肾性水肿的中医药治疗进展  

A review on the TCM treatment of renal edema

作　　者：袁建萍 许正锦[2] YUAN Jianping;XU Zhengjin

机构地区：[1]福建中医药大学,福建福州350122 [2]福建中医药大学附属厦门市中医院,福建厦门361015

出　　处：《中医临床研究》2024年第6期135-138,共4页Clinical Journal Of Chinese Medicine

摘　　要：现代医学认为肾性水肿的发病病机繁杂,并且疾病在不同时期的病机可不相同,故肾性水肿的病机不可以用单一的病机来解释,临床上对于肾性水肿的病机存在“充盈不足”和“充盈过度”两种机制,但多数学者认为肾性水肿的主要病机还是与低蛋白血症及肾小球滤过率下降相关。现代医学在治疗肾性水肿方面常以利尿剂为主要的治疗方案,但是利尿剂的使用却很容易产生诸多的并发症,如脂质、尿酸等的代谢异常,电解质的紊乱等。中医在肾性水肿的治疗方面有其独特的优势,虽然中医学中并无肾性水肿之名,但其可归属中医的“水肿”范畴。中医认为肾性水肿的发病涉及五脏六腑,并且其病性常表现为虚实夹杂,故临床治疗上不可以拘泥于一法,常需补虚与泻实同用,并非单纯补虚或泻实。中医治疗肾性水肿的方法众多,多数学者主要从脏腑进行辨证论治。然文章主要从治法方面进行总结论述,目前临床上常用的治法包括宣肺发汗利水、益气利水、健脾温阳利水、益肾温阳利水、滋阴利水、活血利水、疏利三焦等方面。现对以上中医治疗方法进行总述,并且提出在常规辨证治疗基础上运用苓桂剂类方治疗肾性水肿的思路。Modern medicine believes that the pathogenesis of renal edema is complicated,and the pathogenesis of the disease is different in different periods,so the pathogenesis of renal edema can not be explained by a single pathogenesis.There are two clinical mechanisms for the pathogenesis of renal edema:“insufficient filling”and“excessive filling”.However,most scholars believe that the main pathogenesis of renal edema is still related to hypoproteinemia and decreased glomerular filtration rate.Modern medicine often uses diuretics as the main treatment plan for renal edema,but the use of diuretics is easy to produce many complications,such as abnormal metabolism of lipids and uric acid,and electrolyte disorders.It is found that TCM has its unique advantages in the treatment of renal edema.Although there is no name of renal edema in TCM,it can be divided into the category of“edema”in TCM.TCM believes that the incidence of renal edema involves the five viscera and six organs,and its disease is often manifested as a mixture of deficiency and excess,so dinical treatment can not be confined to one method,which often needs to supplement deficiency and purge the excess instead of simply supplementing deficiency or purging the excess.There are many methods to treat renal edema in TCM,and most scholars mainly treat the disease based on Zangfu viscera(脏腑)syndrome differentiation.However,this article mainly summarizes and discusses the treatment methods,the current commonly used clinical treatment methods include releasing lung by sweating and removing water,benefiting Qi(气)and removing water,invigorating spleen and warming Yang(阳)and removing water,invigorating kidney and warming Yang and removing water,nourishing Yin(阴)and removing water,activating blood and removing water,and regulating Sanjiao(三焦).Now the above TCM treatment methods are summarized,and we put forward the idea of using Linggui prescription(苓桂剂)to treat renal edema on the basis of conventional syndrome differentiation.

关 键 词：肾性水肿 中医药 苓桂剂 治疗进展 

分 类 号：R256.5[医药卫生—中医内科学]