汤水福采用益气升提法治疗肾性蛋白尿经验

TANG Shui-Fu’s Experience in Treating Renal Proteinuria by the Method of Replenishing and Elevating Qi

汤水福教授认为,慢性肾脏病肾性蛋白尿的出现乃因脾肾亏虚而致机体升清降浊功能失常,浊毒内蕴。早期以脾肾气虚为主,中后期因脾肾亏虚日久,浊毒蕴结,正虚与邪实互为因果。基于肾性蛋白尿的气机升降失调的关键病机,汤水福教授以健脾补肾法为基础,结合湿浊瘀毒弥漫三焦的邪实特点,针对性地使用祛湿、泻浊、化瘀之法,同时重视采用益气升提法以调节脾肾气机。早期在健脾益肾基础上加用升麻、柴胡等助清阳之气上升的药物,使精微得固,蛋白尿得解;中后期,病程日久,诸邪内扰,清浊逆乱,则以降浊为基础,佐以益气升提药如黄芪、白术、茯苓、山药、升麻、柴胡等,使气机升降协调,清升浊降,保护肾功能,延缓慢性肾脏病进展。

Professor TANG Shui-Fu believes that the development of renal proteinuria in chronic kidney disease is due to the deficiency of spleen and kidney,which leads to the malfunction in lifting lucid yang and lowering turbid yin of the body and the internal retention of turbid-toxin.The early stage of renal proteinuria is mainly induced by qi deficiency of spleen and kidney,and the middle and late stage of renal proteinuria results from the long-lasting spleen and kidney deficiency together with damp-toxin accumulation and is characterized by the mixture of healthyqi deficiency and pathogenic-qi excess.Aimed at the key pathogenesis of the dysfunction of ascending and descending of qi movement,Professor TANG Shui-Fu treated the renal proteinuria with the principal method of strengthening the spleen and tonifying the kidney,combined with method of eliminating dampness,draining turbidity and dissolving stasis targeted at the pathogenic-qi excess of damp-turbidity and stasis-toxin diffusing in the triple energizer.Meanwhile,the use of the method of replenishing and elevating Qi for regulating the qi movement of the spleen and kidney was stressed.In the early stage of renal proteinuria,the Chinese medicines with the actions of promoting the lifting of lucid yang such as Cimicifugae Rhizoma and Bupleuri Radix were added on the basis of herbs for strengthening the spleen and benefiting the kidney,so that the essence can be consolidated and proteinuria can be eliminated.In the middle and late stage of renal proteinuria,the course of the disease lasted a long time,and the internal attack of the pathogens caused the reversal and chaos of the lucid yang and turbid yin.In this case,treatment should follow the principal method of lowering turbid yin and by the assistance of the herbs for replenishing and elevating qi such as Astragali Radix,Atractylodis Macrocephalae Rhizoma,Poria,Dioscoreae Rhizoma,Cimicifugae Rhizoma,and Bupleuri Radix,so that the ascending and descending of qi movement can be coordinated,the lucid yang is raised and turbid yin is directed downward,the renal function is protected and the progression of chronic kidney disease is slowed down.