从溺窍辨治反复发作性尿路感染  

Differentiation and Treatment of Recurrent Urinary Tract Infection based on the Theory of "Seminal Orifice"

作　　者：胡聿昕 陈晔欣 高子衡 王润泽 王耀献[1] HU Yuxin;CHEN yexin;GAO ziheng;WANG runze;WANG yaoxian(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing,100078;Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学东直门医院,北京东城100700 [2]北京中医药大学

出　　处：《中医杂志》2024年第10期1009-1012,1025,共5页Journal of Traditional Chinese Medicine

基　　金：国家科技重大专项(2017ZX09304019);中医药传承与创新“百千万”人才工程(岐黄工程)岐黄学者(国中医药人教发[2018]12号)。

摘　　要：从溺窍的角度辨治反复发作性尿路感染(rUTI),提出尿路属“溺窍”范畴,认为排尿的生理过程与溺窍的功能密切相关。从窍体、窍枢、窍神三个维度架构了溺窍与五脏功能的生理联系,即肺热阴伤邪侮则窍体失养、心火灼燔神乱则窍神不利、肾虚肝郁脾滞则窍枢不利。rUTI初期以窍枢不利为主,当标本兼治,虚实兼顾,注重伴随症状的治疗,常根据辨证选用滋水清肝饮、肾着汤加减;中期窍体失养与窍神、窍枢不利同时存在,治当利窍通淋,常以清心莲子饮加减;后期以窍体失养为主,需进一步养窍体以防复,常以五子衍宗丸合二仙汤加减。同时针对窍体、窍枢、窍神选用特色药物,以祛外邪、扶正气以养窍体,畅情志、通气机以利窍枢,通心肾、养心神以安窍神。In the differentiation and treatment of recurrent urinary tract infection(rUTI) from the perspective of the seminal orifice,it is proposed that the urinary tract belongs to the category of "seminal orifice",and the physiologi-cal process of urination is closely related to the function of the seminal orifice.From the three dimensions of orifice body,orifice pivot and orifice spirit,the physiological relationship between seminal orifice and the function of five visera is constructed,that is,lung heat,yin damage and pathogen counter-restriction lead to malnutrition of orifice body;burning heart fire and spirit disorder lead to unfavorable orifice spirit,and kidney deficiency,liver constraint and spleen stagnation lead to unfavorable orifice pivot.In the early stage of r UTI,there is usually unfavo-rable orifice pivot,for which the treatment principle should be treating the root and the branch simultaneously,consi-dering both deficiency and excess,and paying attention to the management of accompanied symptoms.Zishui Qinggan Beverage (滋水清肝饮) and modified Shenzhuo Decoction (肾着汤) are often selected based on syndrome differen-tiation.In the mid-dle stage,lack of nourishment of the orifice body and unfavorable orifice spirit and pivot coexist,and the treatment should be draining the orifice and unblocking strangury,commonly withmodified Qingxin Lianzi Beverage (清心莲子饮).In the late stage,loss of nourishment of the orifice body is the main pathogenesis,and it is necessary to further nourish the orifice body to prevent recurrence,and modified Wuzi Yanzong Pills (五子衍宗丸) and Erxian Decoction (二仙汤) is often used.Furthermore,the specific medicinals should be selected targeting at the orifice body,orifice pivot,and orifice spirit,so as to nourish orifice body by dispelling external pathogens and rectify healthy qi,to drain orifice pivot by freeing emotions and minds and unblocking qi movement,and to calm orifice spirit by unblocking heart and kidney and nourishing heart spirit.

关 键 词：尿路感染 淋证 溺窍 窍体 窍神 窍枢 

分 类 号：R277.5[医药卫生—中医学]