基于“脾肾湿瘀”理论探讨痛风性肾病辨治

Discussion on Differentiation and Treatment of Gouty Nephropathy Based on the Theory of“Dampness and Blood Stasis from Spleen and Kidney Deficiency”

国医大师郑新辨治痛风性肾病(GN)以脾肾气虚兼湿热血瘀为主要证型,以加味参芪地黄汤为核心组方。采用“审证求因、以方测证”法推测“脾肾湿瘀”是GN关键病因病机,认为脾肾亏虚、湿瘀内生、久结成石、伏于肾络是GN反复难愈的根源,“扶脾肾,化湿瘀”是基本法则,临证时将健脾益肾、清热通淋、化湿除瘀三者有机结合进行分期辨证论治,疗效显著。现将郑新辨治GN经验总结如下,并附医案一则,以飨同道。

National TCM master Zheng Xin diagnosed and treated gouty nephropathy(GN)with spleen and kidney qi deficiency combined with dampness heat and blood stasis as the main syndrome type,and the core formula was modified Shenqi Dihuang Decoction.Using the method of“differentiating syndromes to identify causes and testing syndromes by formula”,it is speculated that“dampness and blood stasis from spleen and kidney deficiency”are the keys to the etiology and pathogenesis of GN in TCM.The roots of GN repeated refractory are thought to be spleen and kidney deficiency,dampness and turbidity internal stagnation,blood stasis endogenous,dampness and blood stasis forming stone,and underlying kidney collateral.“Strengthening spleen and kidney,removing dampness and blood stasis”is the basic rule.In clinical practice,invigorating the spleen and kidney,clearing heat and freeing strangury,clearing away dampness and removing stasis are organically combined for staged syndrome differentiation and treatment,with definite curative effect.Here is a summary of Zheng Xin’s experience in treating GN,with a medical case attached for the benefit of colleagues.