基于“中气不足,溲便为之变”探讨再发性尿路感染辨治思路

Discussion on the differentiation treatment of recurrent urinary tract infections based on“Zhongqi Deficiency Leading to Urine and Defecation Change”

再发性尿路感染(RUTI)是临床常见的感染性疾病,多见于老年、绝经后妇女及免疫缺陷人群,以反复发作、缠绵难愈为特点,是临床治疗难题。本文基于《黄帝内经》“中气不足,溲便为之变”理论,结合西医学病理机制,探讨RUTI的核心病机与辨治思路。中气不足、湿浊伏邪、流连阴窍是RUTI的核心病机;中气不足,脾失谏议为发病基础;脾虚水湿不运,湿浊客于阴窍为发病诱因;中气不足,无力祛邪,湿浊伏于下焦,流连不去,成为伏邪,伺机而发,是RUTI反复发作之根源。治疗方面,重视患病人群特点,以中气为重,调平扶正贯穿始终。发作期攻补兼施,以调平为贵;缓解期调养中气,以扶正为要。以期充实RUTI从中气论治的理论依据,为其临床研究和治疗提供新的思路。

Recurrent urinary tract infection(RUTI)is a common clinical condition mostly seen in the elderly,post-menopausal women,and people with immunodeficiency.It is characterized by its intractable nature and a high recurrence rate,making it a clinical treatment challenge.We discuss the core pathogenesis and treatment of RUTI based on the theory of“Zhongqi Deficiency Leading to Urine and Defecation Change”in the Yellow Emperor’s Classic of Internal Medicine and the pathological mechanism of modern medicine.On this basis,it is proposed that Zhongqi deficiency,dampness and turbidity,and lingering in the yin orifice are the core pathogenic mechanisms of RUTI.Zhongqi deficiency and loss of activity of the spleen are the basis of the disease.Spleen deficiency,water dampness,and dampness and turbidity in the yin orifice induce RUTI.Zhongqi deficiency impedes the dispelling of evil,so the dampness lies in the lower jiao and lingers on,becoming a vague evil,waiting for an opportunity to flare up,which is the root cause of recurrent RUTI.In terms of treatment,we attach importance to the characteristics of the patient and focus on the Zhongqi,and harmonize the middle qi throughout.During the attacking period,both attack and tonification are applied,and during the remission period,the middle energy is nourished and righteousness is supported.The aim is to enrich the theoretical basis of the treatment of RUTI from the Zhongqi and to provide new ideas for clinical research and treatment.