蒋雪峰 张伟

【摘 要】 文章从伏风理论对咳嗽变异性哮喘的中医病因病机进行探讨，首先从风为阳气之变动探讨内风、外风的内涵，认为风邪致病的实质是机体营卫气血阴阳失衡的结果，伏风是机体内部的气血阴阳失衡状态下，欲要发作疾病，表现为风邪致病的一种状态；再从外风留伏内潜和先天体质禀赋两种情况讨论了伏风发作的病因病机，认为伏风是儿童咳嗽变异性哮喘的发病宿根，为咳嗽变异性哮喘的中医辨证论治提供了新的思路。

【关键词】 风邪；伏邪；伏风；咳嗽变异性哮喘；体质

【中图分类号】R725.6   【文献标志码】 A    【文章编号】1007-8517（2023）08-0018-04

Abstract：This paper discusses the pathogenesis and pathogenesis of cough variant asthma in traditional Chinese medicine based on the theory of Fufeng， and discusses the connotation of inner wind and outer wind from the change of wind as yang qi， it is believed that the essence of the pathogenesis of wind pathogens is the result of the imbalance of yin and yang of yin and yang of the bodys yin and yang. Fufeng is a state in which the bodys internal qi， blood， yin and yang are out of balance， and a disease is about to occur， which is manifested as a state of pathogenic wind. Then， the etiology and pathogenesis of Fufeng attack were discussed from the two situations of external wind lingering and internal latent and congenital physical endowment， and it was considered that Fufeng was the root cause of cough variant asthma in children. Fufeng theory provides a new idea for the TCM dialectical treatment of cough variant asthma.

Key words：Pathogenic Wind; Incubative Pathogen; Fufeng; Cough Variant Asthma; Physical Endowment

咳嗽變异性哮喘（cough variant asthma，CVA）是儿童慢性咳嗽中最常见的疾病，2012年全国多中心研究提示CVA占全国儿童慢性咳嗽发病病因的41.95%［1］，近些年来发病率不断上升，其主要表现为咳嗽，以干咳为主，咳嗽持续数周，常在运动、夜间、凌晨和（或）清晨发作或加重。CVA发病诱因具有多样性，上呼吸道感染、变应原刺激、剧烈运动、冷空气刺激等都可诱发疾病或使症状加重，且疾病发作特点也呈现时间节律性与季节规律性，其在秋冬季节或季节更替时发病率较高，还存在地域性的特点，笔者在临床随访中发现东北地区冬季CVA发作期的儿童，随家人前往南方温暖湿润的地区后，其咳嗽症状可显著减轻。研究［2］认为CVA发病机制与支气管哮喘相似，由IgE介导的Ⅰ型超敏反应为本病的主要发病机制，同时也有气道炎症、气道重塑、气道高反应性的表现。西医学对于CVA治疗多选用小剂量糖皮质激素、支气管扩张剂及白三烯受体拮抗剂等，此类药物用药时间较长，停药后咳嗽的症状可能会反复，且长期服用可能出现许多副作用，在临床上患儿与家长往往不能坚持医嘱。……