基于“伏其所主”理论论治小儿支气管肺炎

Treatment for pediatric bronchopneumonia based on the theory of "subduing what governs the disease"

摘要

文章基于《素问·至真要大论》 “伏其所主, 先其所因”治则, 结合小儿“肺常不足、脾常虚、肝常有余”的生理病理特点, 探讨小儿支气管肺炎的病机传变规律及分期论治思路。研究认为该病属中医“肺炎喘嗽”范畴, 其发生发展与外邪袭肺、痰浊内生、郁而化热密切相关, 痰热闭肺、肺失宣降为急性期的核心病机, 肺脾两虚、肝木偏旺则构成疾病迁延及反复的重要内在基础。临证应把握“先其所因”与“伏其所主”的动态关系, 初期疏风解表、宣肺止咳, 极期着重清热涤痰、宣肺开闭, 迁延期兼顾清化余邪与益气养阴, 恢复期则以健脾益肺、滋养气阴、调理体质为要, 并根据病情变化适时调整祛邪与扶正的轻重缓急。在内治基础上配合敷胸散等外治法, 可进一步发挥化痰宣肺、通络开闭之效。结合典型病案可见, 该理论能够较好地贯穿小儿支气管肺炎从邪实到正虚的病程变化, 为该病中医分期辨治及内外合治提供较为系统的临床思路。

Abstract

Based on the therapeutic principle of "subduing what governs the disease and addressing the cause first" proposed in Suwen·Zhizhenyao Dalun, and considering the physiological and pathological characteristics of children, which are "the lung is often insufficient, the spleen is often deficient, and the liver is often in excess", the study explores the pathogenesis evolution rules and strategy of stage-based treatment for pediatric bronchopneumonia. The study indicates that pediatric bronchopneumonia belongs to the category of "pneumonia with dyspneic cough" in traditional Chinese medicine, and that its occurrence and progression are closely related to external pathogens invading the lung, endogenous phlegm accumulation, and the transformation of stagnation into heat. Phlegm-heat obstructing the lung and failure of the dispersing and descending of lung constitute the core pathogenesis in the acute stage, while deficiency of both the lung and spleen and relative hyperactivity of the liver form an important internal basis for prolonged disease and recurrence. In clinical practice, the dynamic relationship between "addressing the cause first" and "subduing what governs the disease" should be carefully grasped. In the initial stage, treatment should focus on dispelling wind to release the exterior and diffusing the lung to stop cough. In the peak stage, priority should be given to clearing heat and eliminating phlegm and diffusing the lung and relieving obstruction. During the prolonged stage, residual pathogenic factors should be cleared while Qi and Yin are simultaneously replenished. In the recovery stage, treatment should emphasize strengthening the spleen and lung, nourishing Qi and Yin, and regulating the constitution, with balance between eliminating pathogenic factors and supporting healthy Qi according to changes in the disease condition. On the basis of internal treatment, external therapies such as Fuxiong powder application may further promote phlegm resolution, lung diffusion, collateral unblocking, and relief of obstruction. Evidence from a representative clinical case suggests that therapeutic principle can effectively guide the dynamic transition of pediatric bronchopneumonia from pathogenic excess to deficiency of healthy Qi, thereby providing a relatively systematic clinical approach for stage-based syndrome-differentiated treatment and combined internal and external treatment in traditional Chinese medicine.

关键词

支气管肺炎 / 伏其所主 / 肺炎喘嗽 / 中医治疗 / 分期论治 / 儿童

Key words

Bronchopneumonia / Subduing what governs the disease / Pneumonia with dyspneic cough / Traditional Chinese medicine treatment / Stage-based treatment / Child

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基金资助

2025年辽宁省教育厅自然科学类高校基本科研项目(LJ222510162028)