从水气病角度论治下肢慢性静脉性水肿  

Discussion About Treating Chronic Venous Edema in the Lower Limbs from the Perspective of Edema

作　　者：龙舒妮 LONG Shuni(Guangzhou Xinhai Hospital,Guangzhou,Guangdong,China,510220)

机构地区：[1]广州新海医院,广东广州510220

出　　处：《河南中医》2023年第10期1469-1473,共5页Henan Traditional Chinese Medicine

摘　　要：下肢慢性静脉性水肿病因病机有感受外邪、营卫郁滞,脏腑功能失调与水液停滞、瘀血凝结,治疗总的原则为因势利导,常用汗法、利小便法与下法。汗法益卫固表以调和营卫,用黄芪类方益气通络,方选防己黄芪汤、黄芪桂枝五物汤、三仁汤、藿香夏苓汤、麻黄连翘赤小豆汤等。以脾虚湿盛证为主者,用利小便法,以茯苓类方为主,可灵活运用淡渗利湿、温阳利湿、养阴利水、清热利湿等方法,方选五苓散、防己茯苓汤联合一贯煎、补阳还五汤、四妙散、猪苓汤、越婢汤等。下法主要是指活血化瘀、活血利水法,因血瘀有血虚致瘀、血寒致瘀、血热致瘀、痰湿瘀滞的不同,故在活血化瘀的基础上,有养血活血化瘀、温经活血化瘀、凉血活血化瘀、祛湿化瘀的不同侧重,方选桂枝茯苓丸、当归芍药散、大黄甘遂汤、硝石矾石散、蒲灰散等,以祛瘀为主,兼顾利水。The etiology and pathogenesis of chronic venous edema in the lower limbs include external pathogens,stagnation of nutrient and defense qi,visceral dysfunctions and fluid retention,and blood stasis and coagulation.The general principle of treatment is to guide according to the situation,commonly used methods include sweating,promoting urination,and purgative method.Sweating is used to re-plenish defense qi and consolidate the superficies,harmonize nutrient-defense qi,so the formula type of Huangqi(Radix Scutellariae)can be adopted,such as Stephania Root and Astragalus Decoction,Astragalus and Cinnamon Twig Five Substances Decoction,Three Kernels Decoction,Agastache and Pinellia and Poria Decoction,Ephedra,Coptis and Semen Phaseoli Decoction,etc.For the main syn-drome of spleen deficiency and excessive dampness,it is necessary to pay attention to promoting urination,and the main formula type of Fuling(Poria)can be flexibly used;other methods,such as dispelling dampness with bland diuretics,warming yang to drain dampness,nourishing yin to induce diuresis,etc.can also be adopted,and some related formulas include Five Substances Powder with Poria,Stephania Root and Poria Decoction combined with Effective Integration Decoction,Yang-Supplementing and Five-Returning Decoction,Wonderfully Effective Four Powder,Polyporus Decoction,Maidservant From Yue Decoction,etc.The purgative method mainly refers to the method of activating blood and resolving stasis,and activating blood to induce diuresis because blood stasis has different causes,such as blood deficiency,blood cold,blood heat,and phlegm-dampness,so on the basis of activating blood stasis,there are different fo-cuses on nourishing blood,warming meridians,cooling blood,or dispelling dampness for resolving stasis,that's why the following formu-las,such as Cinnamon Twig and Poria Pill,Chinese Angelica and Peony Powder,Rhubarb and Radix Euphorbiae Kansui Decoction,can be adopted to remove blood stasis and induce diuresis.

关 键 词：下肢慢性静脉性水肿 水气病 汗法 利小便法 下法 《金匮要略》 张仲景 

分 类 号：R259.436[医药卫生—中西医结合]