Pathogenesis and treatment methods of pediatric macrolide-unresponsive Mycoplasma pneumoniae pneumonia based on the "kenang" theory

Macrolide-unresponsive Mycoplasma pneumoniae pneumonia(MUMPP) is a common respiratory disease in pediatrics, with an annually increasing prevalence. This condition is prone to protraction and unresponsiveness to macrolide antibiotic treatment owing to the drug resistance, resulting in immunopathological damage. These factors lead to rapid progression and severe illness, which is frequently combined with various extrapulmonary complications. Based on the traditional Chinese medicine theory of "kenang," this paper uses exogenous Mycoplasma pathogenic toxin as the inducement. It explains that the pathogenesis of MUMPP involves the failure of the lung to disperse and descend qi, the formation of phlegm complicated by blood stasis, known as "kenang," prolonged retention of pathogenic toxins, and consumption of lung qi. It can be summarized as "pathogenic toxin lurking in ′kenang,′ lung deficiency with lingering pathogen." Based on the above understanding of pathogenesis, this paper proposes that treatment should focus on "resolving kenang and unblocking collaterals," adhere to the basic principles of "clearing heat and resolving phlegm, activating blood circulation and unblocking collaterals," and consider "strengthening healthy qi to eliminate pathogenic factors" to prevent recurrence. Combined with clinical symptoms, staged treatment is adopted: Chaige Gaore Decoction is administered to clear heat, disperse pathogens, and intercept latent toxins in the initial stage of exogenous pathogens attacking the lung and latent heat transforming into toxin; modified Weijing Decoction combined with Maxing Shigan Decoction is used to resolve phlegm, remove blood stasis, soften hardness and dissipate masses in the middle stage of phlegm-blood stasis intermingling and initial formation of "kenang"; in the late stage of deep latent kenang and intractable lingering pathogen, insect medicines are added to penetrate collaterals to expel blood stasis and resolve phlegm; in the recovery stage of healthy qi deficiency with lingering pathogen and recurrent "kenang" tendency, Pneumonia Recovery Decoction is administered to strengthen healthy qi and consolidate root, and disperse residual pathogen. This paper presents novel theoretical insights and treatment methods for delaying and blocking the development of intrapulmonary "kenang," thereby promoting precise syndrome differentiation and personalized treatment of children with MUMPP at different stages, and ultimately improving overall clinical efficacy.