肾络癥瘕辨证方法及其临床应用  

Pattern differentiation methods and its clinical application of tangible or intangible abdominal masses of kidney collaterals

作　　者：李雪[1] 高菁[1] 郑时静 彭博 王世长 赵鑫雨 周妍 李靖[1] LI Xue;GAO Jing;ZHENG Shijing;PENG Bo;WANG Shichang;ZHAO Xinyu;ZHOU Yan;LI Jing(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Yanqing Hospital of Beijing Chinese Medicine Hospital,Beijing 102110,China;University of Macao,Macao 999078,China;Beijing Changping District Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 102200,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医医院延庆医院 [3]澳门大学,中国澳门 [4]北京市昌平区中西医结合医院

出　　处：《北京中医药大学学报》2024年第8期1049-1054,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：首都卫生发展科研专项项目(No.首发2018-1-4192);北京中医药大学东直门医院科技创新专项(No.DZMKJCX-2023-016)。

摘　　要：中医治疗慢性肾脏病具有明显优势,但不同中医流派的临床辨证方法存在较大差异。其中,在对肾脏疾病的长期诊疗过程中,吕仁和教授提出并发展了癥瘕学说,并结合临床经验形成了肾络癥瘕辨证方法。辨证方法,是名老中医经验传承中最能体现其临床思辨特点的部分。慢性肾脏病在肾元亏虚的基础上,外感或内生邪气稽留不去,久病入络,造成气滞、血瘀、痰湿、热毒、浊毒等病理产物瘀滞于肾络,造成肾体受损、肾用失司,出现肾络癥瘕。慢性肾脏病基本病机为肾本虚、肾气不足,肾络癥瘕形成。辨证时重视虚损劳衰本虚证和八郁证标实证的变化及组合应用,在此基础上分别用主证候和兼证候辨本虚与标实,主证候固定不变,兼证候随病情不断变化可合并出现。总结患者饮食原则为多精少粗、多奶少肉、分期施膳和对症选膳。本文从定义、理论渊源、病因病机、辨证分治及调护方面,对独特的肾络癥瘕辨证方法进行了梳理和总结,为形成可供临床推广的适宜诊疗方法提供依据。The pattern differentiation method is the most representative part of the inheritance of the experience of renowned practitioners of traditional Chinese medicine,reflecting their clinical thinking characteristics.Among them,Professor LYU Renhe proposed and developed the theory of abdominal masses in the long-term diagnosis and treatment of kidney diseases.Based on his clinical experience,he formed the method of differentiation of Shenluozhengjia(tangible or intangible abdominal masses of kidney collaterals).This differentiation method is characterized by its simple and easy clinical application.Tangible or intangible abdominal masses of kidney collaterals refer to chronic kidney disease,which is based on the basic cause of kidney deficiency.External or internal pathogenic factors cannot be eliminated,and prolonged illness invades the kidney collaterals,causing pathological products,such as qi stagnation,blood stasis,phlegm dampness,heat toxin,and turbid toxin to stagnate in the kidney collaterals,resulting in damage to the kidney body and loss of kidney function.The basic pathogenesis is a deficiency of kidney qi and the formation of tangible or intangible abdominal masses of the kidney collaterals.During pattern differentiation,the type is determined by the deficiency,which is fixed,and the pattern is determined by the excess,which is constantly changing with the condition and can be combined.Furthermore,he summarized the dietary principles as having more essence and less coarseness,more milk and less meat,a phased diet,and the selection of the symptomatic diet.To inherit and improve the theory and clinical practice of the pattern differentiation theory of tangible or intangible abdominal masses of kidney collaterals,this article reviews and summarizes the unique pattern differentiation method of the kidney collateral pattern from the aspects of definition,theoretical origin,etiology and pathogenesis,differentiation and treatment,and regulation,providing a basis for forming suitable diagnosis and treatment metho

关 键 词：肾络癥瘕 辨证方法 慢性肾脏病 虚损劳衰 三型四候 八郁证 

分 类 号：R277.5[医药卫生—中医学]