中医治疗肾性水肿的临床思路  

Study on Clinical Thinking of Treating Renal Edema

作　　者：江理芳 张春戬 JIANG Lifang;ZHANG Chunjian(Heilongjiang Academy of Traditional Chinese Medicine,Harbin,Heilongjiang,China,150036)

机构地区：[1]黑龙江省中医药科学院,黑龙江哈尔滨150036

出　　处：《河南中医》2024年第11期1665-1669,共5页Henan Traditional Chinese Medicine

基　　金：黑龙江省第二批省级中医临床优秀人才研修项目{【2022】28号}。

摘　　要：肾性水肿的发病主要与脏腑功能失司密切相关,尤以肺、脾、肾三脏为主,究其根本,主要病机为本虚标实。肺主宣发肃降,脾主运化水液,肾主温煦化饮,三脏功能相互为用,是维持机体内水液正常运行的重要条件。《素问·汤液醪醴论》中记载了治疗水肿的基本治法——“开鬼门”“洁净府”“去宛陈莝”,即宣通肺气、通腑泄浊、活血化瘀以利水消肿。三法之中“洁净府”最为关键,贯穿疾病始终,发挥好其在“开鬼门”与“去宛陈莝”之间的枢纽作用,在辨证论治的基础上通过温阳化气、益气养阴、利水消肿等“洁净府”的治疗方法达到“祛邪而不伤正,扶正而不助邪”的目的。然三法各有所宜,当抓住主要病机,调养受损脏腑,清除邪气,以维持气血津液正常运行和脏腑功能的正常运转。The onset of renal edema is closely related to dysfunction of the zang and fu organs,particularly the lung,spleen,and kidney.Fundamentally,the primary pathogenesis is deficient root cause and excessive manifestation.The lung governs diffusion and dissemination,purification and descending.The spleen governs transportation and transformation of fluid,and the kidney regulate fluid by warming and resolving.The harmonious function of these three organs is essential for maintaining the normal flow of body fluid.According to Plain Questions,the fundamental treatment methods for edema are"opening the ghost gate""cleaning the mansion"and"eliminating stagnant and obstructive substances."These methods include ventilating lung qi,draining the bowels to eliminate turbid substances,and activating blood circulation to resolve stasis,thus inducing diuresis and relieving edema.Among these methods,"cleaning the mansion"is the most critical,serving as a pivot between"opening the ghost gate"and"eliminating stagnant and obstructive substances."Based on syndrome differentiation and treatment principles,the"cleaning the mansion"method aims to achieve the goal of"expelling pathogenic factors without harming the healthy qi,and supporting the healthy qi without assisting pathogens."Each method has its specific indications,so it is essential to identify the primary pathogenesis,nourish the affected organs,and eliminate pathogenic factors to maintain the normal function of qi,blood,and body fluid.

关 键 词：“开鬼门” “洁净府” “去宛陈莝” 肾性水肿 《黄帝内经》 

分 类 号：R277.592.2[医药卫生—中医学]