从张仲景虚劳证治看肾消病机演变和治疗启示  

Evolution of the pathogenesis of Shen Xiao and its therapeutic enlightenment from ZHANG Zhong-jing’s consumptive concept

作　　者：彭杨芷 江泳[1] 刘威岑 王聪慧 李爽 陈香美 PENG Yang-zhi;JIANG Yong;LIU Wei-cen;WANG Cong-hui;LI Shuang;CHEN Xiang-mei(School of Basic Medicine,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Senior Department of Nephrology,the First Medical Center of PLA General Hospital,Nephrology Institute of the Chinese People's Liberation Army,National Key Laboratory of Kidney Diseases,National Clinical Research Center forKidney Diseases,Beijing Key Laboratory of KidneyDiseaseResearch,Beijing 100853,China)

机构地区：[1]成都中医药大学基础医学院,成都610075 [2]中国人民解放军总医院第一医学中心肾脏病医学部,中国人民解放军肾脏病研究所,肾脏疾病国家重点实验室,国家慢性肾病临床医学研究中心,肾脏疾病研究北京市重点实验室,北京100853

出　　处：《中华中医药杂志》2022年第11期6660-6663,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：四川省科技厅重点研发项目(No.2022YFS0409);成都中医药大学“杏林学者”学科人才科研提升计划(No.BSH2020015);成都中医药大学教育教学改革项目(No.JGYB2020043);四川省中医药发展专项(No.003113005003)。

摘　　要：张仲景承接《黄帝内经》《难经》思想,首提“虚劳”之名,形成了系统诊疗此类疾病的证治方法。虚劳包含病证范围广泛,肾消属于“虚劳”范畴。在虚劳证治的指导下,笔者法仲景辨病抓主症之法,提炼出肾消的主症为“小便如膏油”,兼有“腿消瘦”“渴”“小便数”“眼涩而昏”“阴萎”等表现。肾气虚是肾消的基础病机,阴虚、阳虚是其病机常见演变趋势。肾消治疗当坚持“辨病论治”与“分型论治”结合。“辨病论治”即针对基础病机治疗,应补肾气,可从“少火生气”“直补本虚”“养肾精、益脾气”三法入手;同时仍需结合患者当前证型进行“分型论治”。“辨病”“分型”相结合才能真正体现张仲景“辨证论治”的内涵,实现肾消治疗的理法方药一线贯通。Following the thoughts of Huangdi Neijing and Nan Jing, ZHANG Zhong-jing proposed and summarized the symptoms, pathogenesis and treatment of the ‘consumptive disease’. It includes a wide range of diseases and syndromes, for instance, Shen Xiao belongs to the ‘consumptive disease’. Under the guidance of ZHANG Zhong-jing, the main symptoms of Shen Xiao extracted from ancient literature are ‘turbid urine’ ‘leg emaciation’ ‘thirst’ ‘frequent urination’ ‘dry and discomfotable eye’ ‘impotence’, ect.. Moreover, kidney qi deficiency is the basic pathogenesis of Shen Xiao, and mainly further develope into yin deficiency and yang deficiency. The treatment of Shen Xiao should not only consider disease differentiation, but also refer to the syndrome differentiation. Treatment based on disease differentiation refers to nurishing kidney qi, which can be started with ‘vigorous fire to generating qi’ ‘tonifying kidney qi, reinforcing kidney essence and spleen qi’. In addition, syndrome type need to be considered as well. Only when both disease and sydrome differentiation were took into consideration, can ZHANG Zhongjing’s theory ‘treatment based on syndrome differentiation’ be truly reflected, so that the principles, strategies, formulas and medicinal substances are connected in the treatment of Shen Xiao.

关 键 词：肾消 虚劳证治 辨证论治 肾气虚 基础病机 

分 类 号：R277.5[医药卫生—中医学]