迟继铭教授从舌辨治肾性蛋白尿经验分享

Professor CHI Jiming’s experience in treating renal proteinuria from tongue differentiation

舌象与脾胃的关系联系紧密,舌为胃之镜,舌中候脾胃,查看舌苔、舌质的变化能客观反映病情,体现脾胃功能、寒热湿气、血液运行状态。舌诊及脉诊是中医学独有的诊疗技术。因脉诊主观性强,不同医生对同一患者诊脉时,不能达到统一意见,而且因其可意会不可言传,因此在临床教学中,难以表达也难以领会,脉诊能力的提高更多依赖于学生长时间跟随教师抄方,以师带徒形式,大量进行脉诊锻炼,提高脉诊技能。相较于脉诊,临床教学中,舌诊因描述比较直观、客观,更容易学习,故舌诊较脉诊相比更易掌握且简便。黑龙江省中医药科学院迟继铭教授主要从事中医药治疗慢性肾脏疾病的临床、科研及教学工作。迟教授主张以舌探讨“病-症(舌)-方”辨证方法,四诊合参。从舌辨治蛋白尿主要有三种证型,各有其特征:脾胃气虚常见舌淡或淡红,舌边有齿痕,苔薄,以升阳益胃汤加减为主;气阴两虚常见舌质红,少苔或苔薄白,以清心莲子饮加减为主;湿热内蕴常见舌质淡红或红,苔黄腻,以当归拈痛汤加减为主。本文主要介绍了迟继铭教授从舌辨治蛋白尿的经验,肾性蛋白尿因其病机主要是本虚标实、脾肾亏虚,从脾胃论治蛋白尿,以后天之本补先天之本,效果显著。

The relationship between the tongue and the spleen and stomach is closely related,the tongue is the mirror of the stomach,and the spleen and stomach are waiting in the middle of the tongue,and the changes in the tongue coating and tongue texture can objectively reflect the condition,reflecting the function of the spleen and stomach,cold,heat and humidity,andT blood operation status.Tongue diagnosis and pulse diagnosis are unique diagnosis and treatment techniques in TCM.Due to the strong subjectivity of pulse diagnosis,different doctors cannot reach a unified opinion when diagnosing the pulse of the same patient,and because it can be understood and cannot be spoken,it is difficult to express and comprehend in clinical teaching,and the improvement of pulse diagnosis ability depends more on students to follow the teacher for a long time to copy prescriptions,and in the form of teachers and apprentices,a large number of pulse diagnosis exercises are carried out to improve pulse diagnosis skills.Compared with pulse diagnosis,tongue diagnosis is easier to grasp and simple than pulse diagnosis because the description is more intuitive,objective,and easier to learn in clinical teaching.Professor CHI Jiming of Heilongjiang Academy of Traditional Chinese Medicine is mainly engaged in the clinical,scientific research and teaching of traditional Chinese medicine in the treatment of chronic kidney diseases.Professor CHI advocated using the tongue to explore the disease-symptom(tongue)-prescription syndrome differentiation method,and the four diagnoses were combined.There are three main syndrome types of proteinuria from the tongue,each with its own characteristics:spleen and stomach Qi(气)deficiency often has a pale or pale red tongue,tooth marks on the tongue,and thin moss,which is mainly added or subtracted by the Shengyang Yigao decoction(升阳益胃汤).Qi and Yin(阴)deficiency common tongue red,less moss or thin white moss,mainly to Qingxin Lianzi Yin(清心莲子饮)plus or minus;The damp heat contains common pale red or red tongue,yellow and greasy,and the addition and subtraction of the Danggui Niantong decoction(当归拈痛汤)is the main one.This article mainly introduces Professor CHI Jiming's experience in the treatment of proteinuria from the tongue,because the pathogenesis of renal proteinuria is mainly due to the deficiency of the standard and the deficiency of the spleen and kidney.Treating proteinuria from the spleen and stomach is remarkable,and the acquired nature is supplemented by the innate foundation,and the effect is remarkable.