许筠泄浊祛瘀法治疗产褥期蛋白尿经验

Xu Yun′s Experience of Treating Puerperal Proteinuria with the Method of Purging Turbidity and Removing Blood Stasis

许筠老师认为,产褥期蛋白尿为本虚标实之证,本虚为脾肾两脏功能虚损,标实为湿浊内蕴和瘀血阻滞。产后湿浊和瘀血之邪的盛衰程度与蛋白尿病情轻重相关,邪实越重则病情越重,常采用通阳化气,利湿化浊之法,不同时期均需加入活血化瘀类药物。许老师强调,祛邪务尽,扶正从缓,邪祛则元气自复,邪祛正孤之时再行扶正,补脾固肾,补养气血。常用药对有黄芪与淫羊藿、白术与附子、白术与山药等;常用的药组有黄芪、当归、益母草;地肤子、益母草、蝉蜕;白茅根、芡实、天花粉等;常用的合方有五苓散合六味地黄丸、实脾饮合四逆汤、四君子汤合真武汤等。“病痰饮者,当以温药和之”,但切忌温热太过,在温补同时兼顾行、消、开、导等法,桂枝、附子温燥伤阴,故许老师常用淫羊藿、巴戟天等温润之品取而代之。

Professor Xu Yun believes that puerperal proteinuria belongs to a syndrome of deficient root cause and excessive manifestation.The former refers to deficient function in the spleen and kidney,while the latter refers to internal accumulation of dampness and turbidity and obstruction of blood stasis.The degree of excess and deficiency of postpartum dampness and blood stasis is related to the severity of proteinuria.The more severe the pathogenic excess is,the more severe the disease is.The methods of dredging yang and transforming qi,draining dampness and resolving turbidity are often used,and drugs for promoting blood circulation and resolving stasis need to be added at different stages.Professor Xu emphasizes that pathogens should be dispelled thoroughly,and the body′s healthy qi should be strengthened slowly.After pathogens have been removed and heathy qi is deficient,it is time to strengthen heathy qi,tonify the spleen and consolidate the kidney,and nourish qi and blood.Commonly used drug pairs include Huangqi(Radix Scutellariae)and Yinyanghuo(Herba Epimedii),Baizhu(Rhizoma Atractylodis Macrocephalae)and Fuzi(Radix Aconiti Lateralis Preparata),Baizhu(Rhizoma Atractylodis Macrocephalae)and Shanyao(Rhizoma Dioscoreae),etc.The commonly used drug groups include Huangqi(Radix Scutellariae)-Danggui(Radix Angelicae Sinensis)-Yimucao(Herba Leonuri);Difuzi(Fructus Kochiae)-Yimucao(Herba Leonuri)-Chantui(Periostracum Cicadae);Baimaogen(Rhizoma Imperatae)-Qianshi(Semen Euryales)-Tianhuafen(Radix Trichosanthis),etc.;The commonly used combined formulas include Five Substances Powder with Poria combined with Six-Ingredient Rehmannia Pill,Decoction for Reinforcing the Spleen combined with Frigid Extremities Decoction,Four Gentlemen Decoction combined with True Warrior Decoction,etc."For those who suffer from phlegm retention,warm medicine should be used to resolve it".However,it is important to avoid excessive warming and tonifying.At the same time,besides warming and tonifying,methods such as moving,dispelling,opening,and guiding should be taken into account.Guizhi(Ramulus Cinnamomi)and Fuzi(Radix Aconiti Lateralis Preparata)may harm yin due to warm and dry properies,so Professor Xu often replaces them with warm and moistening products such as Yinyanghuo(Herba Epimedii)and Bajitian(Radix Morindae Officinalis),etc.