基于《金匮要略》理论分期辨治肾病综合征  

Staged Differentiation and Treatment of Nephrotic Syndrome Based on Theory Proposed in Jin Gui Yao Lue

作　　者：张宁[1] 闫璞 ZHANG Ning;YAN Pu(Department of Nephrology and Endocrinology,Wangjing Hospital Affiliated to Chinese Academy of Chinese Medical Sciences,Beijing China 100102)

机构地区：[1]中国中医科学院望京医院肾病内分泌科,北京100102

出　　处：《中医学报》2024年第10期2089-2093,共5页Acta Chinese Medicine

基　　金：中国中医科学院望京医院基础研究苗圃培育计划项目(WJYY-YJKT-2022-09);中国中医科学院科技创新工程项目(CI2021A01609);中国中医科学院望京医院高水平中医医院建设项目中医药临床循证研究专项项目(WJYY-XZKT-2023-04);北京中医药薪火传承“新3+3”工程室站建设项目(2023-SZ-G-19)。

摘　　要：肾病综合征是临床常见病、难治病,在临床诊治中,遵仲景之法,循《金匮要略·水气病脉证并治》的水肿证治之理,将整个病程分为风水、皮水、正水。初期有外感表证病史,或者有皮肤病病史,随后出现眼睑或下肢浮肿者,当循“风水”治疗之旨,重视从肺论治,解表散邪,宣肺利水。中期表证已解,病变在里,以水肿、尿蛋白为主要表现,此期多归属于“皮水”阶段,为内风与水湿相合而为病,应从肝脾论治,一方面祛风柔肝,清热利湿,使肝气疏且内风止,水肿消且蛋白减;另一方面健脾助运,利水消肿。后期病久及肾,气虚及阳,清热伤阳之药的应用使患者常出现怕冷、便溏、小便清长等脾肾阳虚之象,此时归属于“正水”之列,应重视脾肾同治,化气行水。Nephrotic syndrome is a kind of disease which is commonly seen yet difficult to cure in clinical practice.In clinical diagnosis and treatment,by following the method of Zhang Zhongjing medical idea and the principle of edema syndrome treatment proposed in Jin Gui Yao Lue·Shui Qi Bing Mai Zheng Bing Zhi,the entire course of the disease is divided into three stages,namely,Feng Shui,Pi Shui and Zheng Shui.In the early stage,patients suffer from external symptoms or skin diseases,and subsequently experience swelling of the eyelids or lower limbs.In treatment,the treatment principle on"Feng Shui"should be followed,and treating from the Lung should be paid attention to,to relieve exterior syndrome and dispel external evil factors and disperse Lung Qi to dredge Water.In the mid-term stage,the exterior syndrome has been resolved,and the lesion is located inside,with edema and urinary protein as the main manifestations.This period is mostly attributed to the"Pi Shui"stage,which is a disease caused by the combination of internal Wind and Dampness.Treatment should be carried out from perspective of the Liver and Spleen.On the one hand,by dispelling Wind and softening the Liver as well as clearing Heat and relieving Dampness,the Liver Qi can be dispersed and the internal Wind can be stopped,the edema can be reduced and the urinary protein can be decreased;On the other hand,by strengthening the Spleen the Water stagnated can be eliminated and the edema can be relieved.In the later stage of the disease,if the Kidney is affected for a long time,Qi deficiency and Yang deficiency would occur.In addition,the use of Heat clearing and Yang injuring drugs often leads to symptoms of Spleen and Kidney Yang deficiency,with the symptoms such as fear of cold,loose stools as well as clear and long urine.At this time,it belongs to the category of"Zheng Shui",and attention should be paid to the simultaneous treatment of Spleen and Kidney,to transform Qi and promote Water circulation to achieve satisfactory therapeutic effects.

关 键 词：肾病综合征 水肿 分期辨治 《金匮要略》 

分 类 号：R256.5[医药卫生—中医内科学]