阮诗玮从三焦论治肾病综合征经验  

Ruan Shiwei′s Experience in Treating Nephrotic Syndrome from the Perspective of Triple Energizer

作　　者：翁晓娟 黄定 郑焯文 蔡晓津 王建挺[1] WENG Xiaojuan;HUANG Ding;ZHENG Zhuowen;CAI Xiaojin;WANG Jianting(Fujian Provincial People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian,China,350004)

机构地区：[1]福建中医药大学附属人民医院,福建福州350004

出　　处：《河南中医》2024年第9期1349-1354,共6页Henan Traditional Chinese Medicine

基　　金：阮诗玮全国名老中医药专家传承工作室建设项目{国中医药人教函[2022]75号}。

摘　　要：阮诗玮教授基于“因人、因病、因证”结合三焦脏腑之气血阴阳变化,认为肾病综合征的发病与三焦脏腑的气血阴阳变化密切相关,三焦水道不畅,升降不通为其根本病因病机,治疗原则以祛邪、扶正为主,辅以宣发、利水攻逐,健脾、温肾、益气养阴之法。阮教授认为,上焦为主病者辨证为风水相搏证,治疗上强调宣肺通调水道,清其上而固其下矣,多选用麻黄连翘赤小豆汤加减;风寒偏盛者,可去连翘,加紫苏叶、桂枝解表散寒;咳喘较甚者,加前胡降气平喘;见汗出恶风者,加汉防己、生黄芪益气固表、利水消肿。中焦为主病者辨证为外感湿邪证、脾虚湿盛证,分别给予六合汤加减、参苓白术散加减或升阳益胃汤加减治之。下焦为主病者辨证为肾阴亏虚证、肾阳衰微证,分别给予知柏地黄汤加减、济生肾气汤治之。临床小溲数多者,可去泽泻、车前子,加菟丝子、补骨脂固精缩尿;若见喘促、汗出者,加五味子收敛固涩;若兼有头晕头痛,心悸失眠者,可加生龙骨、生牡蛎镇静安神;若见神倦欲睡、泛恶者,可加用茯苓、六月雪等健脾利湿。三焦俱病者辨证为脾肾亏虚证、气阴两虚夹湿证、湿滞瘀血证,分别给予益肾降浊汤加减、《太平惠民和剂局方》清心莲子饮加减、当归芍药散加减等治疗。Professor Ruan Shiwei bases his approach on the principles of "individualized treatment according to person,disease,and syndrome," combining the changes in qi,blood,yin,and yang of the zang-fu organs within the triple energizer.He believes that the onset of nephrotic syndrome is closely related to these changes.The fundamental pathogenesis lies in the obstruction of water pathways in the triple energizer and the dysfunction of ascending and descending processes.The primary treatment principles are to dispel pathogens and strengthen healthy qi,supplemented with methods of dispersing,promoting diuresis,attacking and removing,invigorating the spleen,warming the kidney,replenishing qi,and nourishing yin.Professor Ruan believes that for upper energizer syndromes,diagnosed as wind-water mutual fighting syndrome,the treatment emphasizes ventilating the lung and regulating water pathways,clearing the upper and solidifying the lower,so Modified Ephedra and Fructus Forsythiae and Semen Phaseoli Decoction is often used.For wind-cold predominance,Lianqiao(Fructus Forsythiae) can be removed,and Suye(Folium Perillae) and Guizhi(Ramulus Cinnamomi) added to relieve the exterior and disperse cold.For severe coughing and asthma,Qianhu(Radix Peucedani) can be added to direct qi downward and relieve asthma.For sweating with aversion to wind,Hanfangji(Radix Stephaniae Tetrandrae) and Shenghuangqi(Radix Scutellariae) can be added to tonify qi and strengthen the exterior and promote diuresis and remove edema.For middle energizer syndromes,diagnosed as external dampness pathogen syndrome or spleen deficiency with dampness predominance,Modified Six Harmony Decoction,Modified Ginseng and Poria and White Atractylodes Powder,pr Modified Yang-Raising and Stomach-Boosting Decoction can be used accordingly.For lower energizer syndromes,diagnosed as kidney yin deficiency syndrome or kidney yang deficiency syndrome,Modified Anemarrhena and Phellodendron and Rehmannia Pill,Life-Saving Kidney Qi Decoction can be used respectively.For frequent urin

关 键 词：肾病综合征 从三焦论治 三焦 阮诗玮 

分 类 号：R256.59[医药卫生—中医内科学]