董长令运用瓜蒌薤白桂枝汤治疗尿频验案二则

Treating two cases of frequent urination with Gualou Xiebai Guizhi decoction by DONG Changling

中医尿频属于现代医学的膀胱过度活动症(Overactive Bladder Syndrome,OAB)的范畴。近些年的临床资料显示,我国患此病的人数正在逐年增加,且女性多发,严重影响了患者的生活质量及心理健康,且此病的临床疗效差强人意。中医认为此病多以膀胱及肾虚为本,涉及心、肝、脾、肺、小肠、三焦等脏腑,病机为肾及膀胱的气机失常,膀胱气化功能失司,故常以补肾固摄缩尿为根本大法。而临床上,对运用此法疗效不显者,运用瓜蒌薤白桂枝汤从心论治往往收以良效。从心论治尿频主要以三点为理论依据:第一,肾与膀胱经络相表里,而心与肾经络互联,故心通过经络影响肾和膀胱的功能;第二,心为五脏六腑之大主,通过心主神志的功能直接影响肾和膀胱的功能,同时西医认为OAB与自身精神心理因素相关,通过膀胱自主训练治疗此病也与中医从心论治此病相符合;第三,肾和膀胱的功能需要依赖心之温煦,心阳充盛,肾脏及膀胱的气化才能正常,从而小便正常。而运用瓜蒌薤白桂枝汤主要选用瓜蒌、薤白、桂枝三味核心药组,旨在温阳、通阳,共奏温通心阳以温肾阳而助膀胱气化之功。文章中特列举临床中运用瓜蒌薤白桂枝汤加减治疗此病之验案二则,与同道探讨。

Frequent urination in traditional Chinese medicine belongs to the category of overactive bladder in modern medicine.Clinical data in recent years shows that the number of people suffering from this disease in our country is increasing year by year,and it is more common among women,which seriously affects the quality of life and mental health of patients.The clinical treatment of this disease is not satisfactory.Traditional Chinese medicine believes that this disease is mostly caused by Qi(气) deficiency of bladder and kidney,involving organs such as the heart,liver,spleen,lungs,small intestine,and triple jiao(三焦) and other viscera.The pathogenesis is due to the dysfunction of Qi in the kidneys and bladder,as well as the loss of bladder gasification function,so the fundamental method is often to tonify the kidney,strengthen digestion,and reduce urine.And clinically,For patients with no significant curative efficacy,the Gualou Xiebai Guizhi decoction(瓜蒌薤白桂枝汤) is often used to treat the disease from the perspective of heart,which often receive good effects.The theory of treating frequent urination from the heart is based on the following three points:Firstly,the kidney and bladder meridians are interconnected,and the heart and kidney meridians are interconnected,so the heart affects the kidneys and bladder through meridians.Secondly,the heart is the master of the five organs and six internal organs,and directly affects the function of the kidneys and bladder through the function of governing the mind.At the same time,Western medicine believes that overactive bladder is related to one's own psychological factors,and treating this disease through bladder autonomous training is also consistent with traditional Chinese medicine's treatment of this disease from the perspective of the heart.Thirdly,the function of the kidneys and bladder depends on the warmth of the heart,only when the heart is full of Yang(阳) can the Qi in the kidneys and bladder function normally,leading to normal urination.In the application of the Gualou Xiebai Guizhi decoction,the three medicines of Gualou(Fructus Trichosanthis),Xiebai(Bulbus Allii Macrostemonis),Guizhi(Ramulus Cinnamomi) are mainly selected as the core drug combination,aiming at activating Yang to warm heart Yang and kidney Yang,so as to make bladder gasification function normal.In this article,two clinical cases of applying Modified Gualou Xiebai Guizhi decoction to treat this disease are specifically listed and discussed with the fellow learners.