从少阳主枢论治慢性肾脏病腹膜透析后消化不良

On Treatment of Dyspepsia After Peritoneal Dialysis in Chronic Kidney Disease from"Lesser Yang as Main Pivot"

人体内阳气的运动有三种趋势,太阳为阳气外出趋势,阳明为阳气内入趋势,少阳是阳气开阖的枢纽,是人体气机升降开阖之关键。少阳枢机通利依赖于肝胆气机的调达和三焦通利。慢性肾脏病腹膜透析(peritoneal dialysis,PD)后消化不良病机为肝郁气滞,枢机不利;脾虚湿困,气机上逆;脾肾阳虚,水瘀互结。枢机不利是少阳病的基本病机,少阳枢机不利,肝胆不得疏泄,脾胃失于运化,气滞湿阻,痰湿内生,影响血分,产生瘀血。所以治疗慢性肾脏病PD后消化不良,需“调达枢机,和解少阳”。小柴胡汤是少阳证的代表方剂,其功效为和解少阳,调达枢机,使肝胆气机得以疏泄,则胸胁胀满得舒;胆汁循于常道,则口苦喜呕、咽干目眩得愈;气机不致于郁滞,则内热不生,心烦消失,故可用于治疗慢性肾脏病PD后消化不良。

There are three trends in the movement of yang qi in the human body.Greater yang is the trend of yang qi going out,and yang brightness is the trend of yang entering the body.Lesser yang is the intermediary and pivot of the greater yang and yang brightness,and it is the key to the ascending and descending and opening and closing of the human qi movement.Smooth lesser yang pivot depends on the adjustment of liver and gallbladder qi and the proper function of triple energizer.At the same time,it is also an important guarantee for the normal circulation of qi,blood and body fluid.The pathogeneses of dyspepsia after peritoneal dialysis(PD)in chronic kidney disease include liver depression and qi stagnation,and unfavorable pivot;spleen deficiency,dampness stagnation,counter-flow of qi movement;spleen-kidney yang deficiency,and water and blood stasis in complexity.Unfavorable pivot is the basic pathogenesis of lesser yang disease.Unfavorable lesser yang,the liver and gallbladder failing to disperse,the spleen and stomach failing to transport and transform,qi stagnation and dampness blockage,endogenous phlegm and dampness all affect blood aspect and produce blood stasis.Therefore,the treatment of dyspepsia after PD in chronic kidney disease needs to"adjust the pivot and reconcile lesser yang".Minor Bupleurum Decoction is a representative formula of lesser yang syndrome.By adjusting the liver and gallbladder qi movement,the liver and gallbladder qi movement can be dispersed,and the fullness of chest and flanks will be relieved.If bile flows in the normal way,the patient will not have a bitter mouth,vomiting,dry throat and dizziness.If qi movement is not stagnant,internal heat cannot be generated and annoyance disappears,so Minor Bupleurum Decoction can be used to treat dyspepsia after PD.