基于“阳虚阴结”理论探析温阳法论治特发性膜性肾病

Treatment of idiopathic membranous nephropathy by warming yang according to the theory of "yang deficiency and yin stagnation"

膜性肾病是成人肾病综合征常见的病理类型之一,其中病因未明者称为特发性膜性肾病,中医学将其归属于“水肿病”范畴。“阳虚阴结”理论源于《素问·阴阳应象大论篇》中“阳化气,阴成形”。阳化气不足,阴成形太过,造成痰饮、水湿、瘀血等有形之物聚积,从而产生“阳虚阴结”的病理状态,发为特发性膜性肾病。张琳教授基于此提出,用温阳法论治特发性膜性肾病思路的方法和实践经验,强调温肾阳以化气利水湿。张琳教授临证时将温阳法视为特发性膜性肾病的治疗总纲,即“益火之源,以消阴翳”,注重调补脾肾、温阳散寒通络;同时针对有形实邪,予以温阳化湿、温阳化瘀,并附验案一则以供临床参考。

Membranous nephropathy is one of the common pathological types of adult nephrotic syndrome,and those with unknown causes are called idiopathic membranous nephropathy(IMN).In Chinese medicine,it is classified under the category of "edema".The theory of "yang deficiency and yin stagnation" originates from "Yang is transformed into qi,and yin becomes tangible." in the chapter of "Correspondence between Yin and Yang" in the Plain Questions(Su Wen).The insufficient yang to transform qi and the excessive yin formation lead to the accumulation of tangible things such as phlegm-fluid retention,waterretention,and static blood,resulting in a pathological state of "yang deficiency and yin stagnation",and manifesting as IMN.Based on these,Professor ZHANG Lin put forward the method and practical experience of warming yang to treat IMN,emphasizing warming kidney yang to transform qi and drain water retention.The method of warming yang has been regarded as the general outline of treating IMN,that is,"nourishing kidney yang to restrict excessive yin",paying attention to regulating and tonifying the spleen and kidney,warming yang,dispelling cold,and dredging collaterals,while taking into account tangible pathogens by warming yang and removing dampness,warming yang and removing static blood.A case has been attached for clinical reference.