间者并行,甚者独行——国医大师皮持衡辨治慢性肾衰临证思路发微

“Treating Main and Complicated Symptoms for Mild Diseases While Treating Main Symptoms for Acute Diseases”——Chinese Medicine Master PI Chiheng's Clinical Thinking on Treatment of Chronic Renal Failure

慢性肾衰病机复杂,症候繁多,混淆疑惑,辨证难明,此为“疑”;多脏腑虚损,气血阴阳不调,津液输布失常,病理产物相兼为病,处方不定,此为“难”。因其病情复杂性和多变性,且单一治法容易顾此失彼,故临床不可简单的扶正或祛邪,应有计划有层次多角度多途径施治。皮持衡教授从事肾病研究四十余年,认为慢性肾衰为本虚标实之证,治疗需紧扣病机、标本兼顾、病证结合、中西合参,以调阴阳平衡。皮持衡教授认为“间者并行、甚者独行”理论可有效指导临床,根据该理论采取扶正与祛邪交替给药的治疗方法,使药物既各自独行,又并行其治,既用药精专,又无犯虚虚实实之弊,取效颇佳,值得借鉴。现将皮老临证思路稍作探析,并结合医案进一步佐证,以飨同道。

Chronic renal failure has a complex pathogenesis,numerous symptoms,confusion and difficulty in distinguishing syndromes,which is called“doubt”.Deficiency and damage of multiple Zang-Fu organs,imbalance of Qi,blood,Yin and Yang,abnormal distribution of body fluids and coexistence of pathological products with uncertain prescriptions,make it difficult.Due to the complexity and variability of its condition,and the single treatment method can easily overlook one aspect and lose the other,clinical practice should not simply focus on strengthening the body or eliminating pathogens.The treatment should be planned by hierarchical,multi-angle and multi-pathway approaches.Professor PI Chiheng has been engaged in the research of kidney disease for more than 40 years,and believes that chronic renal failure is a syndrome of deficiency in origin and excess in superficislity.The treatment requires close attention to the pathogenesis,consideration of deficiency in origin and excess in superficislity,the combination of disease and syndrome and the combination of traditional Chinese and Western medicine to regulate the balance of Yin and Yang.Professor PI Chiheng believes that the theory of“treating main and complicated symptoms for mild diseases while treating main symptoms for acute diseases”can effectively guide the clinical practice,and according to this theory,he adopts the treatment method of alternating drugs to strengthen the body and dispel evils,so that the drugs can both act alone and in parallel,and the drugs can be used in a precise manner without committing the disadvantage of deficiency.Now it analyzed the clinical thinking of professor PI and further supported it with medical cases for the benefit of our colleagues.