基于“外损致虚”理论探讨小儿反复呼吸道感染的辨证思路

The Theory of “External Injury Leading to Deficiency” in Pediatric RRTI: An Exploration of Syndrome Differentiation and Treatment

摘要: 小儿反复呼吸道感染(RRTI)作为儿科临床常见病症，近年来其临床表现愈发复杂。清代医家吴澄在《不居集》中提出的“外损致虚”理论，精准揭示了该病的发病机理：患儿素体本就虚弱，外感病初期若治疗不当，会进一步引发营卫失调，进而形成“外邪侵袭–误治伤正–营卫失调–邪伏正损–更易复感”的恶性循环。本研究以该理论为核心，构建了分期辨治体系：发作期采用解托法实现驱邪护正的目标，缓解期运用补托法达到扶正固本的效果。此方案有机融合中医古代理论与现代临床实践，为优化小儿反复呼吸道感染的中医诊疗策略提供了全新方向，对提升临床治疗效果、降低疾病复发率具有重要的指导意义。

Abstract: Recurrent respiratory tract infections (RRTI) in children are a common clinical condition in pediatrics, with their clinical manifestations growing increasingly complex in recent years. The theory of “external injury leading to deficiency”, proposed by Wu Cheng, a physician of the Qing Dynasty, in Bu Ju Ji, accurately reveals the pathogenesis of this disease: a child with an inherently weak constitution, if subjected to improper treatment during the initial stage of an external infection, can develop a disharmony between the nutritive (Ying) and defensive (Wei) systems. This initiates a vicious cycle: “pathogen invasion→improper treatment impairing healthy qi→Ying-Wei disharmony→latent pathogens and depleted healthy qi→increased susceptibility to recurrence”. Centering on this theory, this study constructs a staged syndrome differentiation and treatment system. During the acute stage, the Jie Tuo (resolving and supporting) method is employed to achieve the goal of eliminating pathogens while protecting healthy qi; during the remission stage, the Bu Tuo (tonifying and supporting) method is applied to attain the effect of reinforcing healthy qi and consolidating the body’s foundation. This scheme effectively integrates classical Chinese medical theory with modern clinical practice, providing a novel direction for optimizing TCM diagnosis and treatment strategies for pediatric RRTI. It holds significant guiding value for enhancing clinical therapeutic outcomes and reducing recurrence rates.