叶天士“封固法”治疗肾虚浅析

A Brief Analysis of Ye Tian-shi′s Treatment of Kidney Deficiency by "Sealing and Consolidating Method"

叶天士在治疗肾虚相关病证时,多遵循下焦宜封固的原则,并根据肾虚产生的不同病理状态或兼夹状态,调整"封固法"的具体运用。若单纯元阴、元阳虚损,宜辛润通阳,质厚滋阴;肾虚不摄宜摄肾固真,注重收涩药的运用;阳虚水泛宜温阳泄浊,在治疗时需判断水湿等浊邪与正虚之间的比重,权衡补阴药是否使用及使用剂量;阴虚火旺宜益水制火,佐以清泻相火,然知柏等清相火药的运用需中病即止;肾虚风动宜填收潜固,在封固基础上佐以潜阳,且肾虚风动需与肝阴虚损,肝风内动相区别;奇脉虚损宜温补下元。然"封固法"运用有禁忌,倘若肾虚兼脾胃亏虚,则需平补脾肾;因肾虚而导致阴阳离决不应滋阴,需回阳固脱,二者虽辨证与肾虚证相关,但不可贸用"封固法"。

In the treatment of diseases related to kidney deficiency, Ye Tian-shi followed the principle that lower energizer should be sealed and consolidated, and adjusted the specific application of the method according to the different pathological state or mixed state of kidney deficiency.For original yin insufficiency and original yang insufficiency, the treatment should focus on dredging yang with pungent and moistening properties, nourishing yang with thick essence.For kidney deficiency, the treatment should focus on consolidating kidney essence, paying attention to the use of astringent drugs.For edema due to warming yang and purging turbidity, the treatment should focus on judging the proportion between turbid pathogen such as water dampness and deficient healthy qi,and weighing the use and dosage of yin-tonifying drugs.For excessive fire due to yin deficiency, it is better to use water to restrict fire, and clearing and purging ministerial fire, however, such Chinese medicinals as Zhimu(Rhizoma Anemarrheanae) and Huangbai(Cortex Phellodendri),etc.should be stopped as soon as possible if they are effective.For kidney deficiency disturbing wind, the treatment should focus on supplementing essence, subduing yang on the basis of sealing and consolidating.Besides, it is necessary to know that kidney deficiency disturbing wind is different from that of liver yin deficiency and that of internal stirring liver wind.For damaged extra meridians, the treatment should focus on warming and nourishing lower energizer.However, there are some taboos in the application of "sealing and consolidating method".For example, if kidney deficiency and spleen-stomach deficiency occur together, it is necessary to tonify the spleen and kidney mildly.The separation of yin and yang caused by kidney deficiency should not adopt nourishing yin, but should restore yang and prevent collapse.Although the syndrome differentiation of the two is related to kidney deficiency syndrome, the "sealing and consolidating method" should not be used.