基于内经开阖枢理论从太阴机转认识原发性膜性肾病  

Exploration the taiyin transmission of primary membranous nephropathy based on the theory of"kai he shu(opening,closing,pivoting)"in The Yellow Emperor’s Inner Classic

作　　者：周小姗 郑洋[2] 芮宏亮 赵启涵 董兆珵 侯凡雨 刘宝利[2] ZHOU Xiaoshan;ZHENG Yang;RUI Hongliang;ZHAO Qihan;DONG Zhaocheng;HOU Fanyu;LIU Baoli(Beijing University of Chinese Medicine,Beijing 100029;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University;Changchun University of Chinese Medicine)

机构地区：[1]北京中医药大学,北京100029 [2]首都医科大学附属北京中医医院 [3]长春中医药大学

出　　处：《现代中医临床》2023年第5期59-63,共5页Modern Chinese Clinical Medicine

基　　金：国家自然科学基金面上项目(No.82174314);2020年度首都卫生发展科研专项项目(No.首发2020-2-2234);2019年度医管局培育计划(No.PZ2019016)。

摘　　要：原发性膜性肾病作为成人肾病综合征的主要病因,以水肿为首发表现,在发病初期和迁延不愈阶段均兼有腹胀、便溏等症状。基于临床经验,发现太阴之本虚存在于部分发病人群,外来风邪易侵扰少阴表位,且易入里损及三阴。基于此,水肿发于少阴之表位,病程初期,病机单一,病邪易入里;若病邪拘于太阴,气血郁遏,则病程中后期,病机复杂,由此产生一系列并发症。又可复损及少阴,从而复发;或进一步传至厥阴,进入肾病终末期。结合病邪反应在机体的发病部位,根据六经八纲辨证,该病属少阴太阴合病;基于三阴开阖枢理论,总结原发性膜性肾病病机传化特点当以太阴为本、少阴为始、厥阴为传。并以“太阴本虚”的概念指导治肺脾而治肾的思路,以驱邪外出兼以温里为总则,临床以甘姜苓术汤治疗原发性膜性肾病太阴里虚寒证候,随证化裁,效果良好。Primary membranous nephropathy(PMN)is the main cause of adult nephrotic syndrome,with edema as the first manifestation.Abdominal distension,loose stool and other symptoms can be observed in the early and prolonged stages of the disease.Based on clinical experience,it was found that the deficiency of taiyin may exist in some patients,so that external wind evil may easily attack the exterior shaoyin and further damage the three yin.Therefore,edema occurs in exterior shaoyin.A single pathogenesis is in play at the early stage,yet it is still easy for pathogens to enter the inside.If the evil is confined to taiyin with qi and blood repressed,the pathogenesis will be complex in the middle and late stages of the disease.Resulting in a series of complications.Then,shaoyin can be damaged again,causing relapses.The evil may even further spread to jueyin,leading to the end stage of nephropathy.According to the syndrome differentiation of the six meridians and eight principles,this disease belongs to the combination of shaoyin and taiyin.Based on the theory of"opening,closing,and pivoting"of the three yin,the pathogenesis of PMN should be studied with taiyin as the base,shaoyin as the beginning and jueyin as the transmission.The idea of treating the kidney by treating the lung and spleen is guided by the concept of"deficiency of taiyin".The main principle is to expel evil and warm the interior.In clinical pracice,Ganjiang Lingzhu Decoction is used to treat the deficiency and cold syndrome of taiyin in PMN,which is adjusted based on symptoms and the desirable efficacy can be achieved.

关 键 词：原发性膜性肾病 开阖枢理论 太阴 温里 甘姜苓术汤 

分 类 号：R259[医药卫生—中西医结合]