郁瘀的相互转化与胶结贯穿了小儿肺炎的发生与进展过程。该文基于“郁瘀闭肺”的病机理论并根据肺炎的发生与 发展特点，提出将小儿肺炎的中医病机分为早、中、后三期：早期外邪侵袭，肺气郁闭；中期郁瘀闭肺，凝滞血脉；后期 郁瘀稽留，余邪伏肺。并因此提出宣肺祛邪、活血化瘀、开郁启闭的治疗小儿肺炎的原则，以及“三期论治小儿肺炎”的 观点：针对肺炎初起之肺气郁闭证，方用银翘散合五虎二陈汤，以清解肺热，化痰定喘；针对肺炎中期之郁瘀胶结证，方 用血府逐瘀汤合宣肺败毒方，以活血逐瘀，宣肺解毒，开郁启闭；针对肺炎后期之郁瘀伏肺证，方用青蒿鳖甲汤合清肺透 邪方化裁，以透热养阴，清瘀启郁，滋阴潜阳。基于“郁瘀闭肺”论治小儿肺炎可显著改善患儿的临床症状，预防肺炎的 传变，为小儿肺炎的临床防治提供参考。

The mutual transformation and intertweaving of qi stagnation and blood stasis exist through the development and progression of pediatric pneumonia. Based on the pathogenic mechanism of qi stagnation and blood stasis obstructing the lungs and by analyzing the progression of pneumonia， this paper proposed that the traditional Chinese medicine（TCM） pathogenesis of pediatric pneumonia can be divided into three stages：early， middle，and late. In the early stage，external pathogens invade and then lead to lung qi stagnation and blockage. In the middle stage，qi stagnation and blood stasis block the lungs and then cause blood vessel stagnation. In the late stage，qi stagnation and blood stasis linger，and then result into the residual pathogens lurking in the lungs. Accordingly， the principles of treating pediatric pneumonia are proposed， i. e.， ventilating the lungs and dispelling pathogens， activating blood circulation and resolving stasis， relieving qi stagnation and unblocking blockage. The strategies for treating pediatric pneumonia in three stages are also introduced：for the early stage of pneumonia characterized by lung qi stagnation and blockage，the formula Yinqiao San combined with Wuhu Erchen Decoction are used for clearing lung-heat， resolving phlegm， and relieving wheezing； for the middle stage of pneumonia characterized by the intertweaving of qi stagnation and blood stasis，the formula Xuefu Zhuyu Decoction combined with Xuanfei Baidu Prescription are used for activating blood circulation and resolving stasis，ventilating the lungs and removing toxins，relieving qi stagnation and unblocking blockage；for the late stage of pneumonia characterized by qi stagnation and blood stasis lingering in the lungs，Qinghao Biejia Decoction and Qingfei Touxie Prescription are used by modification for clearing heat and nourishing yin，resolving blood stasis and relieving qi stagnation，nourishing yin and subduing yang. The approach to treating pediatric pneumonia from the pathogenic mechanism of qi stagnation and blood stasis obstructing the lung show significant efficacy on improving clinical symptoms in children with pediatric pneumonia and preventing the progression of pneumonia， and will provide reference to the clinical prevention and treatment of pediatric pneumonia.

R272.5

福建省自然科学基金面上项目（编号：2023J011635）；厦门市自然科学基金青年项目（编号：3502Z20227109）；北京中医药大学 校级课题项目（编号：2022-BUCMXJKY051）