基于“肾之积”理论探讨温肾化瘀消积法治疗原发性醛固酮增多症

Discussion on the treatment of primary aldosteronism by warming the kidneys,removing blood stasis,and eliminating accumulation based on the TCM theory of “kidney accumulation”

“肾之积”主要指“肾”中存在局限性有形积块,且发作后其积块仍不消散的疾病。中医“肾藏精”功能包含肾上腺的内分泌功能,原发性醛固酮增多症(PA)是因肾上腺腺瘤、结节、增生等导致皮质球状带过度分泌醛固酮而引起的血压升高、血钾降低,故PA属于中医“肾之积”的范畴。“肾之积”(PA)病机为本虚标实:虚为肾虚,以肾阳虚为主;实为痰瘀互结,以瘀血为主。在治疗过程中,要根据初、中、末病期的不同把握补虚和祛实的力量,治疗以温肾助阳、化瘀消积为基本大法,佐以滋阴益肾、祛痰利湿,以桂枝茯苓丸合济生肾气丸为基础方,临证过程中灵活加减。

In traditional Chinese medicine(TCM) terminology,“kidney accumulation” mainly refers to a visible,localized mass of the kidney that does not disappear after onset.The “kidney storing essence” function described in TCM includes the endocrine function of the adrenal gland.Primary aldosteronism is caused by adrenal adenoma,nodules,or hyperplasia leading to the excessive secretion of aldosterone in the cortical glomerular zone,which results in heightened blood pressure and decreased blood potassium levels.Therefore,primary aldosteronism belongs to the disease category of “kidney accumulation” in TCM.The pathogenesis of “kidney accumulation” is based on primary deficiency and superficial excess:deficiency refers to kidney deficiency,mainly kidney yang deficiency;excess refers to phlegm and blood stasis,mainly blood stasis.In the course of treatment,the key treatment principles lie in tonifying deficiency and eliminating excess according to the different stages of disease.Basic treatment involves warming the kidneys and tonifying yang,removing blood stasis,and eliminating accumulation;it should be further supplemented by nourishing kidney yin and eliminating phlegm and dampness.The Guizhi Fuling pill and the Jisheng Shenqi pill were used as the base formulas for treatment in this study,and dosages were adjusted in accordance with individual clinical manifestations of symptoms.