《金匮要略》治疗小便不利刍议  

Discussion About Treating Dysuria in Synopsis of the Golden Chamber

作　　者：陈帅 卢开信 朱虹 CHEN Shuai;LU Kai-xin;ZHU Hong(School of Clinical Medicine of Yangzhou University,Yangzhou,Jiangsu,China,225001)

机构地区：[1]扬州大学临床医学院,江苏扬州225001

出　　处：《河南中医》2020年第8期1138-1140,共3页Henan Traditional Chinese Medicine

基　　金：江苏省中医药科技项目(YB201841)。

摘　　要：《金匮要略》将小便不利分为膀胱气化不利型、湿热蕴结型、上燥下寒型、水热互结伤阴型与脾肾方虚型5型。膀胱气化不利型,当发汗利小便,化气利水,以五苓散或葵子茯苓散为主方;湿热蕴结型,当清热利湿退黄,以茵陈蒿汤为主方,湿热日久,血脉有瘀滞者,以蒲灰散、滑石白鱼散、茯苓戎盐汤为主方;上燥下寒型,当辛凉滋燥,温阳祛寒,以栝楼瞿麦丸为主方;水热互结伤阴型,当清热利水滋阴,以猪苓汤为主方;脾肾亏虚型,当温阳补肾,通利小便,以肾气丸为主方,兼口渴者以栝楼瞿麦丸为主方。肺失宣肃所致小便不利,当开宣肺气,代表方剂为越婢加术汤;脾脏虚弱所致小便不利,当健脾理脾,以苓桂术甘汤温阳健脾化饮,病久入络成瘀后,加入血分药物,行气利水与活血化瘀并重,以茯苓戎盐汤为主方;肾气虚弱所致小便不利,当温补肾阳,补益肾气,代表方剂为金匮肾气丸。According to Synopsis of the Golden Chamber,dysuria can be divided into five types:bladder disturbance qi transformation type,damp heat accumulation type,upper dryness and lower cold type,water-heat interaction injuring yin type and spleen and kidney deficiency type.For bladder disturbance qi transformation type,the treatment should focus on sweating for promoting urination,and transforming qi for promoting urination,Five Substances Powder with Poria or Semen Malvae and Poria Powder are often used.For damp heat accumulation type,the treatment should focus on clearing away heat,removing dampness and jaundice,Virgate Wormwood Decoction is mainly used;for long-time dampness and heat,and blood stasis,Pollen Typhae Charcoal Powder,Talcum and White Fish Powder,Poria and Rock Salt Decoction are mainly used.For upper dryness and lower cold type,the treatment should focus on nourishing dryness with pungent and cool medicinals,warming yang and dispelling cold,and Fructus Trichosanthis and Herba Dianthi Pill is mainly used.For water-heat interaction injuring yin type,the treatment should focus on clearing away heat,promoting diuresis and nourishing yin,and Polyporus Decoction is mainly used.For spleen and kidney deficiency type,the treatment should focus on warming yang and tonifying kidney,promoting urination,Kidney Qi Pill is mainly used.For patients combined with thirst,Fructus Trichosanthis and Herba Dianthi Pill is mainly used.For dysuria due to the lung failing to dispersing and descending,the treatment should focus on dispersing lung qi,and the representative formula is Maidservant From Yue plus Rhizoma Atractylodis Macrocephalae Decoction.For dysuria due to spleen deficiency,the treatment should focus on strengthening spleen and regulating spleen,Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction to warm yang and activate spleen and resolve retention,After the disease has entered the collaterals for a long time,it is necessary to add the medicinals to enter blood aspect to move qi and promo

关 键 词：小便不利 《金匮要略》 从肺论治 从脾论治 从肾论治 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]