从《伤寒论》少阴病探讨慢性肾功能衰竭证治  

Study on the Treatment of Chronic Renal Failure from Lesser Yin Disease in Treatise on Cold Damage Diseases

作　　者：陈曦霞 祝轩 何泳谦 张春燕 CHEN Xixia;ZHU Xuan;HE Yongqian;ZHANG Chunyan(Zengcheng District Hospital of Traditional Chinese Medicine of Guangzhou,Guangzhou,Guangdong,China,510000)

机构地区：[1]广州市增城区中医医院,广东广州510000

出　　处：《河南中医》2023年第11期1621-1624,共4页Henan Traditional Chinese Medicine

基　　金：广州市中医药特色诊疗技术建设项目[穗卫函(2022)2049号]。

摘　　要：慢性肾功能衰竭根本病机为脾肾阳虚,湿浊邪毒壅塞三焦,日久则耗心阳,阴寒内盛,《伤寒论》少阴病病机为心肾阳虚、阴寒内盛,二者病机一致。少阴病可从阴化寒,发为少阴病寒化证,又可从阳化热,发为少阴病热化证。慢性肾功能衰竭湿浊邪毒壅塞三焦,湿浊可化寒,亦可瘀阻化热,二者的病机变化也一致。慢性肾功能衰竭患者脾肾阳虚甚者,可从少阴病寒化证论治,方选真武汤、附子汤等;湿浊瘀阻重者,可从少阴病热化证论治,方选黄连阿胶汤、猪苓汤等;晚期出现肾功能衰竭、心力衰竭等并发症时,可从少阴病死证论治,采用大剂量参麦注射液联合西医治疗。少阴病预后有三:一为正复欲愈证;二为阳回可治证;三为正衰危重证,少阴病后期,应重点关注患者的神志,舌象,脉象,提前防变。慢性肾功能衰竭患者兼发心脏病或年老体弱患者,易发生阴阳衰竭的危候,应防阴阳离决。The basic pathogenesis of chronic renal failure is spleen-kidney yang deficiency,dampness and turbidity and toxin blocking in the triple energizer for a long time,which consumes heart yang,and leads to excessive internal yin cold.According to Treatise on Cold Damage Diseases,the pathogenesis of lesser yin disease is heart-kidney yang deficiency and accumulation of yin-cold internally,which is consistent with the pathogenesis of lesser yin disease.Lesser yin disease can not only transform cold from yin,resulting in cold transfor-mation syndrome of lesser yin,but also transform heat from yang,resulting in heat transformation syndrome of lesser yin.In chronic renal failure,dampness and turbidity block the triple energizer.Dampness and turbidity can not only transform into cold,but also block and transform into heat,and the pathogeneses of both are the same.The spleen-kidney yang deficiency of patients with chronic renal failure can be treated according to the cold transformation syndrome of lesser yin disease,so True Warrior Decoction,and Aconite Decoction,etc.can be adopted.For severe dampness-turbidity-stasis,lesser yin disease can be treated based on heat transformation syndrome of lesser yin,so Coptis and Donkey-Hide Gelatin Decoction,and Polyporus Decoction,etc.can be adopted.For late-stage renal failure,heart failure and other complications,it can be treated based on lesser yin disease death syndrome,so a large dose of Ginseng and Wheat Injection can be adopted.Lesser yin disease prognosis has three types:one is the syndrome of healthy qi recovery which can be cured,one is the syndrome of restoring yang which can be treated,and one is the syndrome of decling healthy qi which is in danger.In the late stage of lesser yin disease,it is necessary to focus on the patient's consciousness,tongue manifestations,pulse condition,and prevent changes in advance.Patients with chronic renal failure complicated with heart disease or elderly and weak patients are prone to critical failure of yin and yang,so it is necessary to

关 键 词：慢性肾功能衰竭 少阴病 少阴病寒化证 少阴病热化证 少阴病死证 《伤寒论》 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]