迟继铭教授运用清心莲子饮治疗肾脏疾病验案举隅

Professor CHI Jiming's experience in treating chronic kidney disease with Qingxin Lianzi Yin

清心莲子饮出自《太平惠民和剂局方》,原方治疗忧思抑郁,烦躁发热;或肾阴虚而致心火上炎,口苦咽干,消渴;或遗精淋漓;或因热邪扰动营血以致血崩等证。慢性肾脏疾病病机复杂,治疗上需紧抓本虚标实这一病机,攻补兼施,才能有所疗效。迟继铭教授临床工作四十余载,精于辨证,在中医治疗肾病方面积累了丰富经验,根据多年临床经验总结肾病综合征、慢性肾小球肾炎的初始阶段多气虚、阳虚,日久而成气阴两虚;慢性肾盂肾炎病情迁延,日久不愈或反复发作,其辨证多为气阴两虚,膀胱湿热,多以慢性肾脏疾病脾肾虚损为其病机关键,二者阳虚气虚,日久则演变为气阴两虚,所谓“阳损及阴”,故益气养阴与清热利湿并用。方中以石莲子清心火、秘精微,为君药,对外泄蛋白尿起到收涩作用,党参、黄芪益气健脾升阳,麦冬、地骨皮滋阴,黄芩主清上焦心肺之热,茯苓、车前子淡渗利湿,柴胡清心利湿、益气养阴。临证治疗时紧守病机,抓住主证,善于变通,遣方灵活,根据临床疾病的不同特点增减药物,收效甚佳。文章分析迟继铭教授运用清心莲子饮治疗肾脏疾病的临床经验并附验案三则,慢性肾小球肾炎、肾病综合征、慢性肾盂肾炎各一例,以期为相关临床治疗提供参考。

Qingxin Lianzi Yin(清心莲子饮) comes from Taiping Huimin Hejiju Fang(《太平惠民和剂局方》),which is used to treat anxiety and depression,irritability and fever,or kidney Yin(阴) deficiency leading to heart-fire flaming,bitter taste and dry throat,diabetes,or spermatorrhea,or metrorrhagia caused by pathogenic heat disturbance of Yingxie(营血) and other symptoms.The pathogenesis of chronic kidney disease is complex,so it is necessary to pay close attention to the pathogenesis of asthenia in origin and excess in superficiality,with the therapy of tonification and purgation in combination,in order to have an effect.Professor CHI Jiming has worked clinically for more than 40 years,knows how to syndrome differentiation,and has accumulated rich experience in the treatment of nephropathy in TCM.According to the summary of clinical experience for many years,it is concluded that the initial stage of nephrotic syndrome and chronic glomerulonephritis is characterized by deficiency of Qi(气) and Yang(阳),and develops into deficiency of both Qi and Yin(阴) over time.The condition of chronic pyelonephritis is extended,does not recover for a long time or occurs repeatedly.Its syndrome differentiation is mainly deficiency of both Qi and Yin and damp-heat of bladder.The key pathogenesis is the deficiency of spleen and kidney in chronic kidney disease.Yang deficiency and Qi deficiency develop into deficiency of both Qi and Yin over time.Yang is damaged and Yin is affected,so the methods of replenishing Qi and nourishing Yin,and clearing heat and promoting dampness are used at the same time.In the prescription,Shilianzi(Semen Caesalpiniae) clears the heart-fire,ans equilibrates refined materials in foodstuff.It is the king medicine,which plays an astringent role in the leakage of albuminuria.Dangshen(Radix Codonopsis) and Huangqi(Radix Astragali)replenish Qi,invigorate the spleen,and increase Yang.Maidong(Radix Ophiopogonis) and Digupi(Cortex Lycii) nourish Yin.Huangqin(Radix Scutellariae) clears heart and lung heat of upper-Jiao(上焦).Fuling(Poria) and Cheqianzi(Semen Plantaginis) remove dampness.Chaihu(Radix Bupleuri) clears heart and removes dampness through diuresis,replenishing Qi and nourishing Yin.In clinical treatment,close attention is paid to observe the pathogenesis,grasp the main syndromes,and prescribe flexibly according to the different characteristics of clinical diseases,with very good therapeutic effects.This paper analyzes Professor CHI Jiming's clinical experience in the treatment of renal diseases with Qingxin Lianzi Yin,and three empirical cases are attached,including one case of chronic glomerulonephritis,one case of nephrotic syndrome and one case of chronic pyelonephritis,in order to provide reference for related clinical treatment.