基于理脾阴思想探讨小儿反复呼吸道感染肺脾气虚证缓解期治疗策略

Treatment Strategies for the Remission Stage of Lung-Spleen Qi Deficiency Pattern in Pediatric Recurrent Respiratory Tract Infections Based on the Theory of Regulating Spleen-Yin

摘要: 小儿反复呼吸道感染(Recurrent respiratory tract infections, RRTI)缓解期的治疗对阻断疾病复发、改善预后具有重要价值。肺脾气虚证是RRTI的常见证型，单纯益气健脾对部分患儿疗效欠佳。清代医家吴澄在著作《不居集》中创立理脾阴理论，强调脾阴濡润运化之功，主张以甘淡柔润之品滋养脾阴，为深化理解本病病机提供独特视角。本研究系统梳理吴澄理脾阴理论内涵，根据脾阴亏虚与肺脾气虚内在病机联系，剖析RRTI肺脾气虚证缓解期病机由气虚向气阴两虚动态演变的过程；在此基础上，构建以滋养脾阴、益气固本为核心的治疗策略，并结合现代临床研究印证其科学性与实用性，以期为丰富RRTI中医治疗提供新思路。

Abstract: Treatment during the remission stage of pediatric recurrent respiratory tract infections (RRTI) is crucial for preventing recurrence and improving prognosis. The lung-spleen qi deficiency pattern is a common clinical presentation of RRTI. However, the approach of simply supplementing qi and fortifying the spleen often yields suboptimal results in some children. The theory of “regulating spleen-yin” (li pi yin), established by Wu Cheng, a physician of the Qing Dynasty, in Bu Ju Ji (The Unresting Collection), emphasizes the moistening and transporting-transforming functions of spleen-yin and advocates nourishing spleen-yin with medicinal characterized by sweet, bland flavors and moistening properties, offering a unique perspective for deepening the understanding of the disease’s pathogenesis. This study systematically reviews the connotation of Wu Cheng’s theory of regulating spleen-yin. Based on the intrinsic pathogenic link between spleen-yin deficiency and lung-spleen qi deficiency, it analyzes the dynamic pathological progression during the remission stage of RRTI presenting with a lung-spleen qi deficiency pattern, which evolves from simple qi deficiency toward combined qi and yin deficiency. Building on this analysis, a treatment strategy centered on nourishing spleen-yin and supplementing qi to consolidate the root is constructed. This strategy’s scientific validity and practical value are corroborated by modern clinical research, providing new insights for enriching traditional Chinese medicine (TCM) treatment strategies for pediatric RRTI.