窦艳春 李建保

【摘 要】 从整体观思想出发，提出运用“上病下取”理论治疗小儿哮喘，秉承“治肺不离于肺、治肺不止于肺”的学术观点，提出此病核心病机为脏腑功能紊乱、气机升降出入失衡，与肺肝脾肾肠胃密切相关。治疗上应将恢复脏腑功能平衡和气机升降出入平衡贯穿始终，以辨“脏腑、气血、虚实、寒热”为具体方法，重视儿童的生理病理特点，灵活遣方用药，使气机和调，脏腑合和，升降如常，则哮喘自平。

【关键词】 儿童哮喘；上病下取；整体观；辨证论治

【中图分类号】R725.6   【文献标志码】 A    【文章编号】1007-8517（2023）08-0001-03

Abstract：Starting from the idea of holistic view，this paper proposes to use the theory of “taking the disease from the top to the bottom” to treat childrens asthma，adhering to the idea of “treating the lung is not separated from the lung，and treating the lung is not limited to the lung”，and puts forward that the core pathogenesis of this disease is the dysfunction of viscera，the imbalance of the rise and fall of Qi，which is closely related to the lung，liver，spleen，kidney，intestines and stomach. In terms of treatment，we should restore the functional balance of the viscera and the balance of the rise and fall of the Qi movement throughout the whole process，take the identification of the ten principles of “viscera，Qi and blood，deficiency and excess，cold and heat”as the specific method，pay attention to the physiological and pathological characteristics of children，and use drugs flexibly，so as to make the movement of vital energy harmony，the viscera harmony，and the rise and fall as usual，so that asthma can be leveled.

Keywords：Childhood Asthma；Treating Disease in the Upper Part of the Body by Managing the Lower；Holistic View；Syndrome Differentiation and Treatment

哮喘是儿童时期常见的疾病，临床表现为反复发作的喘息、气促、胸闷或咳嗽等，此病易反复发作，长期控制不佳则严重影响儿童的身心健康。此外，该病属于临床难治之病，如《寓意草·论浦君艺喘病证治之法》云：“人身难治之病有百证，喘病其最也。”研究［1］还发现儿童时期的哮喘控制不佳会在其成年后继续发作。因此积极控制小儿哮喘的发生发展对儿童终生有益。中医诊治疾病重视整体观和辨证论治，发源于整体观的“上病下取”理论被广泛运用于临床，从“治肺不离于肺、治肺不止于肺”的角度出发，通过辨“脏腑、气血、寒热、虚实”来调整哮喘本脏（肺）以下的脏腑功能和恢复气机正常的升降出入来达到治疗儿童哮喘的目的。

1 基于“上病下取”理论认识儿童哮喘病机

1.1 溯源流，明“上病下取”理论的内涵  “上病下取”理论源于《黄帝内经》。《素问·五常政大论篇》云：“上取下取，内取外取，以求其过……氣反者，病在上，取之下。