Treating pediatric adenoidal hypertrophy from the perspectives of immune bias and trained immunity based on the "deficiency-qi stagnation"

The pathogenesis of pediatric adenoidal hypertrophy is closely associated with deficiency-qi stagnation. Physiological predispositions, along with immune bias and trained immunity imbalance resulting from inadequate postnatal environmental modulation, contribute to the development of an immune-inflammatory microenvironment that promotes pathological lymphoid hyperplasia and, in advanced cases, tissue fibrosis. Therefore, a systematic pathogenic framework is proposed, comprising two interrelated mechanisms: deficiency-qi as the underlying predisposing factor for immune dysregulation, and phlegm accumulation and blood stasis as contributors to maladaptive immune priming. These two pathological processes, deficiency-qi and phlegm-blood stasis, are not isolated but dynamically interact and mutually reinforce one another. Therapeutic strategies should reinforce the essence of the kidney, enhance vital energy, promote recovery of physiological function, use warming herbs to harmonize the zang organs, and regulate the lung and stomach by descending Yangming qi, all of which address the root deficiency and help restore immune homeostasis. Additionally, identifying and eliminating latent pathogenic factors, such as retained heat and dampness, and resolving endogenous wind and the underlying disturbance of "impaired qi transformation" is essential. Such a comprehensive approach may modulate immune regulation and rebalance immune responses, thereby providing valuable insights into the disease mechanism and contributing to improved clinical outcomes.