基于五脏相关理论辨治肾性蛋白尿及应用举隅

Differentiation and treatment of renal proteinuria based on five viscera being related theory and its application

肾性蛋白尿是肾脏病患者早期常见且多发的临床症状,患者会出现周身或双下肢浮肿、体倦乏力、尿中有泡沫等症状,此外,尿蛋白阳性亦可作为诊断肾脏病的指标。该病缠绵难愈,常可引发诸多症状,甚至导致不良后果,因此,对肾性蛋白尿的诊治十分重要。五脏相关理论是一种中医基础理论,五脏在生理和病理方面互相作用,是一个统一的整体,体现中医辨证论治的整体观。可以结合中医五脏相关理论对肾性蛋白尿进行辨治。文章首先论述中医肾与蛋白尿的关系,探究古代医学对蛋白尿与“精”的关系,其次,阐释五脏与肾相关理论,基于此理论提出从心肾、肺肾、肝肾、脾肾四方面分别辨治蛋白尿,并举出名医经验用方用药,为临床诊治蛋白尿提供参考。蛋白尿的产生中医多责之于肺、脾、肾三脏,但笔者临床跟师发现蛋白尿的产生,即精微物质的外泄,不仅与肺、脾、肾三脏相关,亦与心、肝二脏相关。临床可见患者或因心阴亏虚、肝郁气滞而产生蛋白尿,或因不明原因蛋白尿心烦、焦虑,从而导致蛋白尿持续存在。文后附临床诊治与本理论相关的验案一则,该病案提示经3次中药治疗,患者尿中泡沫、尿蛋白以及浮肿症状明显减轻。笔者期冀为临床诊治肾性蛋白尿提供有益思路。

Renal proteinuria is the early common and multiple clinical symptoms of kidney disease patients,patients will have edema of the whole body or lower limbs,fatigue,foam in urine and other symptoms,in addition,urine protein positive can also be used as an indicator of the diagnosis of kidney disease.The disease’s lingering course makes it difficult to cure,and it often causes many symptoms,and even leads to adverse consequences,therefore,the diagnosis and treatment of renal proteinuria is very important.The five viscera being realted theory is a basic theory of traditonal Chinese medicine.The five viscera interact with each other in physiology and pathology,which is a unified whole and reflects the holistic view of TCM differential treatment.Renal proteinuria can be treated according to the theory of five viscera being related in traditional Chinese medicine.This article first discusses the relationship between kidney and proteinuria in traditional Chinese medicine,explores the relationship between proteinuria and“essence”in ancient medicine,secondly,it explains the theory of five viscera being related to the kidney,based on this theory,the article puts forward the treatment of proteinuria from the four aspects of heart and kidney,lung and kidney,liver and kidney,and spleen and kidney respectively,and lists the prescription of famous doctors’experience to provide a reference for clinical diagnosis and treatment of proteinuria.The production of proteinuria is mainly due to the three viscera of the lung,spleen and kidney in traditional Chinese medicine,but the author also finds that the production of proteinuria,the leakage of fine substances,is not only related to the three viscera of the lung,spleen and kidney,but also related to the two viscera of the heart and liver.Clinically,it can be seen that patients suffer from proteinuria due to deficiency of heart Yin(阴)and liver stagnation,or being upset and anxiety due to proteinuria of unknown reasons,leading to the persistence of proteinuria.One case of clinical diagnosis and treatment related to this theory is attached,which indicates that after three times of TCM treatment,the patient’s urine foam,urine protein and edema symptoms are significantly reduced.The author hopes to provide useful ideas for the clinical diagnosis and treatment of renal proteinuria.