柳红芳基于“审因论治”治疗肾性水肿

Liu Hongfang′s Experience in Treating Renal Edema from Perspective of"Shen Yin Lun Zhi"

肾性水肿因其病因繁多、症状杂乱、数症并发的临床特点,既要重视明确的症状和体征进行审证求因,同时在“审因论治”的思维下,强调“辨病寻因”指导“审证求因”,主张结合西医病理、化验检查、影像学技术等,详加分析各疾病引起水肿的病因病机,进而确立治疗法则予以施治方能取得最佳疗效。急性肾炎性水肿看似病位在肾,实乃风邪犯肺,肺气郁闭,通调失司,加之中阳亏虚,脾不制水,共发为水肿,临证治疗取越婢加术汤合苓桂术甘汤为主方,疏风解表,开宣肺气,化解病因,健脾温阳,培土制水,斩断病机,达肺脾同调以治肾之效。糖尿病肾病真阴亏损,水不制火,相火妄动,不安其位,成游离之火,遍历全身,火迫阴津偏离水道,停聚于筋肉之间而不散,浮肿乃作,治疗常以济生肾气丸合水陆二仙丹加减,填补真阴,引火归元,化生肾气,消肿利水。多囊肾水肿多因命门火衰,阳不化阴,蒸化失权,则气冷水寒,流溢失序,出现水肿,故以温阳补血,散寒通滞为治法,取阳和汤为主方治疗。肾萎缩水肿的核心病机为肾形消损,肾气衰微,气不化水,治以六味地黄丸补“形”,以升陷汤调“气”,则肾精得补且肾形渐充,大气发挥斡旋气机之能,气化功能恢复则水肿自然消退。

Renal edema,due to its clinical characteristics of multiple causes,chaotic symptoms and multiple complications,requires attention to clear symptoms and signs for diagnosis and treatment.At the same time,under the thinking of"Shen Zheng Qiu Yin",emphasis is placed on"identifying diseases and finding causes"to guide"Shen Zheng Qiu Yin".It advocates combining pathology in western medicine,laboratory tests,imaging technology,etc.to analyze the causes and pathogenesis of edema caused by various diseases in detail,and then establish treatment rules to achieve the best therapeutic effect.Acute nephritic edema appears to be located in the Kidney,but in reality,it is caused by Wind evil factor invading the Lung.Lung Qi stagnation leads to dysfunction of Water regulation and Spleen dysfunction in managing Water caused by Kidney Yang deficiency,both of which result in edema.Clinical treatment is mainly based on the combination of Yuebi Jiazhu Decoction and Linggui Zhugan Decoction,which can disperse Wind,relieve external evil factor and promote Lung Qi to resolve the cause of the disease,can strengthen the Spleen and warm Yang,cultivate Earth to control Water and then remove the pathogenesis,achieving the effect of Lung and Spleen regulation to treat the Kidney.In diabetes nephropathy,the Kidney Yin deficiency causes Water and Fire imbalance and the running Fire spreads all over the body to force the Yin Fluid going away from the Water channel and stopping between muscles without dispersing and edema takes place.In clinical treatment,modified Jisheng Shunqi Pill and Shuilu Erxian Pill can be used to tonify Yin,lead the Fire return to the original state to transform the Kidney Qi and reduce swelling and Water.Polycystic Kidney edema is often caused by the decline of Yuan energy and Fire,where Yang does not transform into Yin and loses its power.As a result,the Qi and cold Water flow out of order,leading to edema.Therefore,the treatment method is to warm Yang and replenish blood,disperse cold and relieve stagnation and Yanghe Decoction can be used as the main prescription.The core pathogenesis of renal atrophy and edema is the loss of Kidney shape,the decline of Kidney Qi,and the inability of Qi to transform into Water.Treatment with Liuwei Dihuang Pill can supplement the"shape"and Shengxian Decoction can be applied to regulate the"Qi",supplement the Kidney Essence and gradually recover the shape of the Kidney.The sufficient Qi can mediate the Qi mechanism and the recovery of Qi function will naturally lead to the disappearance of edema.