张宏贤 周倩倩 郭璠 姚楠 曾怡瑄 崔霞

〔摘要〕 崔霞教授将伏邪理论引入小儿慢性扁桃体炎的辨治中，认为瘀热留伏是其重要病机。发作期，外邪诱发伏邪，风火相煽，或湿热浸淫，瘀热相搏，重在清热泻火，宣透伏邪，予银翘散合升降散加减或柴胡达原饮加减;缓解期，邪伏血络，瘀热内蕴，治以凉血散瘀，滋阴益气，方以当归复感汤加减。强调瘀热贯穿本病始终，治疗全程酌情凉血散瘀。

〔关键词〕 小儿慢性扁桃体炎;伏邪;瘀热;清热泻火;凉血散瘀;崔霞

〔中图分类号〕R246.4       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.05.012

〔Abstract〕 Professor CUI Xia introduces the theory of hidden pathogen into pediatric chronic tonsillitis， and considers that stasis and heat retention is an important pathogenesis of the disease. During onset period， the hidden pathogen is induced by exogenous pathogen， which is manifested by wind and fire fanning each other or dampness and heat soaking， blood stasis and heat struggling， therefore it is important to clear heat and reduce fire， diffuse hidden pathogen. Yinqiao Powder combined with modified Shengjiang Powder or modified Chaihu Dayuan Decoction were given; In the remission period， the pathogen lurks in the blood collaterals， and blood stasis and heat accumulate in the body. The treatment is to cool the blood and dissipate the blood stasis， tonify Yin and nourish Qi， and the prescription is modified Danggui Fugan Decoction. It is emphasized that the stasis and heat run through the whole course of the disease， and cooling blood and dispersing blood stasis should be taken into account in the whole course of treatment.

〔Keywords〕 pediatric chronic tonsillitis; hidden pathogen; blood stasis and heat accumulation; clear heat and reduce fire; cool blood and disperse blood stasis; CUI Xia

慢性扁桃體炎（chronic tonsillitis， CT）是儿科临床常见病、多发病，多表现为反复发作的咽部不适、发热、扁桃体红肿等，病情迁延可导致鼻窦炎、中耳炎、颈淋巴结炎等并发症，春秋两季多发，多见于4岁以上小儿，发病率达22.04%[1-2]，近几年呈现明显上升趋势[3]。现代医学采用抗生素等对症治疗，对于反复发作或扁桃体过度肥大者，多采用手术摘除疗法。随着耐药菌的不断增加，机体免疫功能下降，容易导致病情迁延不愈、反复发作，严重影响患儿的正常生活和学习[4]。

导师崔霞教授从事儿科临床科研工作近三十年，不断学习，善于创新，受国医大师周仲瑛瘀热理论[5]的影响和启发，根据小儿慢性扁桃体炎常急性反复发作，起病即见里证而无明显外感症状的特点，认为其为伏邪致病，伏邪性质多为瘀热[6]，常因风热或湿热外邪诱发，提出从伏邪辨治本病的临证思路。现将崔教授治疗小儿慢性扁桃体炎的经验介绍如下。……