沈英森辨治肾炎水肿经验

Shen Ying-sen's Experience of Treating Nephritis Edema Based on Syndrome Differentiation

沈英森强调,岭南之人多湿热体质,湿热壅滞三焦,气化失司,为岭南地区肾炎水肿的重要病机之一。水肿病人常见本虚标实,临床兼症复杂,加之病人病程长短不同,体质壮弱不同,需整体考量。临床常见由于肺卫受邪致肾炎水肿加重,外邪袭人,往往首先犯肺,急慢性肾炎发病常见上呼吸道感染或急性扁桃体炎感染后发病,病因多为风热、湿毒之邪从皮毛内归于肺脾,下伤及肾,从而导致肺热气壅。此类病人常见发热恶风、恶寒,头痛鼻塞,咳嗽咽痛,头面眼睑浮肿,或初起浮肿不显继则面目双下肢肿甚,治疗应及时清热解毒、肃降肺气,在风药基础上加银花藤、连翘、牛蒡子、土牛膝、板蓝根、浙贝母、芦根、大黄等。临床中常见病人虚实错杂,上热下寒之证,例如既可见四肢浮肿、腰膝酸软、疲倦乏力的脾肾阳虚寒之证,又见口干鼻燥、咽喉疼痛、甚至鼻涕中带有血丝的肺气壅热之证,如何使药物具有补而不滞、利而不伐的作用,治疗中既可扶正以温补脾肾,又可祛邪以宣达肺气,是临床上经常考虑的问题。遇此类错杂情形,沈老经验为在温阳补益药物中加入银花藤30 g,同时给予银翘解毒丸,嘱早晚各服一丸,可使上述症状消失。沈老在治疗上注重辨病与辨证相结合的原则,医理与实践相结合,辨证准确对症下药,强调"标本结合,以本为主"的基本原则;同时突出"本虚标实、攻补兼施"的治疗方针;灵活运用"标本兼治、分清主次"的个体方案。在对肾炎水肿的治疗中着眼于变化无穷之证,三因制宜巧设处方,值得后学之人认真参酌体会。

Professor Shen Ying-sen stresses that in terms of treating nephritis edema, besides pathogenesis, we should pay atten- tion to combining natural climate, geographical environment, population characteristics of South of the Five Ridges to select drugs. The people there usually have damp heat constitutions with damp heat stagnation of the triple energizer, dysfunction of qi, which is one of the important pathogenesis of nephritis edema in south of the Five Ridges area. The patients with edema usually have deficient root and excessive tip, and complex clinical accompanied symptoms. What＇s more, different lengthes of the course, weak or strong physique should also be considered. In clinical practice, it is common that nephritis edema is worsened due to weiqi of the lung is attacked by pathogens. The exo-pathogens first invade the lung. Acute and chronic nephritis commonly have upper respiratory, tract infection or infection after the onset of acute tonsillitis, the cause is often due to wind heat, and dampness attacking the lung and spleen, hurting the kidney, and then leading to accumulated heat and qi in the lung. Such patients often have fever, aversion to cold, headache, nasal congestion, cough, sore throat, facial and eyelid edema, or swelling was not significant at first, but then face, eyes, and lower limbs begin to become seriously swollen, so the treatment should focus on clearing away head and toxicity and descending pulmonary qi timely. Based on this, Yinhuateng （ Caulis Lonicerae）, Lianqiao （Frtwtus Forsythiae ） , N iubangzi （Fructuz Arctii ） , Tuniuxi （Radis et Rhizome Achyranthes ） , Banlangen （Radix lsatidis ） , Zhe- bei （Bulbzas Fritillariae Thunbergii）, Lugen （Rhizoma Phragmitis）, Dahuang （Radix et Rhizoma Rhei） can be added. In clini- cal practice, the patients with intermingled deficiency and excess syndromes, upper heat and lower cold, are common. For exam- pie, they not only have spleen-kidney yang deficiency syndrome marked by swollen limbs, waist soreness, fatigue, but also syn- drome accunarlated puhnonary qi and heat in the lung marked by dry mouth and dry nose, sore throat, even blood in the nasal discharge. How to make the drugs have nourishing functions without delay, smoothing without attacking; How to strengthen healthy qi to warm and nourish the spleen and kidney, and remove pathogens to disperse pulmonary qi at the same time. These questions are often clinically considered. When facing the above similar situations, Professor Shen adds 30g of Yinhuateng （Caulis Lonicerae） into drugs for warming yang and nourishing, gives the patient Yinqiao Jiedu Pills for oral administration, twice daily, in the morning and evening respectively to remove the above symptoms. In short, Professor Shen stresses the princi- ple of combination of disease and syndrome differentiation, combination of medical knowledge and practice, using drugs based on accurate differeutiation. He emphasizes the basic principles of combination of root and tip with root as priority, regards using at- tacking and nourishing to treat deficient root and excessive tip as the treatment guideline. He flexibly uses individual project ac- cording to treating both root and tip and distinguishing between primary and secondary. In terms of nephritis edema, he pays at- tention to changes of syndromes and flexibly deals with them according to many factors, which is worth learning.