孔薇辨治肾性水肿经验

Professor Kong Wei′s Experience in Differentiation and Treatment of Renal Edema

肾性水肿总以脾虚失制,肾不摄水为发病之本。肾性水肿多因表里俱虚,以脾肾气虚为本,加之肺虚卫表不固,易于受风而致水肿。慢性肾脏病所致水肿则多以脾肾亏虚为本,一方面脾虚土难制水,肾虚失于开阖,久则气机不畅,津液不布,湿盛水闭,甚则湿浊蕴热,瘀血不去而致水肿反复;另一方面,病情迁延或可伤及脾肾之阳,真阳怯少,水寒不化而致水肿难消。临证需仔细评估病程,分清主次,表里兼顾,把握治疗重点,于内以清补脾肾,固护正气为根本;于外重视固表祛邪,淡渗利水,兼以气血同治,从而达到缓解水肿,减毒增效的目标。

Renal edema is always caused by Spleen deficiency and Kidneys failing to intake water.Renal edema is mostly due to deficiency of both exterior and interior,with Spleen and Kidney Qi deficiency as the root,coupled with deficiency of Lung and unconsolidation of the defensive exterior,it is easy to be affected by Wind and cause edema.Edema caused by chronic kidney disease is mostly based on Spleen and Kidney deficiency.On the one hand,Spleen deficiency causes soil difficult to make water,and Kidney deficiency fails to keep hole opened and closed.For a long time,the Qi movement would not be smooth,the body fluid will not be distributed,the dampness predominant and water would be closed,the dampness-turbid will accumulate heat,and the blood stasis will not go away,resulting in repeated edema.On the other hand,the prolonged course of the disease may damage the Yang of the Spleen and Kidney,the Kidney Yang is less and timid,and the Water-cold does not melt,resulting in edema that is difficult to disappear.In clinical diagnosis,it is necessary to carefully evaluate the course of the disease,distinguish the primary and secondary,take into account the external and internal factors,and grasp the focus of treatment.Internally,it is fundamental to clear and supplement the Spleen and Kidney,thus protecting the vital Qi.Externally,it focuses on solidifying the symptoms and eliminating pathogens,promoting diuresis,and simultaneously treating Qi and Blood,so as to achieve the goal of relieving edema,reducing toxicity,and increasing efficiency.