基于“脾为之卫”理论辨治儿童反复呼吸道感染

Treating Recurrent Respiratory Tract Infections in Children Based on the Theory of “Spleen as the Defensive Organ”

摘要: 反复呼吸道感染(RRTIs)是儿科常见呼吸系统疾病，病情迁延难愈，严重影响生长发育，西医长期用药存在局限，中医药调理体质优势突出。中医将本病归属于“虚人感冒”“久咳”范畴，多侧重于从肺论治，常忽视脾虚失司、卫气不固的核心作用。基于《内经》“脾为之卫”理论，本病发病机制与脾脏运化及防御功能密切相关，脾运失调、精微难布是内在根源，卫表失固、外邪侵袭为外在诱因，正虚邪恋、痰瘀伏留造成病情反复。基于此，治疗当标本兼顾，健脾固本以充卫气，祛邪化痰散瘀以除余患，辅以小儿推拿、食疗调护。本文从“脾为之卫”角度探析本病病机与治法，为小儿RRTIs中医诊疗提供思路。

Abstract: Recurrent respiratory tract infections (RRTIs) are common pediatric respiratory diseases characterized by prolonged and difficult-to-cure conditions, significantly affecting growth and development. Conventional Western medicine has limitations in long-term treatment, whereas traditional Chinese medicine (TCM) offers distinct advantages in regulating constitution. In TCM, this condition is categorized under “infection in debilitated individuals” and “prolonged cough”, with treatment primarily focused on the lungs, often overlooking the core role of spleen deficiency leading to impaired regulation and weakened defensive qi. Based on the classical theory from the Nei Jing (“the spleen serves as the protector”), the pathogenesis of RRTIs is closely related to the spleen’s functions of transformation and transportation and its defensive role. Dysfunction of the spleen’s transformation leads to inadequate distribution of vital substances, while compromised exterior defenses allow external pathogens to invade. The persistence of disease results from a combination of deficiency of healthy qi, lingering pathogenic factors, and accumulation of phlegm and blood stasis. Therefore, treatment should address both the root and symptoms: strengthen the spleen and consolidate the body’s foundation to enrich the defensive qi, eliminate pathogens, resolve phlegm, and disperse stasis to remove residual conditions, supplemented by pediatric massage and dietary therapy for supportive care. This article explores the pathogenesis and therapeutic approaches of RRTIs from the perspective of “the spleen serves as the protector”, offering insights for TCM diagnosis and treatment in pediatric patients.