基于“伏毒”理论探讨儿童难治性肺炎发生机制和防治思路

Discussion on Mechanism and the Prevention and Treatment Strategy of Refractory Pneumonia in Children Based on Theory of“Latent Toxin”

难治性肺炎是儿科临床中的疑难性疾病及热点研究疾病,目前的临床诊疗体系尚不完备,常规治疗效果不甚理想。该文通过对“伏毒”理论进行系统性梳理,归结出伏毒乃毒邪藏匿体内作祟,具有伏而不觉、发时始显的特点,且可与多种病理产物相互胶结成为新的致病因素,致使儿童难治性肺炎症状繁杂,缠绵难治。并基于“伏毒”理论拓展,阐明本病“正虚毒伏,其虚在肺肾”的中医发病机制,指出伏毒是导致其反复发作、难以速去的关键。同时总结各时期以毒邪为主的不同特点的病理变化表现,由此归纳提出“前驱期理气化痰,使痰毒有所出;急性期清热化瘀兼以补益肺肾,化瘀毒于无形,祛毒邪外出;恢复期佽助正气,防病反复”的分期治疗概要,以期为后续相关研究提供思路和方法,进而开拓临床诊疗小儿难治性肺炎的思路。

Refractory pneumonia is a difficult and hot research disease in pediatric clinic.The current clinical diagnosis and treatment system is not complete,and the conventional treatment effect is not very ideal.Through a systematic review of the theory of“latent toxin”,this paper concludes that latent toxin is the hidden poison in the body,with the characteristics of being concealed and only apparent at the time of attack,and can cement with a variety of pathological products to become a new pathogenic factor,resulting in the complex symptoms and the difficult treatment of refractory pneumonia in children.Based on the theory of“latent toxin”,this paper clarifies that the pathogenesis of this disease in TCM is“deficiency of vigor and toxin accumulation,and the deficiency is in the lung and kidney”,and points out that latent toxin is the key to repeated attacks and difficulty in rapid recovery.At the same time,the pathological changes of different characteristics of toxins in each period are summarized,and the staged treatment outline of“regulating Qi and reducing phlegm in the prodromal stage to remove phlegm and toxin;clearing heat and removing stasis in the acute stage to nourish the lung and kidney,removing stasis and toxin invisibly,and removing toxins out of the body;helping the healthy Qi in the recovery stage to prevent relapse”is proposed,in order to provide ideas and methods for subsequent related research,and then develop the ideas for the clinical diagnosis and treatment of refractory pneumonia in children.