马骥肾气丸法辨治肾病综合征经验述要  

Prof.Ma Ji’s experience in treating nephrotic syndrome with Shenqi Pill

作　　者：陈飞[1] 韩洁茹[1] 王雪华[1] 姜德友[1] CHEN Fei;HAN Jieru;WANG Xuehua;JIANG Deyou(Heilongjiang University of Chinese Medicine,Harbin 150040)

机构地区：[1]黑龙江中医药大学,哈尔滨150040

出　　处：《现代中医临床》2024年第1期112-116,共5页Modern Chinese Clinical Medicine

基　　金：黑龙江省博士后资助项目(No.LBH-Z19213);黑龙江省高等教育教学改革一般项目(No.SJGY20210828);黑龙江省中医药科研项目(No.ZYW2022-052,No.ZYW2023-121);黑龙江省高等教育学会“十三五”高等教育科研课题(No.16G125);国家中医药管理局全国名老中医药专家传承工作室建设项目(国中药人教函[2022]75号文件)。

摘　　要：肾病综合征是因多种疾病和不同病因、病理损伤所致的一组临床综合征,水肿是最主要的临床表现。马骥教授在治疗肾病综合征方面具有独特的临证经验。强调肾病综合征属《金匮要略》水气病之少阴正水,五脏辨病论治属中医肾脏疾病范畴,予肾气丸最为相宜,即辨病为先、专病专方。肾气丸法为本虚标实之肾病综合征而设,临证当详辨症情、推究病机、察其阴阳,对标实证更应细考其水、瘀、毒之因,采取补肾利水、化瘀解毒等法,即病证结合,审机参变。肾气丸法具体应用包括:脾肾阳虚证治以温补脾肾、化气利水,予离明肾气汤主之;脾肾气虚证治以补脾益肾、助阳化气,予复元固本汤主之;阴阳两虚证治以滋补肝肾、益阴泄浊,予六五地黄汤主之;气阴两虚证治以益气养阴、扶正祛邪,予加减复元固本汤合二至丸主之。肾气丸法的思维特色为:阴阳互济,兼顾体用;益肾为主,兼顾他脏;益肾利水,兼顾瘀阻。结合临床医案对马教授肾气丸法辨治肾病综合征经验进行介绍。Nephrotic syndrome encompasses a spectrum of conditions arising from diverse ailments,varied etiologies,and pathological impairments,prominently manifesting as edema.Prof.Ma Ji possesses distinctive clinical expertise in managing nephrotic syndrome.He underscores that nephrotic syndrome aligns with shaoyin zhengshui(typical edema induced by lesser yin) in the shuiqi(edema) disease recorded in Jin Gui Yao Lue(Essentials from the Golden Cabinet),and proposes that the condition falls in the category of kidney diseases based on disease differentiation and treatment from the perspective of the five zang organs,for which Shenqi Pill(Kidney Qi Pill) is the most suitable medication.Emphasizing a personalized approach,he favors prescribing Shenqi Pill based on prioritizing differential diagnoses.The Shenqi Pill method addresses nephrotic syndrome with deficiency as the root and excess as the branch.Clinical practice necessitates meticulous symptom analysis,comprehensive exploration of pathogenesis,yin-yang observation,and critical assessment of factors such as water accumulation,blood stasis,and toxicity.The method focuses on nourishing the kidneys while promoting diuresis,resolving stasis and toxicity,merging disease-specific and syndrome-based insights to tailor treatment strategies.The Shenqi Pill method encompasses various applications:The treatment of spleen and kidney yang deficiency syndrome involves warming and tonifying the spleen and kidney,facilitating the transformation of qi and fluids,for which Liming Shenqi Decoction is the core formula.Managing spleen and kidney qi deficiency entails tonifying the spleen and kidney,boosting yang and facilitating the transformation of qi,and the main formula is Fuyuan Guben Decoction(Original Qi-Restoring and Foundation-Consolidating Decoction).Addressing yin and yang deficiency aims at nourishing the liver and kidney,boosting yin and relieve turbidity,for which Liuwu Dihuang Decoction(Six Plus Five Ingredients Rehmannia Decoction) should be used as the core.Treating qi and

关 键 词：肾气丸法 肾病综合征 专病专方 名医经验 马骥 

分 类 号：R256.5[医药卫生—中医内科学] R259[医药卫生—中医学]