heaven” that sustains the life activities of the body as well as the transformation and engendering of qi, blood, and fluids. Therefore, since “the spleen is often insufficient” it causes food not be transformed into the subtle essences of water and grain to be absorbed and used by the body; water cannot be transformed into fluids to be absorbed as nutrients by the body and stagnates in the intestines, transforming into dampness and heat over time. Moreover, the spleen and stomach are the pivot of the qi dynamic’s upbearing and downbearing. The movements of the large and small intestines are controlled by the moving and transforming functions of the spleen qi; a disorder of the upbearing and downbearing of spleen qi in which the turbid qi fails to bear downward will cause constipation. The lung and large intestine have an interior-exterior relationship; if there is heat in the lung this can engender heat in the large intestine, causing the large intestine to fail convey the stool. Congestion of lung qi can cause disharmony in the upbearing and downbearing of the qi dynamic, leading to disordered intestinal function and constipation. The liver governs free coursing and it can regulate the qi dynamic throughout the body. It can promote the movement and transformation functions of the spleen and stomach as well as the conveyance function of the large intestine, and it aids the large intestine in excretion. In children, the liver is often in superabundance. The liver corresponds to wood, and it controls movement and upbearing. In chapter 8 of Su Wen ［Plain Questions］, entitled “Treatise on the Arcane Book of the Orchid Chamber in the Spirit Tower”, the liver holds the office of general. Children tend to exhibit emotional instability and irritability. Because the liver governs free coursing, free flow, upbearing, and effusion, children who are spoiled by their parents may develop capricious and irritable personalities. Thus, if children do not get their way, they may start wailing or throw a temper tantrum, which can intensify the liver fire to the point of causing liver qi constraint that can transform into heat. Heat damaging the fluids causes disharmony in the intestines that leads to constipation. Because in children “the spleen is often insufficient and the liver is often in superabundance”, abnormalities in the function of these two organs in a child’s body can cause disease. Due to the liver’s excess upbearing and discharging, the yang qi rises up and restrains the spleen earth. The spleen was insufficient to start with; restrained by the liver, it loses its function of movement and transformation, causing pediatric constipation. This is why phenomena such as crankiness and poor appetite are commonly seen in children in clinical practice. Chapter 3 of Su Wen ［Plain Questions］, “Treatise on Vital Qi Connecting with Heaven”, says: “The yang qi, in extreme anger, will make the qi of the body move recklessly and blood will rush up to the head, causing the person to experience a sudden reversal ［of qi flow］. ” The movement of blood and the transportation and metabolism of fluids also depend on the upbearing, downbearing, and inward and outward movements of qi, so qi constraint and poor fluid transportation and metabolism lead to pediatric constipation. Therefore, in pediatric constipation, although the disease is in the large intestine, the pathomechanism has a close relationship with the lung, spleen, and liver that cannot be overlooked.

Tui na is performed using simultaneous supplementation and drainage; the main treatment principles are coursing the liver and rectifying the qi, fortifying the spleen, and harmonizing the stomach.

There are many causes of pediatric constipation, which are often diagnosed in folk medicine as heat, qi, or insufficiency, among others. When performing tui na, the manipulation techniques used include those that fortify the spleen, rectify qi, and nourish yin. In the past, most treatments focused on drainage methods, but spleen insufficiency is a physiological characteristic in children. From a young age, the author studied tui na with her uncle and started using drainage methods to treat constipation. When tui na was performed, patients would improve, but as soon as the manipulations stopped, they would relapse. This was mainly due to overlooking children’s spleen insufficiency, which caused the point prescriptions and tui na treatment to yield unsatisfactory results because they did not address the root cause of pediatric constipation. The author has combined the folk TCM diagnosis and treatment methods passed down from her uncle with the physiological and pathological characteristics of children, namely that “the spleen is often insufficient, and the liver is often in superabundance”. Pediatric tui na should supplement that which is insufficient and reduce that which is in superabundance. In clinical practice, one should use simultaneous supplementation and drainage manipulation techniques, with fortifying the spleen and moving qi as the main treatment principles. This has yielded ideal results in the course of treatment.

The basic manipulation techniques are summarized as follows:

In cases with repletion constipation: focus on clearing, supplementing, enriching yin, and unblocking the stool. Clear and supplement the large intestine¹, clear the liver², clear the lung³, supplement the spleen⁴, move water into earth⁵, and knead Erma⁶ and Yongquan ［KD-1］.

In cases with insufficiency constipation: focus on supplementing insufficiency and moistening the intestines to unblock the stool. Clear and supplement the spleen, massage Erma, supplement the kidney⁷, and massage Wailao⁸.

The combined use of these manipulation techniques will fortify the spleen without causing congestion, move qi without damaging it, clear heat without damaging the central burner, moisten dryness without creating greasy obstructions, and unblock the stool safely. This method can treat constipation without harming the child’s digestive system and can strengthen the digestive functions. It can be regarded as a gentle and effective new tui na treatment method for pediatric constipation.

Typical case

Hai, male, 1 year and 10 months of age, was treated on December 6^th, 2011. Chief complaint: constipation with hard stool like sheep droppings. Glycerin enemas had been administered for 15 months. At times, he also had abdominal distention and pain, poor appetite, and restless sleep. The tongue body was pale red with white, greasy fur. This pattern is the spleen failing to move and transform, poor execution of the qi dynamic, and the large intestine failing to perform its function of conveyance. Therefore, tui na treatment focused on fortifying the spleen, harmonizing the stomach, rectifying qi, and unblocking the stool. The point prescription involved supplementing the spleen, moving Neibagua⁹, and clearing the large intestine. Initially, treatment was done twice a day; after 3 days, it was done once daily. After a week, Hai’s stool was completely normal and glycerin enemas were no longer needed.

In clinical tui na practice, pediatric constipation is relatively common. The majority of cases are due to improper feeding, dietary intemperance, or other diseases affecting the normal movement and transformation functions of the spleen and stomach. When these movement and transformation functions are in disharmony, the qi dynamic will not run smoothly. Therefore, when performing tui na, drainage should be combined with enriching yin to unblock the stool, and fortifying the spleen and harmonizing the stomach should be combined with moving qi to unblock the stool, treating the branch and root simultaneously. Using manipulation techniques such as supplementing the spleen, clearing heat and supplementing the large intestine, Bagua, and Banmen10 to treat pediatric constipation can yield results that exceed expectations.

Recurring common cold

Wang, a 5-year-old male, was treated on April 26th, 2015. He had experienced recurring common colds for 3 years, catching cold more than¹⁰times a year. At the time of treatment, he had a cold with a fever of 38.5 degrees Celsius that had persisted for several days. His body was thin and weak, and his face was dull yellow in color. He also had sneezing, a runny nose with yellow mucus, coughing, decreased intake of food, and constipation. His tongue was red with yellow fur. His fingertips were purple and stagnant. This pattern is a subtype of wind-heat common cold. The treatment method was fortifying the spleen and diffusing the exterior evil. The treatment included opening Tianmen¹¹, pushing Kangong¹², kneading Taiyang, clearing Tianhe¹³, supplementing the spleen, clearing the liver channel, and clearing the lung channel. This was done once a day for 7 days as 1 course of treatment. The child’s symptoms completely disappeared; after continuous treatment for 1 month, his immunity improved significantly and he no longer experienced recurring common colds.

Night sweating

Li, a 2-year-old female, had her first intake on April 18^th, 2015.

Clinical presentation: the patient would start sweating when she fell asleep, producing beads of sweat the size of soybeans, mostly on her head, face, and back. This had been occurring every day for more than 1 year. Western medicine was ineffective, and the child would not tolerate Chinese herbal medicine, acupuncture, or moxibustion, so she was brought to the tui na clinic. Accompanying symptoms included frequent low-grade fevers, listlessness of essence-spirit, and low food intake. The tongue body was pale red with thin white fur. Treatment principles were harmonizing construction and defense, nourishing yin, and clearing heat. Treatment involved supplementing the spleen channel, moving Bagua, Banmen, kneading Baihui ［GV-20］, supplementing the kidney, and kneading Shending14. After 1 course of massage treatment, symptoms gradually decreased in severity; after 3 courses of treatment, the patient was cured.

Pediatric enuresis

On July 5^th, 2015, Chen, a 6-year-old male, was treated for nocturnal enuresis. His parents reported that every night he would wet the bed 2 to 3 times. His face was white, with a fatigued spirit and lack of strength. His four limbs were cold and he had a poor appetite.

The tongue body was pale with thin white fur. The treatment methods used were supplementing the spleen and kidney and securing the urine. The treatment used Baihui ［GV-20］, Renzhong ［GV-26］, supplementing the kidney channel, Sanyinjiao ［SP-6］, and Dantian¹⁵, once daily. After 1 course of treatment, the enuresis decreased in frequency. After 3 courses of treatment, the enuresis stopped and after 2 reinforcing courses of treatment, he was cured.

Pediatric anorexia

Wang was a 7-year-old female with a 3-year history of anorexia. Her body was small and thin, and her face was dull yellow in color. She liked to eat snacks. She had a runny nose with turbid mucus and phlegm, low food intake, thin stool, normal urination, and no issues with sleep. The tongue body was dull red with red sides and tip. The fur was yellow and geographic. The fingertips were purple and stagnant.

The treatment method was fortifying the spleen and harmonizing the stomach, enriching yin, and clearing heat. The treatment involved opening Tianmen, pushing Kangong, kneading Erhougaogu¹⁶, Taiyang, supplementing the spleen, moving Neibagua, kneading Banmen, and kneading Erma. After 3 days, the runny nose symptoms were basically gone and the geographic tongue fur had mostly resolved. After a final reinforcing treatment, the patient was cured.

Conclusion

In the clinical practice of pediatric tui na, we have found that the reasons why pediatric illnesses tend to recur are all due to parents’ giving an improper diet, and poor lifestyle, and clothing choices. It is said that health is “30 percent treatment, 70 percent maintenance”; parents’ care and maintenance is an important part of this. Children’s spleen and stomach are insufficient and weak, and their organs are delicate. If they eat too much, the spleen and stomach will be damaged, causing improper function of the spleen and stomach’s movement and transportation in the center burner, and obstructing the activities of qi and blood. Pediatric tui na treatment stimulates the channels and network vessels as well as acupuncture points to activate the body’s self-healing system and adjust organ functions, thereby achieving the ability to resist disease and fend off external evils. Tui na treatment can effectively replace medication and decrease the amount of damage that medication causes to the body, enabling more children to benefit.

Authors:

Yang Xingui is the president of the Zhang Zhongjing School of Chinese Medicine Research Institute in Henan province and a fifth-generation Yang TCM practitioner.

Lin Sen is a TCM practitioner and vice-president of the Zhang Zhongjing School of Chinese Medicine Research Institute in Henan province. Lin is also an assessor for China’s National Occupational Skills Testing Authority, a seventh-generation Lin TCM practitioner, inheritor of Huang Baoju’s Huang scalp acupuncture intangible cultural heritage, inheritor of TCM master and professor Tang Zuxuan’s academic legacy, and a practitioner of Han-Tang Five-Qi Five-Element acupuncture.

Translator’s Notes:

1. Clear and supplement the large intestine: in pediatric tui na, the large intestine point is the radial side of the index finger where the flesh of the palm meets that of the back of the hand. To clear the large intestine, push from the base of the index finger to the fingertip. To supplement the large intestine, push from the tip of the index finger to its base. Clearing and supplementing the large intestine means pushing back and forth from the fingertip to the base of the finger.

2.Clear the liver: in pediatric tui na, the liver channel is on the palmar aspect of the index finger. To clear the liver, push from the base of the palmar aspect of the index finger to the fingertip.

3. Clear the lung: in pediatric tui na, the lung channel is on the palmar aspect of the ring finger. To clear the lung, push from the base of the palmar aspect of the ring finger to the fingertip.

4. Supplement the spleen: in pediatric tui na, the spleen channel point is located on the pad of the distal phalanx of the thumb. To supplement the spleen, push along the radial side of the thumb from the tip to the base.

5. Move water into earth: use the moving technique (i.e. light, gentle, slow circular movements) from the kidney channel point on the palmar surface of the child’s little finger, across the ulnar side and root of the palm, to the spleen channel point on the palmar surface of the thumb.

6. Erma: this point is found on the dorsal aspect of the hand in a depression between and distal to the heads of the fourth and fifth metacarpal bones.

7. Supplement the kidney: in pediatric tui na, the kidney channel point is on the ulnar side of the palmar aspect of the little finger. To supplement the kidney, push from the fingertip to the root of the little finger.

8. Wailao (Wailaogong): This point is found in the center of the dorsal aspect of the hand.

9. Neibagua: this point is on the center of the palmar surface of the hand, and consists of a circle around the center of the palm with a radius equal to the distance from the center of the palm to the point between the inner 2/3 and outer 1/3 of the base of the middle finger.

10. Banmen: this point is located on the palmar surface of the hand slightly below the center of the flat pale area of flesh below the thumb.

11. Opening Tianmen: the point Tianmen is the straight line from between the eyebrows to the anterior hairline. To open Tianmen, alternate using the thumbs of both hands to push up from between the eyebrows to the anterior hairline.

12. Kangong: this point is the horizontal line from between the eyebrows to the end of the eyebrow.

13. Clearing Tianhe: this point is found on the center line of the flexor aspect of the forearm. It is a straight line from the center of the wrist crease to the center of the elbow crease. To clear Tianhe, push from the center of the wrist crease to the center of the elbow crease.

14. Shending: this point is found at the tip of the little finger.

15. Dantian: this point is located on the lower abdomen between 2 and 3 cun below the umbilicus.

16. Erhougaogu: This point (literally “protruding bone behind the ear”) is located within the hairline behind the ear, in the depression below the posterior border of the mastoid process.

小兒推拿治療便秘

楊新貴林森

摘要:本文重點探討小兒便秘。小兒推拿治療便秘看似大腸有病其實病機關鍵在小兒脾胃、肺、肝等臟腑功能失調、大腸傳導失司。又加上小兒飲食青菜、水果、水的攝入少，所以引起小兒便秘，在臨床上主要採取補瀉兼施的推拿治療手法。主要以健脾和胃、行氣通便為推拿治療的原則，還有准確的穴位組合是治療小兒便秘的主要治療方法，來解決小兒便秘的根本問題。

關鍵詞: 小兒便秘肺脾肝大腸小兒推拿

小兒便秘是小兒的常見病、多發病，隨著生活水平的提高，飲食和生活習慣發生了改變，便秘兒童逐漸呈上升趨勢。小兒便秘是一組症候群，包括食欲減退、腹脹、腹痛、臍痛、夜寐不安，嚴重者可導致脫肛、肛裂，或者使小兒因恐懼不敢排便，會加強腹脹、腹痛，而情緒不安。對小兒身心健康和生長發育造成不良影響。

小兒有獨特的生理、病理特點，因而推拿治療小兒便秘與成人不同，單純地用清熱手法往往適得其反。為此，筆者根據多年來治療小兒便秘的臨床經驗體會如下：

小兒便秘的病因病理自古以來各名家多有論述，如：《幼科鐵鏡》“肺與大腸有熱，熱則津液少而便閉。”《百問》“ 便秘，乃是肺家有熱在裡，流入大腸以致秘結不通乃實熱也。”《巢式病源》“小兒大便不通者，臟腑有熱乘與大腸故也。胃為水穀之海，水穀之精化為血氣，其糟粕行於大腸絡三焦五臟不調和，熱氣歸於大腸，熱實故大便不通也”。

現代中醫領域中認為，因為小兒便秘與飲食不當有很大關係，因小兒飲食素愛偏不愛飲水，不愛食青菜、水果，又加之飲食不節，因脾為氣血生化之源，“後天之本”主機體生命活動的持續和氣血津液的化生。因而，“脾常不足”使食物無法轉化為水穀精微被人體吸收利用；水無法轉化為津液被人體吸收為營養停滯腸道，日久化溼、化熱，且脾胃為氣機升降之樞紐，大、小腸之運動受脾氣運化功能的支配，脾氣升降失常，濁氣不降導致便秘。肺與大腸相表裡，如有肺熱可使大腸生熱，導致大腸傳導功能失職，肺氣壅滯可導致氣機升降失調，腸道功能失常而導致便秘，肝主疏泄能調暢週身氣機，能促進脾胃運化功能和大腸傳導功能而助大便的排泄。小兒肝常有餘，肝屬木、主動、主升，《素問.靈蘭秘典論》中，肝者為將軍之官，小兒情緒不穩及情緒急躁。因肝主疏泄、疏通、升發，小兒因家長溺愛養成任性、急躁的性格。因而不隨兒願便嚎啕大哭、暴跳如雷，易加重肝火致使小兒肝氣不舒，氣鬱化熱。使腸道因熱傷津精液失調而導致便秘。因小兒“脾常不足、肝常有餘”，而二者共同在小兒體內發揮不正常作用而致病。由於肝的升泄太過，陽氣升騰而來克脾土，脾本不足，又被肝克就失去運化功能，造成小兒便秘。因而臨床上常見小兒脾氣暴燥、食欲不振等現象。《素問.生氣通天論》說：“陽氣者，大怒則形氣絕，而血菀於上，使人薄厥。”血的執行和津液的輸佈代謝，亦有賴於氣的升降出入運動，因此氣的鬱結、津液的輸佈代謝不暢而導致小兒便秘。所以小兒便秘雖病在大腸，但病機與肺、脾、肝有著密切關係不可疏忽。

推拿補瀉兼施，疏肝理氣、健脾和胃為主要治療原則。

小兒便秘的原因很多，民間辨證主要為熱、氣、虛等，推拿時以健脾、理氣、養陰等推拿手法。因過去治療中主要以瀉法為主，但小兒因脾常不足的生理特點，筆者自幼跟叔父學時，開始用瀉法治療便秘，推了就好，手法停則復發，主要疏忽了小兒脾不足，所以配穴推拿時不理想，難以從根本上治療小兒便秘，筆者結合民間祖傳中醫叔父的傳統中醫診療方法，結合小兒脾常不足、肝常有餘的生理、病理特點，小兒推拿應補其不足，損其有餘，臨床採取補瀉兼施的推拿手法，以健脾行氣為主要的推拿治療原則，治療過程中取得了理想的效果。

基本手法總結如下：

實秘：以清補滋陰通便為主，清補大腸¹，清肝²、清肺³，補脾⁴，運水入土⁵、揉二馬⁶、揉涌泉等。

虛秘：以補虛潤腸通便為主，清補脾，二馬，補腎⁷、外勞⁸等。

這種手法並用使得健脾而不擁阻，行氣而不傷氣，清熱而不傷中，潤燥無膩礙，通下無過虞。既能治療便秘又能使小兒消化系統不受損，增強消化功能，在治療小兒推拿便秘上不失為一種平和而有效的推拿治療新發。

典型案例

海某，男，一歲十個月，2011年12月6日。主訴：大便秘結糞質堅硬如羊糞，用了 15 個月開塞露，時伴有腹脹腹痛、飲食不振、夜寐不安、舌質淡紅，苔白膩。證屬脾失健運，氣機執行不暢，大腸傳導失職，所以推拿以健脾和胃，理氣通便為主。配穴、補脾，運內⁹，清大腸等，開始每日二次，三天後每日一次。一週後海某大便完全正常，告別開塞露。

小兒推拿在臨床上，小兒便秘比對常見。多因為喂養不當、飲食不知自節，或有其他疾病影響脾胃正常的運化功能。胃運化失調，氣機執行不暢。所以推拿時瀉下，滋陰通便相結合。健脾和胃，行氣通便相結合標本兼治療，手法補脾、清補大腸、八卦、板門¹⁰等來治療小兒便秘有意想不到的結果。

易感兒

2015年 4月26日，王某男 5歲。復感冒3年，一年內感冒 10 次以上，就診時感冒，發燒 38.5 度持續幾天，身體瘦弱，面色暗黃，打噴嚏，流黃鼻涕，咳嗽，厭食，納差，便秘。舌紅，苔黃。指紋紫滯。辨證分型屬於風熱感冒治法健脾和宣散表邪。開天門¹¹、推坎宮¹²、揉太陽、清天河¹³、補脾、清肝經、清肺經等，一天一次七天為一個療程，孩子病症完全消繼續調理一個月後，孩子免疫力大為提高，之後孩子不再反復感冒。

盜汗

2015年4月18日，李某，女2歲，初診

臨床表現：患者入睡汗出，汗珠如黃豆大小，頭面後背多見，一年多了每天如此，西藥治療無效，小孩不接受中藥、針灸治療，前來就診，常伴低熱，精神萎靡，納差，舌質淡紅，苔薄白治則以調和營衛，養陰清熱。補脾經、運八卦、板門、揉百會、補腎、揉腎頂14等。按摩一個療程後逐漸減輕，三療程後痊愈。

小兒遺尿

2015年7月05日，陳某男6歲夢中遺尿，家長口述每晚尿床 2—3次，面色白，神疲乏力，四肢冷，食欲不振，舌質淡苔薄白。

法以補脾腎，固澀小便。方用百會，人中，補腎經，三陰交，丹田¹⁵等。一天一次一個療程後遺尿次數減少，三療後不再遺尿，之後鞏固兩個療程痊愈。

小兒厭食

王某某，女7歲，厭食3年，身體瘦小，面色暗黃，平素好吃零食，鼻流濁涕，有痰，納差，大便稀，小便正常，睡眠尚可，舌質暗紅，舌邊尖紅，苔黃，地圖舌，指紋紫滯。

法以健脾和胃，滋陰清熱。方用開天門、推坎宮、揉耳後高骨¹⁶、太陽、補脾、運內八卦、揉板門、揉二馬等。三天後流涕症狀基本消失，地圖舌基本消失。最後鞏固治療後痊愈。

小結

在小兒推拿的臨床中，我們發現小兒疾病之所以反復發作，都是由於家長的飲食、起居、穿衣不當所造成的。“三分調，七分養”家長的養護占很重要的比例，小兒脾胃虛弱，臟腑嬌嫩，飲食自倍，傷及脾胃，使得中焦脾胃運化不當，阻礙氣血的執行，小兒推拿療法刺激經絡、穴位，激發人體自愈系統，調整臟腑機能，達到抗病，抵御外邪的能力。推拿療法可以很好地交替藥物，減少藥物對人體的傷害，讓更多的小孩受益。