王雪峰教授基于“主客交”理论探讨儿童过敏性疾病的病机演变及证治策略

Exploration in the pathogenic evolution and syndrome treatment strategies of allergic diseases in children by Professor Wang Xuefeng based on the theory of "host-guest interaction"

摘要

儿童过敏性疾病（如特应性皮炎、过敏性鼻炎、过敏性结膜炎）以慢性复发性、多系统受累为核心特征, 其“正气亏虚-邪气胶结”的病理本质与中医“主客交”理论高度契合。“主客交”理论出自吴有性《温疫论》, 原用于阐释温疫后期邪伏血脉之痼疾, 后逐渐拓展应用于慢性顽固性疾病。儿童脏腑娇嫩, 易虚易实, 尤适宜以“主客交”理论辨治。文章以“主为正气、客为邪气、交为胶结”为核心内涵, 结合儿童“肺常不足、脾常不足、肾常虚”的生理特点, 系统阐释特应性皮炎、过敏性鼻炎、过敏性结膜炎的“主客交”病机：儿童先天禀赋不耐、肺脾肾亏虚为“主虚”之根；风、寒、湿、热之外邪与痰、瘀等内生病理产物侵袭为“客邪”之因；邪正胶结于肌肤、鼻窍、目窍之络脉, 形成“正虚邪恋、胶结难解”的病理状态, 表现为急性期“主客初交”、慢性期“主客深交”的动态演变。基于此, 提出“扶正达邪、通络搜邪、分解主客”的治疗原则, 急性期以祛邪为主、兼扶正气, 慢性期以扶正为本、兼顾搜络剔邪, 并拟定分病论治方案及儿科化用药策略, 为儿童过敏性疾病的个体化诊疗提供理论支撑与新视角。

Abstract

Pediatric allergic diseases (such as atopic dermatitis, allergic rhinitis, allergic conjunctivitis) are characterized by chronic recurrence and multi-system involvement. The pathological nature of "deficiency of healthy Qi-cementation of pathogenic Qi" is highly consistent with the theory of "host-guest interaction" in traditional Chinese medicine. The theory of "host-guest interaction" comes from Wu Youxing's Wen-Yi Lun (Treatise on Pestilence). It was originally used to explain the chronic diseases of pathogenic factors remaining in blood vessels in the late stage of Wen Yi (epidemic diseases), and then gradually expanded and applied to chronic refractory diseases. Children's Zang-fu organs are delicate, prone to both deficiency and excess, so it is especially suitable for treatment according to the theory of "host-guest interaction". In the paper, the core connotation is "the host is healthy Qi, the guest is pathogenic Qi, and the intersection is cementation", and considering the physiological characteristics of "the lung often being insufficient, the spleen often being insufficient, and kidney often being deficient", the "host-guest interaction" pathogenesis of atopic dermatitis, allergic rhinitis, and allergic conjunctivitis is systematically explained: children's innate intolerance and deficiency of the lung, spleen and kidney are the root of "host deficiency"; the invasion of the external pathogenic factors such as wind, cold, dampness and heat and the endogenous pathological products such as phlegm and stasis are the cause of "guest pathogen". The cementation of pathogenic Qi and healthy Qi in the collaterals of skin, nasal orifices and eye orifices forms a pathological state of "deficient healthy-Qi giving rise to lingering pathogens and cementation being difficult to relieve", which is manifested as the dynamic evolution of "primary host-guest interaction" in the acute stage and "deep host-guest interaction" in the chronic stage. Based on this, the treatment principle is proposed, which is "reinforcing the healthy Qi to eliminate pathogenic factors, dredging collaterals to search for pathogenic factors, and separating host from guest". In the acute stage, the main goal is to eliminate pathogenic factors with the healthy-Qi reinforced. In the chronic stage, the basic principle is to reinforce the healthy-Qi while searching collaterals to eliminate pathogenic factors. The treatment plan and pediatric medication strategy are formulated to provide theoretical support and new perspectives for the individualized diagnosis and treatment of allergic diseases in children.

关键词

过敏性疾病 / 特应性皮炎 / 过敏性鼻炎 / 过敏性结膜炎 / 主客交 / 病因病机 / 中医诊疗 / 儿童

Key words

Allergic diseases / Atopic dermatitis / Allergic rhinitis / Allergic conjunctivitis / Host-guest interaction / Etiology and pathogenesis / Traditional Chinese medcine diagnosis and treatment / Child

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基金资助

第七批全国老中医药专家学术经验继承项目 (国中医药人教函〔2022〕76号)