中医药治疗儿童腺样体肥大的研究进展——基于“病机–证型–治法”的整合述评

Research Progress on Traditional Chinese Medicine in the Treatment of Pediatric Adenoid Hypertrophy—An Integrative Review Based on “Pathogenesis-Syndrome Type-Treatment”

摘要: 腺样体肥大是儿童期常见的上呼吸道疾病，以鼻塞、打鼾、张口呼吸为主要表现，长期可致“腺样体面容”、阻塞性睡眠呼吸暂停低通气综合征及生长发育障碍。中医学多将其归入“鼻渊”“痰核”“鼾眠”等范畴，核心病机为小儿肺脾常虚、痰湿内生，复感外邪或变应原刺激，痰、热、瘀互结于鼻咽，本虚标实。本文以“病机–证型–治法”为主线，系统综述中医药治疗儿童腺样体肥大的研究进展，按肺脾气虚证、痰热瘀结证、肺经蕴热/风邪犯肺证、气血瘀阻证等分证归纳二陈汤、加味温胆汤、补中益气汤、会厌逐瘀汤、七味白术散等经典名方，以及鼻渊通窍颗粒、散风通窍滴丸、疏风解毒胶囊、玉屏风颗粒、补中益气颗粒等中成药的应用。现有临床研究表明，中医药治疗可改善鼻塞、打鼾、张口呼吸等症状，促进腺样体回缩，降低A/N值及炎症因子水平，提高生活质量，与西药联用可增强疗效并降低复发率。但现有研究仍存在样本量小、盲法及安慰剂对照不足、证型与疗效标准不统一、儿童药代动力学及长期安全性数据缺乏等问题。未来应开展多中心、随机双盲、安慰剂对照试验，统一证候与疗效评价体系，并深入探讨其作用机制，为中医药治疗儿童腺样体肥大提供更高级别证据。

Abstract: Adenoid hypertrophy (AH) is a common upper respiratory disease in children, characterized by nasal congestion, snoring, and mouth breathing. Long-term AH may lead to adenoid facies, obstructive sleep apnea-hypopnea syndrome (OSAHS), and growth and developmental disorders. With AH generally classified in traditional Chinese medicine under categories such as “biyuan,” “tanhe,” and “hanmian,” and its core pathogenesis involving a tendency toward lung and spleen deficiency in children, endogenous phlegm-dampness, recurrent invasion by external pathogens or stimulation by allergens, and the intermingling of phlegm, heat, and blood stasis in the nasopharynx, with root deficiency and branch excess, this review systematically reviews advances in traditional Chinese medicine (TCM) for pediatric AH within a “pathogenesis-syndrome type-treatment” framework. It focuses on classical formulas—Erchen Decoction, Modified Wendan Decoction, Buzhong Yiqi Decoction, Huiyan Zhuyu Decoction, and Qiwei Baizhu Powder—and Chinese patent medicines—Biyuan Tongqiao Granules, Sanfeng Tongqiao Dropping Pills, Shufeng Jiedu Capsules, Yupingfeng Granules, and Buzhong Yiqi Granules—for different syndrome types including lung and spleen qi deficiency, binding of phlegm, heat, and blood stasis, heat accumulation in the lung meridian/wind invasion of the lung, and qi stagnation and blood stasis. Clinical evidence suggests that TCM may alleviate nasal congestion, snoring, and mouth breathing; promote adenoid regression; reduce the adenoid-to-nasopharyngeal (A/N) ratio and inflammatory cytokine levels; and improve quality of life. When combined with Western medicine, TCM may enhance efficacy and reduce recurrence. However, current studies are limited by small sample sizes, insufficient blinding and placebo control, inconsistent syndrome differentiation and outcome criteria, and scarce pediatric pharmacokinetic and long-term safety data. Future multicenter, randomized, double-blind, placebo-controlled trials with unified syndrome and efficacy evaluation systems are needed, together with mechanistic studies, to provide higher-quality evidence for TCM in pediatric AH.