从“因加而发”理论探讨变应性鼻炎的病机演变规律及分期辨治

谢双斌; 梁凤霞; 薛廷政

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谢双斌, 梁凤霞, 薛廷政.从“因加而发”理论探讨变应性鼻炎的病机演变规律及分期辨治[J].湖南中医药大学学报,2026,46(5):993-999[点击复制]

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从“因加而发”理论探讨变应性鼻炎的病机演变规律及分期辨治

谢双斌,梁凤霞,薛廷政

(湖北中医药大学针灸骨伤学院, 湖北武汉 430060;湖北时珍实验室, 湖北武汉 430060)

摘要:

基于“因加而发”理论探讨变应性鼻炎（AR）病机的演变规律，认为肺脾肾三脏虚损为内在发病之“因”，风、寒等外邪侵袭为触发疾病之“加”，内外新故合邪终致邪壅清窍、津液失固而“发”病。若未及时干预，病势可进展为亢盛、迁延及变证，形成“因-加-发-盛-缓-变”的完整病程。临证时应紧扣此规律分期辨治。AR静止期宜固本培元调其“因”，方用培元固本汤加减；发作前窗口期宜御邪于先阻其“加”，方用玉屏风散合桂枝汤加减；发作先兆期宜截断于微挫其“发”，方用苍耳子散加减；急性发作期宜急治其标平其“盛”，方用麻黄附子细辛汤合苍耳子散加减；迁延期宜扶正祛邪顾其“缓”，方用补中益气汤合苍耳子散加减；久病变证期宜温阳逐瘀杜其“变”，方用金匮肾气丸合通窍活血汤加减。该分期辨治体系标本兼顾、攻补有序，全程贯穿“未病先防、既病防变”思想，亦兼顾已发救治与瘥后防复，以期为临床防治AR提供新的思路与依据。

DOI：10.3969/j.issn.1674-070X.2026.05.017

投稿时间：2026-03-01

基金项目:国家自然科学基金面上项目（82274634）；湖北省自然科学基金中医药创新发展联合基金项目（2025AFD500）。

Pathogenesis evolution and stage-based pattern differentiation and treatment of allergic rhinitis based on the theory of "onset due to combined internal deficiency and external triggering factors"

XIE Shuangbin, LIANG Fengxia, XUE Tingzheng

(College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei 430060, China;Hubei Shizhen Laboratory, Wuhan, Hubei 430060, China)

Abstract:

Based on the theory of "onset due to combined internal deficiency and external triggering factors" to explore the pathogenesis evolution of allergic rhinitis (AR), this team proposes that deficiency of three Zang organs including the lung, spleen, and kidney constitutes the internal "cause" (yin) of disease onset, while external pathogenic factors such as wind and cold act as the "trigger" (jia) that induces the attack. The combination of pre-existing internal deficiencies and new external pathogenic factors ultimately leads to congestion of the orifices by pathogens and instability of body fluids, thereby triggering the "onset" (fa). If not intervened in time, the disease can progress to stages of hyperactivation, protracted stage, and further complications, forming a complete disease course of "cause-trigger-onset-hyperactivation-protracted stage-complication stage" (yin-jia-fa-sheng-huan-bian). Clinical management should adhere to this law by applying stage-based pattern differentiation and treatment. During the quiescent stage of AR, treatment aims to consolidate the body's foundation and regulate the "cause", using modified Peiyuan Guben Decoction. During the pre-attack window stage, treatment focuses on preventing the triggering factor by strengthening the Wei-defensive qi, using modified Yupingfeng Powder combined with Guizhi Decoction. During the prodromal stage of an impending attack, treatment aims to abort the "onset" at an early stage, using modified Cang'erzi Powder. During the acute attack stage, priority is given to treating the manifestation to control the "hyperactivation", using a combination of modified Mahuang Fuzi Xixin Decoction and Cang'erzi Powder. During the protracted stage, treatment aims to support the healthy qi while eliminating pathogens to address the "protracted" state, using modified Buzhong Yiqi Decoction combined with Cang'erzi Powder. During the long-standing stage with secondary complications, treatment aims to warm yang and remove blood stasis to halt the "complications", using modified Jinkui Shenqi Pill combined with Tongqiao Huoxue Decoction. This stage-based pattern differentiation and treatment system balances the manifestations and root causes, and follows an orderly sequence of attacking pathogenic factors and tonifying the body. It runs through the entire process with the principles of "preventing disease before it begins" and "preventing progression after disease onset", while also addressing acute episodes and preventing recurrence after recovery. The aim is to provide new ideas and evidence for the clinical prevention and treatment of AR.

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