黄金昶以“少阳属肾”“少阳主骨”立论辨治肾癌转移  

Huang Jinchang′s Experience in Treating Renal Carcinoma Metastasis Based on"Shaoyang Belonging to Kidney" and "Shaoyang Governing Bone"

作　　者：陈瑞鸥 姜欣 张巧丽[1,2] 阙慈嫺 张善辉[1] 黄金昶 CHEN Ruiou;JIANG Xin;ZHANG Qiaoli;QUE Cixian;ZHANG Shanhui;HUANG Jinchang(The Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing China 100029;Institute of Acupuncture and Oncology,Beijing University of Chinese Medicine,Beijing China 100029)

机构地区：[1]北京中医药大学第三附属医院,北京100029 [2]北京中医药大学针灸肿瘤研究所,北京100029

出　　处：《中医学报》2023年第4期766-770,共5页Acta Chinese Medicine

基　　金：国家自然科学基金项目(82074545);北京市自然科学基金项目(7202122)。

摘　　要：肾癌肺转移的病机为肺肾两虚,三焦阻滞,痰湿不化。由于肾癌的发生本于肾虚,肾阴不足,阴损及阳,肾的气化功能减弱,三焦运行气血津液功能失常,肺脏得不到气血津液的滋养,日久致肺气阴不足。气阴两虚,肺失宣肃,导致肺的津液不能散布,痰饮水湿留滞于肺,日久成积。肾主骨,少阳主骨膜,由于肾癌本为肾元亏损,肾精不足不能充养骨骼,骨骼失于濡养,易被邪气侵袭;同时,少阳运行气血津液的动力来源于肾,肾虚则少阳枢机不利,痰湿瘀血内生并伏留于正虚的骨之筋膜,日久成积。肾癌肺、骨转移与“少阳属肾,肾上连肺,故将两脏”“少阳主骨”息息相关,故治疗肾癌在补肾固本的同时,尤其重视疏利少阳。临床上立足整体,重视局部,通补结合,针对肾癌肺转移选用六味地黄丸合柴胡达原饮、海白百冬汤加减;肾癌骨转移选用桂附地黄丸合柴芩剂、阳和汤加减,并强调日常饮食情志调护。The pathogenesis of lung metastases from renal carcinoma is the deficiency of both the Lung and the Kidney,blockage of Sanjiao,and failure in eliminating Phlegm and Dampness.Renal carcinoma is originated in Kidney deficiency,in which deficiency of Kidney Yin negatively affects the Kidney Yang,which weakens the Qi transformation function of the Kidney.When the function of Qi,Blood,and body Fluid in the Sanjiao is abnormal,and the Lungs cannot be nourished by Qi,Blood,and body Fluid,resulting in insufficient Lung Qi and Yin over time.Deficiency of both Qi and Yin causes the Lung′s failure in clearing and descending,resulting in the inability of the body Fluid in the Lungs to disperse,and then the Phlegm,Water,and Dampness stay in the Lungs and get accumulated over time.The Kidney governs bones,and the Shaoyang governs the periosteum.Because renal carcinoma is originally caused by the loss of Kidney essence,which fails in nourishing the bones,and the bones that lose their nourishment are easily attacked by pathogenic Qi.At the same time,the power of Shaoyang to support the movement of Qi,Blood,and body Fluid comes from Kidney.If the kidney is deficient,the pivot of Shaoyang will be unfavorable,and Phlegm,Dampness and blood stasis will generate inward and stay in the fascia of the deficient bones,and get accumulated over time.Lung and bone metastasis of renal carcinoma is closely related to"Shaoyang belonging to Kidney and Kidney being connected to Lung so the two Zang are closely connected"and"Shaoyang governing the bone".Therefore,in treatment of renal carcinoma dredging and benefiting Shaoyang while nourishing the Kidney and strengthening the foundation should be paid special attention to.Clinically,it should be based on the whole,pay attention to the local area,by combining dredge method and tonic method,and the following priscriptions should be chosed:modified Liuwei Dihuang Pill combined with Chaihu Dayuan Drink,Haibai Baidong Decoction for lung metastases from renal carcinoma.Modified Guifu Dihuang Pills com

关 键 词：肾癌 肺转移 “少阳属肾” “少阳主骨” 骨转移 少阳不利 疏利少阳 黄金昶 

分 类 号：R249.27[医药卫生—中医临床基础]