基于“中气下陷”理论探析膜性肾病的病机及诊治思路

Pathogenesis and Diagnosis and Treatment Ideas of Membranous Nephropathy Based on Theory of “Sinking of Qi of Middle-jiao”

基于中气下陷理论探讨膜性肾病的病机,提出“湿蕴脾肾,中气下陷”的病机理论,其中以风邪外侵,中土亏损为发病先导,中气不足,脾肾亏虚为发病基础,气机凝滞,湿瘀阻络为病机核心,毒损脾肾,中气下陷为病情进展,大气虚散,脏腑衰惫为病重结局,中气亏虚贯穿膜性肾病发病始终。论治当取升阳举陷大法,强调早期调补脾肾,御风于外,中期祛湿化瘀解毒,升阳通络,晚期升阳益胃排毒,兼顾心肾虚损。

Based on the theory of“sinking of Qi of middle-jiao”,the pathogenesis of membranous nephropathy was discussed,and the pathogenesis theory of“wet spleen and kidney cause sinking of Qi of middle-jiao”was proposed,in which the external invasion of wind and evil and the loss of middle earth were the precursors,and the deficiency of Qi of middle-jiao and the deficiency of spleen and kidney were the basis of the pathogenesis.In addition,the coagulation of the Qi mechanism and wet stasis obstructing collaterals were the core of the pathogenesis;the poison damage to the spleen and kidneys and the sinking of Qi of middle-jiao were the progression of the disease.The dispersion of the atmosphere and the failure of the internal organs were the outcome of the disease,and the deficiency of Qi of middle-jiao ran through the incidence of membranous nephropathy.The disease should be treated with the method of lifting Yang and raising sinking,and the early regulation of the spleen and kidneys and the prevention of external wind should be emphasized.The middle stage should focus on removing dampness,stasis,and detoxification,lifting Yang,and dredging collaterals.In the late stage,the method of lifting Yang,benefiting the stomach,and detoxifying should be adopted,and the heart and kidney deficiency should be both considered.