“随其所得”理论辨治小儿不明原因发热思路

Discussion on differentiation and treatment of fever of unknown origin in children by the the theory of‘Suiqi Suode’

小儿不明原因发热(FUO)属于中医“内伤发热”范畴,是儿科临床常见的疑难杂症之一,其病因繁多,诊断困难,治疗棘手,目前位于前三位的发病原因分别为感染性疾病、结缔组织疾病及肿瘤疾病,这与宿食、水湿、痰瘀和无形邪热结合关系密切。笔者基于张仲景“随其所得”理论,提出小儿不明原因发热的核心病机为邪热内伏、实邪盘踞、相合而发,以峻下热结、清热化湿、化痰祛瘀、滋阴健脾为治疗方法,祛除有形实邪,使无形邪热无所依附,从而使热邪得以解除,有助为小儿FUO提供新的辨证思路。

Fever of unknown origin in children belongs to the category of internal injury fever'in traditional Chinese medicine.It is one of the common hard cases in pediatric clinics.The causes of fever of unknown origin in children is numerous and it is hard to diagnose and treatment.The top three causes of fever of unknown origin in children are infectious diseases,collagen vascular disease and malignancy,which are closely related to the combination of food,damp evil,phlegm and stasis of blood and invisible evil fever.Based on the theory of‘Suiqi Suode’of ZHANG Zhongjing,the author notes that the core pathogenesis of fever of unknown origin in children is the evil heat lurks inside and combines with tangible evil.With drastic purgation,clearing heat and transforming dampness,resolving phlegm and dispelling stasis,nourishing yin and strengthening the spleen as the treatment methods,the tangible evil can be removed and the invisible evil heat has no attachment,so that the heat evil can be lifted.It helps to provide new ideas for the diagnosis and treatment of fever of unknown origin in children.