经方治疗肾系水肿病的研究与分析
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摘要
水肿是指因各种原因导致体内水液潴留,泛溢肌肤,以头面、眼睑、四肢、腹背、甚至全身浮肿为特征的一类疾病。肾系水肿是指因肾系疾病及肾虚、肾主水功能异常所导致的一类以水肿为主要表现的疾病。肾系水肿为难治性疾病,若得不到及时治疗,会进一步恶化,甚至进入肾功能衰竭期,乃至危及生命。目前虽然西医在治疗急性肾炎、慢性肾炎、肾病综合征等以水肿为主症的肾系疾病时,疗效显著,但仍有一部分患者少效或无效。而中医对于肾性水肿的治疗疗效好,尤其是仲景经方在治疗水肿方面疗效显著,并在数千年的临床实践中得到验证。
本研究以《伤寒杂病论》中的五苓散、真武汤、猪苓汤为研究对象,通过对大量古今文献进行综述与分析,系统研究上述方剂治疗肾系水肿为主的多种疾病的应用特点及规律。
论文分为文献综述和研究分析两个部分。第一部分文献综述,总结了五苓散、真武汤、猪苓汤的现代临床应用及研究进展。第二部分首先将上述三方在《伤寒杂病论》中的应用特点、病因病机及加减化裁规律进行了系统研究与分析；然后论述了隋唐、宋元及明清时期代表医家对水肿病病因病机、治则治法的认识；接着总结并提炼了现代中医名家运用上述三方治疗水肿的临床经验；最后从方剂衍化、历代名家应用、方证鉴别诊断、方证疑点讨论、方证研究、现代临床应用这几个方面对上述三方进行了较为深刻的研究与分析,并提出自己的观点与想法。
通过以上研究得知五苓散功用在于通阳化气利水,治疗因气化不利而导致的诸多水肿及小便不利,疗效显著,广泛应用于多种因肾脏器质性疾病及肾气化不利导致的水肿病。真武汤功效为温肾阳、利水湿、助气化,用于治疗多种肾阳虚衰、水饮内停之证,每获良效。猪苓汤利水滋阴并举,主治水热互结证,治疗水肿日久不去而伤阴的复杂水肿病,疗效显著。总之,经方治疗肾系水肿具有非常广泛的前景,已有的研究显示了经方具有良好临床疗效,值得进一步深入研究与发掘。
Edema is a kind of disease whose characteristic clinical manifestation is abnormal fluid retention in the body and further involving the muscles and skin caused by various reasons. It marked by the dropsy of the face, eyelids, limbs, abdomen and back, even the whole body. Renal edema a kind of disease whose characteristic clinical manifestation is edema caused by the kidney disease or kidney deficiency or kidney loosing control the water. It is refractory disease. If renal edema is not treated immediately and correctly, the patients'condition will get worse and even result in kidney failure or death. The west medicine has obvious therapeutic effect in treating acute or chronic nephritis, and nephritic syndrome whose manifestations are edema. But still some patients get little effect or no effect. The traditional Chinese medicine especially the classical prescriptions have very obvious curative effect in treating renal edema. It has been testified in the clinical practice in the past thousands of years.
This research which summarized and analyzed a great quantity of literature in ancient and modern time is a systemic study on WuLingSan, ZhenWuTang, and ZhuLingTang which are recorded in Cold-attack and Miscellaneous Diseases. It explains the practical traits and rules of these three prescriptions on treating various diseases whose characteristic clinical manifestation are edema.
This article is divided into two parts which are literatures'summary and investigative analysis. In the first part, the author summarized the modern clinical application and researching progression on WuLingSan, ZhenWuTang, and ZhuLingTang. In the second part, firstly the author researched and analyzed systematically the applied the three prescriptions'characteristic, etiopathogenisis, pathogenesis and regularities of changing prescriptions in Cold-attack and Miscellaneous Diseases. Then the author discuss the famous doctors'opinions of etiopathogenisis, pathogenesis, principles and methods on edema in Sui dynasty, Tang dynasty, Song dynasty, Yuan dynasty, Ming dynasty and Qing dynasty. The third step, the author summarized and extracted the clinical experience of the modern doctors treating edema with these three prescriptions. In the end, the author research and analyzed deeply on evolutions of these prescriptions, experiences of the famous doctors in every dynasty, distinguish diagnoses, doubtful point discussing, and modern clinical practice. At last, the author put forward her own opinions and ideas.
It can be summarized through this research that WuLingSan has function of activating Yang, dispersing Qi, alleviating water retention, and has widely obvious therapeutic effect of edema caused by failure of qi flowing. ZhenWuTang has function of warming kidney Yang, alleviating water retention, helping qi flowing. It can be used for edema which has the syndrome of kidney Yang deficiency and water retention. ZhuLingTang emphasizes both nourishing Ying and alleviating water retention. Its main indication is the syndrome of water and heat knotting together. It has very obvious therapeutic effect of complicated edema which is a long time of edemad has Ying deficiency. In conclusion, it's much wised to use classical prescription to treat renal edema. The existing researches have showed the excellent clinical therapeutic effects of classical prescriptions. So it's very worthy to do some further research on classical prescriptions.
本研究以《伤寒杂病论》中的五苓散、真武汤、猪苓汤为研究对象,通过对大量古今文献进行综述与分析,系统研究上述方剂治疗肾系水肿为主的多种疾病的应用特点及规律。
论文分为文献综述和研究分析两个部分。第一部分文献综述,总结了五苓散、真武汤、猪苓汤的现代临床应用及研究进展。第二部分首先将上述三方在《伤寒杂病论》中的应用特点、病因病机及加减化裁规律进行了系统研究与分析；然后论述了隋唐、宋元及明清时期代表医家对水肿病病因病机、治则治法的认识；接着总结并提炼了现代中医名家运用上述三方治疗水肿的临床经验；最后从方剂衍化、历代名家应用、方证鉴别诊断、方证疑点讨论、方证研究、现代临床应用这几个方面对上述三方进行了较为深刻的研究与分析,并提出自己的观点与想法。
通过以上研究得知五苓散功用在于通阳化气利水,治疗因气化不利而导致的诸多水肿及小便不利,疗效显著,广泛应用于多种因肾脏器质性疾病及肾气化不利导致的水肿病。真武汤功效为温肾阳、利水湿、助气化,用于治疗多种肾阳虚衰、水饮内停之证,每获良效。猪苓汤利水滋阴并举,主治水热互结证,治疗水肿日久不去而伤阴的复杂水肿病,疗效显著。总之,经方治疗肾系水肿具有非常广泛的前景,已有的研究显示了经方具有良好临床疗效,值得进一步深入研究与发掘。
Edema is a kind of disease whose characteristic clinical manifestation is abnormal fluid retention in the body and further involving the muscles and skin caused by various reasons. It marked by the dropsy of the face, eyelids, limbs, abdomen and back, even the whole body. Renal edema a kind of disease whose characteristic clinical manifestation is edema caused by the kidney disease or kidney deficiency or kidney loosing control the water. It is refractory disease. If renal edema is not treated immediately and correctly, the patients'condition will get worse and even result in kidney failure or death. The west medicine has obvious therapeutic effect in treating acute or chronic nephritis, and nephritic syndrome whose manifestations are edema. But still some patients get little effect or no effect. The traditional Chinese medicine especially the classical prescriptions have very obvious curative effect in treating renal edema. It has been testified in the clinical practice in the past thousands of years.
This research which summarized and analyzed a great quantity of literature in ancient and modern time is a systemic study on WuLingSan, ZhenWuTang, and ZhuLingTang which are recorded in Cold-attack and Miscellaneous Diseases. It explains the practical traits and rules of these three prescriptions on treating various diseases whose characteristic clinical manifestation are edema.
This article is divided into two parts which are literatures'summary and investigative analysis. In the first part, the author summarized the modern clinical application and researching progression on WuLingSan, ZhenWuTang, and ZhuLingTang. In the second part, firstly the author researched and analyzed systematically the applied the three prescriptions'characteristic, etiopathogenisis, pathogenesis and regularities of changing prescriptions in Cold-attack and Miscellaneous Diseases. Then the author discuss the famous doctors'opinions of etiopathogenisis, pathogenesis, principles and methods on edema in Sui dynasty, Tang dynasty, Song dynasty, Yuan dynasty, Ming dynasty and Qing dynasty. The third step, the author summarized and extracted the clinical experience of the modern doctors treating edema with these three prescriptions. In the end, the author research and analyzed deeply on evolutions of these prescriptions, experiences of the famous doctors in every dynasty, distinguish diagnoses, doubtful point discussing, and modern clinical practice. At last, the author put forward her own opinions and ideas.
It can be summarized through this research that WuLingSan has function of activating Yang, dispersing Qi, alleviating water retention, and has widely obvious therapeutic effect of edema caused by failure of qi flowing. ZhenWuTang has function of warming kidney Yang, alleviating water retention, helping qi flowing. It can be used for edema which has the syndrome of kidney Yang deficiency and water retention. ZhuLingTang emphasizes both nourishing Ying and alleviating water retention. Its main indication is the syndrome of water and heat knotting together. It has very obvious therapeutic effect of complicated edema which is a long time of edemad has Ying deficiency. In conclusion, it's much wised to use classical prescription to treat renal edema. The existing researches have showed the excellent clinical therapeutic effects of classical prescriptions. So it's very worthy to do some further research on classical prescriptions.
引文
[1]赵纪生.五苓胶囊与五苓散治肾性水肿疗效比较.江西中药,2001,32(4)：51
[2]刘根昌.自拟利水消肿汤治疗水肿二例分析.实用中医内科杂志,2004,18(6)：497-498
[3]刘清平.加味五苓散治疗肾炎水肿的观察.海南医学,2003,14(9)：110
[4]徐桂芝.中草药治疗肾小球肾炎临床疗效观察.中国初级卫生保健,2003,17(9)：87
[5]张晓明,李锋.肾性水肿中医临床治疗浅析.陕西中医,2002,23(4)：327-329
[6]黄瑞钿.五苓散临床应用举隅.新中医,2001,33(8)：61-62
[7]刘静仪.五苓散临床运用.四川中医,2001,19(10)：76
[8]梁贻俊,侯丕华,刘春芳.用“三焦同开法”治疗急进性肾炎无尿症的体会.新中医,2001,33(7)：3-4
[9]王怡,何立群,邹士林.郑平东教授治疗肾病水肿经验介绍.中国医刊,2000,35(6)：44-45
[10]李学铭.我治肾病水肿.浙江中医杂志,1998,6(1)：243-245
[11]杨百京.加味五苓散治疗西药利尿药欠效之水肿16例。农垦医学,2003,25(2)：102-103
[12]赵秀英,等.五苓散加味治疗更年期妇女水肿。河北中西医结合杂志,1998,77(4)：565
[13]冯根群.五苓散加减治疗水肿80例.河南中医,2003,23(9)：28-29
[14]李传岐.五苓散加味治疗特发性水肿.山西中医,2006,22(5)：9
[15]静馨,等.五苓散治疗中风后急性尿潴留32例.福建中医药,2001,32(5)：34
[16]贺辉.五苓散治疗女性尿道综合征体会.河南中医,2004,24(2)：75
[17]邢月明.葶苈生脉五苓散治疗慢性充血性心力衰竭.中西医结合杂志1983,(3)：15
[18]张书林.加味五苓散治晚期膀胱癌.四川中医,1989,(4)：26
[19]司徒宝珍,罗陆一.罗陆一教授运用真武汤的临证经验.内蒙古中医药,2008年 11期：1-2
[20]孙文江,石君华.真武汤治疗阳虚型肾病综合征水肿临床观察.湖北中医杂志,2009,31(6)：46-47
[21]刘奇.真武汤治慢性肾衰阳虚水泛证浅析.辽宁中医药大学学报,2009,11(4)：41-42
[22]陈立.真武汤异病同治应用体会.实用中医药杂志,2009,25(2)：101-102
[23]孙灵芝,相修平.真武汤治验举隅.山西中医,2009,25(5)：33-34
[24]张北野,张斗江.健脾温肾利水法治疗特发性水肿46例.安徽中医临床杂志,1999,11(3)：176
[25]魏仲南.温阳利水法治疗糖尿病肾病水肿.福建中医药,2006,37(4)：37-38
[26]张高林.赵文鼎副主任医师应用真武汤经验琐谈.甘肃中医学院学报,2005,22(4)：7-8
[27]陶建国.真武汤临床运用体会.云南中医中药杂志,2006,27(4)：68-69
[28]包翠杰,许进林.真武汤治疗慢性肾功能衰竭体会.甘肃中医学院学报,2001,12(20)：23-24
[29]李光华.真武汤加味治疗充血性心力衰竭30例.中西药信息,1995,(6)：25
[30]胡斌.真武汤之临床新用.浙江中医杂志,1990,(6)：276
[31]毕明义.真武汤治疗带下病118例.山东中医杂志,1994,(10)：448
[32]何幼斌.真武汤治疗尿路结石并肾积水30例.湖北中医杂志,2003,(4)：42
[33]徐杰新.真武汤治疗肾阳亏虚型良性前列腺增生症疗效观察.广西中医药,2001,24(3)：6
[34]李素兰.辨证治疗肾病水肿50例.陕西中医,2002,23(10)：888
[35]陈明.刘渡舟运用猪苓汤的经验——76例验案分析.山东中医药大学学报,2001,24(1)：41
[36]张晓明,李锋.肾性水肿中医临床治疗浅析.陕西中医,2002,23(4)：327
[37]蓝小琴,付皓云,高鸣.中西医结合治疗慢性肾小球肾炎疗效观察.湖北中医杂志,2008,30(12)：26-27
[38]张敏,赵润栓.猪苓汤加味治疗肾病综合征21例疗效观察.国医论坛,2005,20(4)：8-9
[39]郭秀丽.猪苓汤治验5则.新中医,2004,36(11)：65-66
[40]黄玉娇,莫健平,龙艳.滋阴清热利水法治疗慢性肾炎阴虚湿热型疗效探讨.河北医药,2006,28(7)：626
[41]陈亦人.《伤寒论》求是.北京：人民卫生出版社,1987.P592
[42]赖真.猪苓汤治疗泌尿系结石40例分析.暨南大学学报(医学版),1999,6(26)：12
[43]朱克俭.猪苓汤加味治疗肾积水30例体会.河北中医,1987,9(5)：10
[1]李全,等.五苓散规范化的探讨.中医函授通讯,1994,(6)：5
[2]封银曼,等.五苓散证治规律研究.国医论坛,1994,(4)：4
[3]沈映君.中药药理学.北京.人民卫生出版社,2000,10：P473
[4]易安全.五苓散加茅根汤治疗急性肾炎.四川中医,1990,(6)：29
[5]孙界平.五苓散为主治疗早期肾功能不全20例.新中医,1987,(7)：44
[6]赵佐.慢性肾炎激素撒减过程中的中药治疗经验.中医杂志,1990,(10)：17-18
[7]陈齐鸣.黄芪五苓散为主治疗特发性水肿56例.浙江中医杂志,1991,(2)：44
[8]程剑华,等.五苓散加味治疗化疗性肾衰的临床研究.中医杂志,1993,(1)：42
[9]苏大培.五苓散加味治疗肾积水.四川中医,1985,(10)：23
[10]唐声罨,等.真武汤临床运用点滴经验.中医杂志,1965,(7)：39
[11]陈敬标.运用真武汤对阳虚水泛所致各证治疗的体会.浙江中医杂志,1965：(8)：20
[12]梁自温.温阳利水汤新解.新中医,1976,(6)：293
[13]张长恩.真武汤证研究.北京中医杂志,1991,(1)49
[14]靳育民,等.温肾补阳法治疗慢性肾小球肾炎135例.陕西中医,1994,(10)：441
[15]谢鸣.中医方剂现代研究.北京：学苑出版社,1997,1452
[16]陈梅芳,等.利水法在肾少尿中的应用。中医杂志,1981,(11)：35
[17]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究.中国医药学报,1991,6(4)：10
[18]杨长明.真武汤加减治疗慢性肾功能衰竭12例.湖南中医杂志,1990,(1)：24
[19]尚炽昌,等主编.仲景方药研究应用精鉴.北京：人民军医出版社,1999,697
[20]龙仲川.加味真武汤治疗肾盂积水40例.湖北中医杂志,1993,(2)：23
[21]柴有华.猪苓汤加味治疗产后癃闭20例.陕西中医,1991,12(5)：209
[22]谢鸣.中医方剂现代研究.北京：学菀出版社,1997：1453
[23]肖旭滕.苓桂术甘汤加味治疗难治性肾病综合征17例.新中医,1994,(8)：23
[24]姚筱农.苓桂术甘汤加味治疗小儿水肿.江苏中医,1995,16(6)：14
[25]陈尚书.加味茯桂术甘汤治疗特发性水肿.新中医,1992,(2)：34
[2]刘根昌.自拟利水消肿汤治疗水肿二例分析.实用中医内科杂志,2004,18(6)：497-498
[3]刘清平.加味五苓散治疗肾炎水肿的观察.海南医学,2003,14(9)：110
[4]徐桂芝.中草药治疗肾小球肾炎临床疗效观察.中国初级卫生保健,2003,17(9)：87
[5]张晓明,李锋.肾性水肿中医临床治疗浅析.陕西中医,2002,23(4)：327-329
[6]黄瑞钿.五苓散临床应用举隅.新中医,2001,33(8)：61-62
[7]刘静仪.五苓散临床运用.四川中医,2001,19(10)：76
[8]梁贻俊,侯丕华,刘春芳.用“三焦同开法”治疗急进性肾炎无尿症的体会.新中医,2001,33(7)：3-4
[9]王怡,何立群,邹士林.郑平东教授治疗肾病水肿经验介绍.中国医刊,2000,35(6)：44-45
[10]李学铭.我治肾病水肿.浙江中医杂志,1998,6(1)：243-245
[11]杨百京.加味五苓散治疗西药利尿药欠效之水肿16例。农垦医学,2003,25(2)：102-103
[12]赵秀英,等.五苓散加味治疗更年期妇女水肿。河北中西医结合杂志,1998,77(4)：565
[13]冯根群.五苓散加减治疗水肿80例.河南中医,2003,23(9)：28-29
[14]李传岐.五苓散加味治疗特发性水肿.山西中医,2006,22(5)：9
[15]静馨,等.五苓散治疗中风后急性尿潴留32例.福建中医药,2001,32(5)：34
[16]贺辉.五苓散治疗女性尿道综合征体会.河南中医,2004,24(2)：75
[17]邢月明.葶苈生脉五苓散治疗慢性充血性心力衰竭.中西医结合杂志1983,(3)：15
[18]张书林.加味五苓散治晚期膀胱癌.四川中医,1989,(4)：26
[19]司徒宝珍,罗陆一.罗陆一教授运用真武汤的临证经验.内蒙古中医药,2008年 11期：1-2
[20]孙文江,石君华.真武汤治疗阳虚型肾病综合征水肿临床观察.湖北中医杂志,2009,31(6)：46-47
[21]刘奇.真武汤治慢性肾衰阳虚水泛证浅析.辽宁中医药大学学报,2009,11(4)：41-42
[22]陈立.真武汤异病同治应用体会.实用中医药杂志,2009,25(2)：101-102
[23]孙灵芝,相修平.真武汤治验举隅.山西中医,2009,25(5)：33-34
[24]张北野,张斗江.健脾温肾利水法治疗特发性水肿46例.安徽中医临床杂志,1999,11(3)：176
[25]魏仲南.温阳利水法治疗糖尿病肾病水肿.福建中医药,2006,37(4)：37-38
[26]张高林.赵文鼎副主任医师应用真武汤经验琐谈.甘肃中医学院学报,2005,22(4)：7-8
[27]陶建国.真武汤临床运用体会.云南中医中药杂志,2006,27(4)：68-69
[28]包翠杰,许进林.真武汤治疗慢性肾功能衰竭体会.甘肃中医学院学报,2001,12(20)：23-24
[29]李光华.真武汤加味治疗充血性心力衰竭30例.中西药信息,1995,(6)：25
[30]胡斌.真武汤之临床新用.浙江中医杂志,1990,(6)：276
[31]毕明义.真武汤治疗带下病118例.山东中医杂志,1994,(10)：448
[32]何幼斌.真武汤治疗尿路结石并肾积水30例.湖北中医杂志,2003,(4)：42
[33]徐杰新.真武汤治疗肾阳亏虚型良性前列腺增生症疗效观察.广西中医药,2001,24(3)：6
[34]李素兰.辨证治疗肾病水肿50例.陕西中医,2002,23(10)：888
[35]陈明.刘渡舟运用猪苓汤的经验——76例验案分析.山东中医药大学学报,2001,24(1)：41
[36]张晓明,李锋.肾性水肿中医临床治疗浅析.陕西中医,2002,23(4)：327
[37]蓝小琴,付皓云,高鸣.中西医结合治疗慢性肾小球肾炎疗效观察.湖北中医杂志,2008,30(12)：26-27
[38]张敏,赵润栓.猪苓汤加味治疗肾病综合征21例疗效观察.国医论坛,2005,20(4)：8-9
[39]郭秀丽.猪苓汤治验5则.新中医,2004,36(11)：65-66
[40]黄玉娇,莫健平,龙艳.滋阴清热利水法治疗慢性肾炎阴虚湿热型疗效探讨.河北医药,2006,28(7)：626
[41]陈亦人.《伤寒论》求是.北京：人民卫生出版社,1987.P592
[42]赖真.猪苓汤治疗泌尿系结石40例分析.暨南大学学报(医学版),1999,6(26)：12
[43]朱克俭.猪苓汤加味治疗肾积水30例体会.河北中医,1987,9(5)：10
[1]李全,等.五苓散规范化的探讨.中医函授通讯,1994,(6)：5
[2]封银曼,等.五苓散证治规律研究.国医论坛,1994,(4)：4
[3]沈映君.中药药理学.北京.人民卫生出版社,2000,10：P473
[4]易安全.五苓散加茅根汤治疗急性肾炎.四川中医,1990,(6)：29
[5]孙界平.五苓散为主治疗早期肾功能不全20例.新中医,1987,(7)：44
[6]赵佐.慢性肾炎激素撒减过程中的中药治疗经验.中医杂志,1990,(10)：17-18
[7]陈齐鸣.黄芪五苓散为主治疗特发性水肿56例.浙江中医杂志,1991,(2)：44
[8]程剑华,等.五苓散加味治疗化疗性肾衰的临床研究.中医杂志,1993,(1)：42
[9]苏大培.五苓散加味治疗肾积水.四川中医,1985,(10)：23
[10]唐声罨,等.真武汤临床运用点滴经验.中医杂志,1965,(7)：39
[11]陈敬标.运用真武汤对阳虚水泛所致各证治疗的体会.浙江中医杂志,1965：(8)：20
[12]梁自温.温阳利水汤新解.新中医,1976,(6)：293
[13]张长恩.真武汤证研究.北京中医杂志,1991,(1)49
[14]靳育民,等.温肾补阳法治疗慢性肾小球肾炎135例.陕西中医,1994,(10)：441
[15]谢鸣.中医方剂现代研究.北京：学苑出版社,1997,1452
[16]陈梅芳,等.利水法在肾少尿中的应用。中医杂志,1981,(11)：35
[17]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究.中国医药学报,1991,6(4)：10
[18]杨长明.真武汤加减治疗慢性肾功能衰竭12例.湖南中医杂志,1990,(1)：24
[19]尚炽昌,等主编.仲景方药研究应用精鉴.北京：人民军医出版社,1999,697
[20]龙仲川.加味真武汤治疗肾盂积水40例.湖北中医杂志,1993,(2)：23
[21]柴有华.猪苓汤加味治疗产后癃闭20例.陕西中医,1991,12(5)：209
[22]谢鸣.中医方剂现代研究.北京：学菀出版社,1997：1453
[23]肖旭滕.苓桂术甘汤加味治疗难治性肾病综合征17例.新中医,1994,(8)：23
[24]姚筱农.苓桂术甘汤加味治疗小儿水肿.江苏中医,1995,16(6)：14
[25]陈尚书.加味茯桂术甘汤治疗特发性水肿.新中医,1992,(2)：34