于作洋从肺论治小儿遗尿症经验

Yu Zuoyang’s experience in the treatment of infantile enuresis from the lung

于作洋教授致力于中医临床和教学30余年,具有丰富的临床经验,其认为疾病的发生离不开气机的紊乱,故在治疗上注重理肺调气。小儿遗尿症是儿童时期常见疾病,中医治疗此疾病优势显著。多数医家将其病因病机归于肾脾肺虚,提及肺于片瓦之地,并多从虚证论治,从实证论者寥寥无几。于教授治疗小儿遗尿症,重视从肺论治,提倡肺肾同治。肺主通调水道,为“水之上源”,且主一身气,调理气的升降出入,在水液代谢中起到枢纽作用;且肺为肾之母,母病及子,故从肺论遗尿不可小觑。根据小儿肺脾肾常不足的生理特点,以及易寒易热、易虚易实的病理特点,小儿遗尿症不能单责虚证,往往虚实夹杂,实证亦不得忽视。在治疗上强调辨证论治,推崇肺肾同治、虚实兼顾,以补肾为本,理气为重。多用缩泉丸、桑螵蛸散等补肾固摄,常选麻黄宣肺利水,柴胡、前胡、杏仁调理气机,兼有肺热者加减麻杏石甘汤、泻白散等清泻肺热,兼有肺虚者配伍补中益气汤等补肺益本,诸药合用,肺气得调,肾气得固,而遗尿自止。

Professor Yu Zuoyang has devoted himself to TCM for more than 30 years and has rich clinical experience in pediatric diseases.He believes that disorder of qi movement is closely related to the development of diseases,therefore,the treatment should be focused on regulating qi movement.Infantile enuresis is a common disease in children,and TCM has a significant advantage in its treatment.Most physicians attribute the etiology and pathogenesis to deficiency of kidney,spleen and lung,and some thinks that the disease is caused by lung deficiency rather than excessive syndrome.Professor Yu believes that infantile enuresis is closely related to the lung,and advocates the treatment of both lung and kidney.On the one hand,lung is considered as"the upper source of water"and governs the regulation of water passage as the hub of waterway,and it also governs the rise and fall,export and import of qi.On the other,lung is the mother organ of the kidney,and disorder of mother-organ may affect child-organ,therefore,it is reasonable to treat enuresis from lung.According to the characteristics of children,infantile diseases is often caused by insufficiency of lung,spleen or kidney,or combined with cold,heat,or excess.In the treatment of infantile enuresis,the syndrome of excess should not be ignored.In terms of treatment,Professor Yu emphasizes syndrome differentiation,simultaneous treatment of lung and kidney(considering deficiency and excess),tonifying kidney as the root,regulating qi as the key.In terms of medicinals and prescriptions,he often uses Suoquan Pills,Sangpiaoxiao Powder to tonify and consolidate kidney,Ma Huang to ventilate lung and excrete water,Chai Hu,Qian Hu and Xing Ren to regulate qi movement.If the patient is combined with lung heat,modified Maxing Shigan Decoction,Xiebai Powder can be applied to clear lung heat;if the patient is combined with lung deficiency,Buzhong Yiqi Decoction can be applied.When necessary medicinals are applied,qi of the lung and the kidney can be regulated and the enuresis can be cured.