益气利水活血法治疗肾病综合征的机理探讨
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摘要
肾病综合征属于《金匮》水气病范畴,《金匮》中特别重视气血水三者之间的关系。水进入人体要靠脏腑气化始能代谢,脏腑功能虚衰或失调,气不能行水,故过量水液停蓄而形成水气。肾病综合征即是水气内停以浮肿为主要特征的疾病。气病则血病,血不利则为水,水不利则病血,故《金匮》除按阴阳表里分为风水、皮水、正水、石水、黄汗:按五脏分为心水、肺水、肝水、脾水、肾水外,又按气、血、水之间的关系分为血分、水分、气分。
根据肾病综合征的临床表现,按照中医辨证,特别根据《金匮》气血水并治的理论,对多数肾病综合征病人提出以益气利水活血为治疗大法,益气主要健脾气补肾气。根据临床经验精选药物黄芪、党参、生地、山萸肉、山药、茯苓、泽泻、丹皮、炒白术、桑白皮、大腹皮、陈皮、冬瓜皮、益母草、泽兰。组成益气消肿汤,方中黄芪、党参、山药、白术、茯苓健脾益气;生地黄、山萸肉、山药补肾气;桑白皮、大腹皮、陈皮、冬瓜皮,以皮治皮(善治皮水),利水消肿;益母草、泽兰既能活血又能利水。临床治疗肾病综合征,尤其西医用激素治疗效果不好时,此方在减轻症状、消除尿蛋白、降低血压等方面收到满意效果。
“益气利水活血法”是治疗肾病综合征的基本治法,但由于病人体质不同、病变轻重差异,临床表现有别,还应根据辨证而加减用药。
Nephrotic syndrome belongs to moisture disease category in《Jingui》,which values the relationships in QI、Blood and Water. The water in human body’s metabolism depends on viscera gasification. If visceral functions wake or disorder, Qi can’t carry water, the water deteriorates to form moisture disease. So does the Nephrotic syndrome, as the main characteristic with edema disease. Qi diseases cause blood diseases, blood disfluency causes water, water disfluency causes blood diseases, so there are fengshui、pishui、zhengshui、shishui、huanghan five types by Yinyangbiaoli; xinshui、ganshui、feishui、pishui、shenshi by five zang-organs; and the blood phase、the qi phase、moisture by the relationship in qi、blood and water.
Based on the Nephrotic syndrome’s clinical conditions, according to TCM syndrome differentiation, especially the theory of qi -blood-water treated together in《Jingui yaolue》, this paper proposes the treatment principle of nourish qi-promote water-activate blood to Nephrotic syndrome patients, nourish qi majors in replenish the spleen-qi and tonifying the kidney-qi. According to the clinical experience, choices milkvetch root, asiabell/ dried rehmannia root/ pulp of dogwood fruit/ chinese yam/indian bread/ alismatis rhizome/ moutan bark/ parched white atractylodes rhizome/mulberry bark/ areca peel/ tangerine peel/chinese waxgourd peel/ leonurus heterophyllus/ lycopus herb to make up nourish qi- detumescent decoction. In this decoction, milkvetch root/ asiabell/ chinese yam/ parched white atractylodes rhizome/ indian bread strengthen the spleen and replenish qi; dried rehmannia root/ pulp of dogwood fruit/ chinese yam tonify the kidney-qi,;mulberry bark/ areca peel/ tangerine peel/chinese waxgourd peel are good at the pishui treatment, diuresis-promoting and detumescence; leonurus heterophyllus/ lycopus herb can activate blood and diuresis-promoting. On the clinical treatment of Nephrotic syndrome, especially when hormone therapy was not good, this decoction had satisfied results at abating symptom/ eliminating Upro/ lowering blood pressure and other aspects.
“Nourish qi-promote water-activate blood law”is the basic rule to treat Nephrotic syndrome, but because of patients’constitutional difference and pathologic changes’difference, the clinical conditions are different, so the doctors have to modify dosage according to differentiation.
根据肾病综合征的临床表现,按照中医辨证,特别根据《金匮》气血水并治的理论,对多数肾病综合征病人提出以益气利水活血为治疗大法,益气主要健脾气补肾气。根据临床经验精选药物黄芪、党参、生地、山萸肉、山药、茯苓、泽泻、丹皮、炒白术、桑白皮、大腹皮、陈皮、冬瓜皮、益母草、泽兰。组成益气消肿汤,方中黄芪、党参、山药、白术、茯苓健脾益气;生地黄、山萸肉、山药补肾气;桑白皮、大腹皮、陈皮、冬瓜皮,以皮治皮(善治皮水),利水消肿;益母草、泽兰既能活血又能利水。临床治疗肾病综合征,尤其西医用激素治疗效果不好时,此方在减轻症状、消除尿蛋白、降低血压等方面收到满意效果。
“益气利水活血法”是治疗肾病综合征的基本治法,但由于病人体质不同、病变轻重差异,临床表现有别,还应根据辨证而加减用药。
Nephrotic syndrome belongs to moisture disease category in《Jingui》,which values the relationships in QI、Blood and Water. The water in human body’s metabolism depends on viscera gasification. If visceral functions wake or disorder, Qi can’t carry water, the water deteriorates to form moisture disease. So does the Nephrotic syndrome, as the main characteristic with edema disease. Qi diseases cause blood diseases, blood disfluency causes water, water disfluency causes blood diseases, so there are fengshui、pishui、zhengshui、shishui、huanghan five types by Yinyangbiaoli; xinshui、ganshui、feishui、pishui、shenshi by five zang-organs; and the blood phase、the qi phase、moisture by the relationship in qi、blood and water.
Based on the Nephrotic syndrome’s clinical conditions, according to TCM syndrome differentiation, especially the theory of qi -blood-water treated together in《Jingui yaolue》, this paper proposes the treatment principle of nourish qi-promote water-activate blood to Nephrotic syndrome patients, nourish qi majors in replenish the spleen-qi and tonifying the kidney-qi. According to the clinical experience, choices milkvetch root, asiabell/ dried rehmannia root/ pulp of dogwood fruit/ chinese yam/indian bread/ alismatis rhizome/ moutan bark/ parched white atractylodes rhizome/mulberry bark/ areca peel/ tangerine peel/chinese waxgourd peel/ leonurus heterophyllus/ lycopus herb to make up nourish qi- detumescent decoction. In this decoction, milkvetch root/ asiabell/ chinese yam/ parched white atractylodes rhizome/ indian bread strengthen the spleen and replenish qi; dried rehmannia root/ pulp of dogwood fruit/ chinese yam tonify the kidney-qi,;mulberry bark/ areca peel/ tangerine peel/chinese waxgourd peel are good at the pishui treatment, diuresis-promoting and detumescence; leonurus heterophyllus/ lycopus herb can activate blood and diuresis-promoting. On the clinical treatment of Nephrotic syndrome, especially when hormone therapy was not good, this decoction had satisfied results at abating symptom/ eliminating Upro/ lowering blood pressure and other aspects.
“Nourish qi-promote water-activate blood law”is the basic rule to treat Nephrotic syndrome, but because of patients’constitutional difference and pathologic changes’difference, the clinical conditions are different, so the doctors have to modify dosage according to differentiation.
引文
[1]王吉耀.内科学[M].北京:人民卫生出版社,2006:574.
[2]徐蓉娟.内科学[M].北京:中国中医药出版社,2006:206.
[3]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:188.
[4]范永升.金匮要略[M].北京:中国中医药出版社,2007:194.
[5]程树清.金匮正水探讨[J].北京:北京中医学院学报.1988,(2):17]
[6]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:193.
[7]林永法等,谈金匮五脏水的临床意义[J].济南:山东中医.1995,(12):533
[8]周仲瑛.中医内科学[M].北京:中国中医药出版社,2008:345.
[9]周仲瑛周学平中医内科杂病证治精义[M].北京:人民卫生出版社,2008:421
[10]魏荔彤.金匮要略方论本义[M].北京:人民卫生出版社,1997.
[11]张介宾.景岳全书肿胀[M].北京:人民卫生出版社,1991:495.
[12]张仲景.金匮要略水气病脉证并治. [M].北京:人民卫生出版社,2005:54.
[13]张子和.儒门事亲[M].天津科学技术出版社,2000:77.
[14]田代华等.素问汤爷醪醴论[M].北京:人民卫生出版社,2005:27.
[15]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:186.
[16]范永升.金匮要略[M].北京:中国中医药出版社,2007:202.
[17]唐宗海.血证论[M]北京:人民卫生出版社,2005:8 .[18]王洪武.雷公藤多甙治疗老年肾病综合征近期疗效观察[J],中国中西医结合肾病杂志2001,2:72
[19]聂玉清.中西医结合治疗难治性肾病综合征14例疗效观察[J],中西医结合实用临床急救1999,6(5):235
[20]石鹏.活血化瘀法与肾病综合症[J].陕西中医,1997,3:19.
[21]曾庆英.“开鬼门、洁净腑”主体法治疗肾病综合征。[J].贵阳中医学院学报,1991,1:19.
[22]田代华等.素问汤液醪醴论[M].北京:人民卫生出版社,2005.
[23]丁济良.分清标本治疗肾病水肿的体会[J].哈尔滨:黑龙江中医药,1989,1:47.
[24]徐远祥.加味实脾饮治疗肾病综合征实验研究[J].成都:四川中草药研究,1995,37—38:64.
[25]平世昌.补气活血法治疗肾病综合征23例[J].黑龙江中医药,2000,12:16.
[26]杨丽莎.中西医结合治愈肾病综合征一例[J].四川中医,1989,10:28.
[27]吴谦.医宗金鉴[M].北京:中国中医药出版社,1994,1:346.
[28]陈瑞敏.调肾汤治疗肾病综合征临床体会[J].北京:中国中医基础医学杂志,2005,11(9):718.
[29]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:290.
[30]沈自尹.肾的研究(续集)[M].上海:上海科学技术出版社,1990:116-118
[31]洪同森等.益肾宁治疗肾病激素撤退肾阳虚证的临床研究——附100例临床分析[J]北京:中国中西医结合杂志,1992;12(6):330-331
[32]赵国达.健脾肾蛰汤治肾病综合征的临床观察[J].中国中西医结合脾胃杂志,1997,5(1):45.I
[33]李义林.应用固本活血利尿法治疗肾病综合征[J],西安:陕西中医函授1991,5:31
[34]张琳琪.难治性肾病综合征与中医与血瘀症的关系[J].第七届全国中西医结合肾病会议论文汇编:79.
[35]战淑坤.运用中药治愈肾病综合征3例[J],哈尔滨:黑龙江中医药,1993,1:20页
[36]薛长连.高辉远治疗肾病综合征经验[J].成都:四川中医,1993,7:9.
[37]刘爱萍.略论肾病综合征中医治疗[J].长治:长治医学院学报,1996,10(1):63.
[38]刘春思.石景亮治疗慢性肾炎经验撷菁[J]光明中医2008,23(4):429
[39]贾云科.对肾病综合征辨证施治体会[J].包头医学,1995,19(4):20
[2]徐蓉娟.内科学[M].北京:中国中医药出版社,2006:206.
[3]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:188.
[4]范永升.金匮要略[M].北京:中国中医药出版社,2007:194.
[5]程树清.金匮正水探讨[J].北京:北京中医学院学报.1988,(2):17]
[6]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:193.
[7]林永法等,谈金匮五脏水的临床意义[J].济南:山东中医.1995,(12):533
[8]周仲瑛.中医内科学[M].北京:中国中医药出版社,2008:345.
[9]周仲瑛周学平中医内科杂病证治精义[M].北京:人民卫生出版社,2008:421
[10]魏荔彤.金匮要略方论本义[M].北京:人民卫生出版社,1997.
[11]张介宾.景岳全书肿胀[M].北京:人民卫生出版社,1991:495.
[12]张仲景.金匮要略水气病脉证并治. [M].北京:人民卫生出版社,2005:54.
[13]张子和.儒门事亲[M].天津科学技术出版社,2000:77.
[14]田代华等.素问汤爷醪醴论[M].北京:人民卫生出版社,2005:27.
[15]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:186.
[16]范永升.金匮要略[M].北京:中国中医药出版社,2007:202.
[17]唐宗海.血证论[M]北京:人民卫生出版社,2005:8 .[18]王洪武.雷公藤多甙治疗老年肾病综合征近期疗效观察[J],中国中西医结合肾病杂志2001,2:72
[19]聂玉清.中西医结合治疗难治性肾病综合征14例疗效观察[J],中西医结合实用临床急救1999,6(5):235
[20]石鹏.活血化瘀法与肾病综合症[J].陕西中医,1997,3:19.
[21]曾庆英.“开鬼门、洁净腑”主体法治疗肾病综合征。[J].贵阳中医学院学报,1991,1:19.
[22]田代华等.素问汤液醪醴论[M].北京:人民卫生出版社,2005.
[23]丁济良.分清标本治疗肾病水肿的体会[J].哈尔滨:黑龙江中医药,1989,1:47.
[24]徐远祥.加味实脾饮治疗肾病综合征实验研究[J].成都:四川中草药研究,1995,37—38:64.
[25]平世昌.补气活血法治疗肾病综合征23例[J].黑龙江中医药,2000,12:16.
[26]杨丽莎.中西医结合治愈肾病综合征一例[J].四川中医,1989,10:28.
[27]吴谦.医宗金鉴[M].北京:中国中医药出版社,1994,1:346.
[28]陈瑞敏.调肾汤治疗肾病综合征临床体会[J].北京:中国中医基础医学杂志,2005,11(9):718.
[29]陶汉华.金匮要略研读心悟[M].北京:人民卫生出版社,2008:290.
[30]沈自尹.肾的研究(续集)[M].上海:上海科学技术出版社,1990:116-118
[31]洪同森等.益肾宁治疗肾病激素撤退肾阳虚证的临床研究——附100例临床分析[J]北京:中国中西医结合杂志,1992;12(6):330-331
[32]赵国达.健脾肾蛰汤治肾病综合征的临床观察[J].中国中西医结合脾胃杂志,1997,5(1):45.I
[33]李义林.应用固本活血利尿法治疗肾病综合征[J],西安:陕西中医函授1991,5:31
[34]张琳琪.难治性肾病综合征与中医与血瘀症的关系[J].第七届全国中西医结合肾病会议论文汇编:79.
[35]战淑坤.运用中药治愈肾病综合征3例[J],哈尔滨:黑龙江中医药,1993,1:20页
[36]薛长连.高辉远治疗肾病综合征经验[J].成都:四川中医,1993,7:9.
[37]刘爱萍.略论肾病综合征中医治疗[J].长治:长治医学院学报,1996,10(1):63.
[38]刘春思.石景亮治疗慢性肾炎经验撷菁[J]光明中医2008,23(4):429
[39]贾云科.对肾病综合征辨证施治体会[J].包头医学,1995,19(4):20