反复呼吸道感染(recurrent respiratory tract infections,RRTI)是儿科的常见病、多发病,指1年以内发生上、下呼吸道感染的次数频繁,超出了一定范围[1],具有反复发作、迁延日久的特点,可形成恶性循环,影响小儿生长发育.机体免疫功能紊乱是引起儿童RRTI的高危因素[2].肠道微生态在免疫反应中对呼吸道传染病的抵抗起到一定作用[3],肠道微生态失衡可改变宿主免疫状态,导致抵抗力下降而引起RRTI,这与中医"肺与大肠相表里"关系密切.研究证实,中医药通过健脾治疗RRTI疗效显著,对肠道菌群亦有调节作用.因此,本文基于肠道微生态探讨健脾治疗RRTI的作用机制,以期为科学研究及临床应用提供参考.

雷丰(1833—1888),字少逸,号松存,晚清医家,浙江三衢(今衢州)人,是"浙派中医"中时病学派的代表人物,著有《时病论》《逸仙医案》《医家四要》等[1].雷丰所著《时病论》在《黄帝内经》基础上以四时为轴,论述不同季节外感时病和伏邪致病的发病机理和证治特点,以法立方,在传承经典的基础上不断创新,体现了浙派医家在时病诊治上的贡献[2].《时病论》概括了时病的60种治法(处方),约二分之一处方使用了鲜药,具有透邪外达、顾护津液、升阳健脾、开窍急救等功效,形成鲜明的特点.运用鲜药是雷丰诊治时病不可忽视的部分,对现代中医临床具有一定的指导意义.

陈华教授认为小儿反复呼吸道感染缓解期的临床症状不明显,临床诊疗须辨证与辨体质相结合,注重因人、因地制宜,结合江浙地区的气候及地域特点,治宜补益肺脾、益气养阴,用药轻灵平和,既要时时顾护脾胃之气,又要补中寓消,灵活加减.附案例1则,以资验证.

露蜂房为胡蜂科昆虫果马蜂、日本长脚胡蜂或异腹胡蜂的巢.露蜂房性味甘平,归肝、肺、胃经,为疡医要药,具有祛风攻毒、杀虫止痛的功效,内服与外用皆可.《医学入门》记载露蜂房用于治疗乳痈、齿疼、痔疮、崩漏、风疹和小儿咳嗽等,临床上该药在肿瘤、皮肤病和免疫系统疾病等方面多有应用.笔者在长期临床观察中,注意到露蜂房治疗多种儿科疾病取得了较好疗效,现摘录相关病案介绍如下.

"一味丹参散,功同四物汤"出自《妇人明理论》,主治月经不调、产前胎动、产后恶血不下、冷热劳、腰脊痛、骨节烦疼等症.在我看来,丹参散功擅活血祛瘀,但与四物汤的活血祛瘀之功微有区别,其补血和血效果不及四物汤.而且四物汤除了活血祛瘀外,还有其他许多功用,经过适当化裁,可用治多种血分病症.

Objective] To explore and summarize clinical experience and academic characteristics of Lei Shaoyi on treating latent-qi leading to diarrhea. [Methods] By analyzing theory of“Impaired by wind in spring, one must get diarrhea containing undigested foods in summer”and related typical clinical cases in treatise on seasonal diseases clinical experience of Lei Shaoyi on treating latent-qi leading to diarrhea has been summarized. [Results] Lei Shaoyi put forward that the pathogenesis of latent-qi leading to diarrhea was "wood restrains earth". There were two types of latent-qi leading to diarrhea: lienteric diarrhea and through-flux diarrhea. Due to suffering from disease for a long time, patients with latent-qi leading to diarrhea often were characterized by more asthenia syndrome and less sthenia syndrome, therefore, treatment was given priority to invigoration method.Lei Shaoyi was good at taking advantage of prescriptions and herbs with nature of light, clear and scattering for dispersing to expel inner delitescent pathogenic factors and emphasizing on protecting the spleen and stomach simultaneously. In clinical practice, Lei Shaoyi always adjusted treatments according to different clinical symptoms of diarrhea accompanied with other syndromes, which saved a lot of patients with critical illness.[Conclusions] The treatment methods created by Lei Shaoyi were not only inherited from The Yellow Emperor’s Inner Classic, but also the sublimation of his personal clinical experience, which was well worth learning by physicians of later generations.