从"元气耗损,因加而发"发病观探讨艾滋病病机演变及免疫重建不全治疗思路OA

Although highly active antiretroviral therapy(ART)effectively suppresses human immunodeficiency virus(HIV)replica-tion,some patients still develop incomplete immune reconstitution(INR),which remains a significant clinical challenge in AIDS treat-ment.Clinical analysis indicates that its core pathogenesis lies in the depletion and impaired recovery of Primordial Qi.Based on the"Theory of Primordial Qi"and the disease onset concept of"Onset Due to Additive Factors"from the Yellow Emperor's Inner Classic,this article explores the pathogenesis evolution of AIDS.As stated in Lingshu·Thief Wind,"When a latent pathogen remains without manifestation…the qi and blood become internally disordered,and two qi contend with each other… it must manifest due to additive factors."Following HIV infection,the Ai Toxin lurks over time as a"latent pathogen,"deeply residing in the Sanjiao,covertly consu-ming Primordial Qi,and damaging the foundation of the lung,spleen,and kidney.If internal factors such as emotional distress,fa-tigue,or dietary irregularities combine with external factors like recurrent infections or drug toxicity("additive factors"),they activate the"latent pathogen,"leading to"internal disorder of qi and blood"and ultimately causing the disease to"manifest".Severe deple-tion of Primordial Qi,deep-seated lingering of the pestilential toxin,and endogenous generation of phlegm,dampness,and stasis re-sult in deficiency of healthy qi and binding of pathogens—a complex intermingling of host and guest factors that perpetuates the disease course and exacerbates the condition.The INR state is fundamentally characterized by exhaustion of Primordial Qi.Accordingly,this paper establishes the treatment principle of"consolidating Primordial Qi,fortifying the healthy Qi and dispelling pathogens,with strat-ified treatment",which includes cultivating and reinforcing Primordial Qi while clearing residual toxin,applying stratified treatment by vigorously supplementing Primordial Qi and detoxify and expel pathogens methods according to different syndromes characteristics and immune states,and regulating inducing factors to intercept disease progression and prevent deterioration.This study provides a theoreti-cal foundation for systematically understanding the pathogenesis evolution of AIDS and the Traditional Chinese Medicine-based treat-ment of INR,holding significant theoretical and clinical value for guiding integrated Chinese-Western medicine approaches in promoting immune reconstruction and improving the quality of life for AIDS patients.