黄春林精准辨证慢性肾心综合征

Accurate Syndrome Differentiation of Chronic Reno-cardiac Syndrome by Huang Chunlin

肾心综合征的主要病机为脾肾两虚,心肾不交,水湿、浊毒、瘀血内蕴,治疗应病证结合,分期论治。肾衰竭期,主要表现为心脾两虚或心肾阴虚,无明显水湿浊毒表现者,主张健脾养心或滋肾宁心为主;尿毒症期,主要表现为心肾阳虚、脾肾气(阳)虚,水湿浊毒瘀血明显者,当以健脾温肾强心、利湿化浊活血为法;而对于已行肾脏替代疗法的患者,水湿浊毒已经被透析清除,早期表现为气阴两伤,瘀血内留,则可应用益气养阴活血大法;晚期表现为阴阳两虚,血瘀内阻,应以阴阳并补为大法。

The main pathogenesis of reno-cardiac syndrome is both spleen and kidney deficiency,disharmony between heart and kidney,water dampness,turbid toxin and blood stasis.The treatment should be combined with disease and syndrome and treated by stages.In the stage of renal failure,it is mainly manifested as deficiency of both heart and spleen or deficiency of heart and kidney yin,and there is no obvious manifestation of water dampness and turbid toxin,so it is suggested that spleen should be invigorated and heart should be nourishing or kidney should be nourishing;in uremic stage,for the patients with deficiency of heart and kidney yang,deficiency of spleen and kidney qi(yang),and obvious water dampness,turbid toxin and blood stasis,we should treat them by strengthening spleen,warming kidney,strengthening heart,and promoting the circulation of blood;for the patients who have been treated with renal replacement therapy,the water dampness and turbid toxin has been removed by dialysis.In the early stage,there are two injuries of qi and yin,and the blood stasis is left inside,so the method of benefiting qi,nourishing yin and activating blood circulation can be used;in the late stage,the deficiency of both yin and yang and the internal obstruction of blood stasis should be treated by the combination of tonifying yin and yang.