基于肝主疏泄从肝论治肾实证理论探析

Treating kidney excess patterns by treating liver based on the theory of liver governing free coursing

自宋代钱乙提出"肾主虚,无实也",学者对于肾实证便很少提及,以致肾实证在临床上未被充分认识,对其病因、病机阐述不明,临床疗效不佳。根据当今时代特点,研究发现肾实证在临床发病率日益增高,笔者通过查阅文献与古籍,基于肝主疏泄理论对肾实证进行探析,认识到肝主疏泄对肾主闭藏及肝失疏泄与肾实证具有紧密的相关性,肝主疏泄调控着肾精藏泄与肾气开阖,肝失疏泄、肝气郁结可引发肾失藏泄、肾水失调及窍道壅闭等证,从而导致肾气机紊乱失常,邪壅肾内。肾实证临床表现主要以满、闷、壅、塞为特点,气机郁滞是其内在本质,因此提出肝失疏泄是导致肾实证的主要病机。治疗以疏肝为主要方法,并综合理气解郁、调心安神、活血祛瘀、温阳散寒等治法以恢复肝主疏泄之能,气机调畅,即可化解肾气壅塞之态,扭转肾实加剧之势。

Since Qian Yi of Song Dynasty stated that "kidney deficiency patterns predominate over excess patterns", kidney excess patterns have been rarely mentioned, thus they are far from fully understood in clinical practice. Their etiology and pathogenesis were unclear, and treatment effects were unsatisfactory. Studies have shown that the prevalence rate of kidney excess patterns is increasing in modern times. Based on research on literature and ancient books, the author analyzed the kidney excess patterns based on the theory of liver governing free coursing, which has a close correlation with kidney’s storing fucntion and kidney excess patterns. Liver governs free coursing, regulating the kidney essence accumulation and the opening and closing of kidney qi. Liver failing to govern free coursing with liver qi stagnation could result in kidney failing to store, kidney water imbalnce and obstruction of orifices and channels. Kidney qi movement is thus disordered, leading to obstruction of pathogenic factors in kidney. Such kidney excess patterns are characterized by fullness, stuffiness, obstruction and blockage. Qi stagnation is the major underlying mechanism. Therefore, it is proposed that liver failing to govern free coursing is the main pathogenesis of kidney excess patterns. Treatment methods are to soothe the liver, regulate qi, relieve depression, regulate heart and calm mind, activate blood circulation and remove blood stasis, warm yang and disperse cold, etc. By restoring the liver’s ability to regulate the qi movement, kindey qi stagnation can be resolved, and kidney excess pattern can be rectified.