戴恩来教授基于“毒损肾络”理论治疗肾性水肿验案举隅

The empirical case of Professor DAI Enlai of treating renal edema based on the theory of toxic damage to renal collaterals

水肿是肾脏病的典型症状,也是肾内科疾病最常见的临床症状之一,缠绵难愈。西医学认为,肾性水肿的发生多由低蛋白血症导致胶体渗透压失衡,或由电解质紊乱导致水钠潴留等造成。西医治疗肾性水肿通常使用利尿剂,通过影响肾小球滤过率和重吸收作用等,促进机体排水、排尿,但长期使用会加剧机体水和电解质紊乱、糖代谢异常,加重水肿。中医药的介入可阻止肾性水肿进展。中医基础理论认为,水肿的病位主要在肺、脾、肾,关键在肾;病理因素多为湿、瘀互结。肾为水脏,与水肿的发生关系密切,水液的运化依赖于肾阳的蒸腾气化及开阖作用。戴恩来教授认为,“毒邪”存在于慢性肾脏病的始终,其中以“瘀毒”“湿毒”最为常见,且二者极易结合,导致肾性水肿迁延难愈。“毒损肾络”,则肾失开阖,蒸化失司,水液代谢失常,溢于肌肤,发为水肿。戴恩来教授基于“毒损肾络”理论,运用“解毒通络法”治疗肾性水肿,取得较为满意的临床疗效。本研究基于“毒损肾络”的理论基础及“解毒通络”法的具体应用,总结戴恩来教授治疗肾性水肿的经验,为临床治疗肾性水肿提供新思路。

Edema is a typical symptom of renal disease and one of the most common clinical symptoms of renal diseases,which is difficult to cure.Western medicine believes that the occurrence of renal edema is mostly caused by colloid osmotic pressure imbalance due to hypoproteinemia,or water and sodium retention due to electrolyte disorders.In the treatment of renal edema in Western medicine,diuretics are usually used to promote body drainage and urination by affecting the glomerular filtration rate and reabsorption.However,long-term application of diuretics can aggravate water and electrolyte disorders,and abnormal glucose metabolism in the body,and then aggravate the occurrence and development of edema.The intervention of traditional Chinese medicine is needed at this time to prevent the progression of renal oedema.According to the basic theory of traditional Chinese medicine,the disease location of edema mainly lies in the lung,spleen and kidney,and the key disease location lies in the kidney;the pathological factors are mainly dampness and blood stasis.The kidney is water viscera,which is closely related to the occurrence of edema.The transport of water and liquid depends on the transpiration,gasification and opening and closing effects of kidney Yang(阳).Professor DAI Enlai believes that toxic evil exists in the whole course of chronic kidney disease,of which stasis poison and wet poison are the most common evils,and the two are easy to combine,leading to renal edema prolongation and difficult to heal.Toxic damage to renal collaterals causes renal opening and closing dysfunction,the evaporative function is abnormal,and water and fluid metabolism is abnormal,which overflows in the skin and becomes edema.Based on the theory of toxic damage to renal collaterals,Professor DAI Enlai applies the method of detoxification and dredging collaterals to treat renal edema,and has achieved a relatively satisfactory clinical effect.Based on the theoretical basis of toxic damage to renal collaterals and the specific application of the detoxification and dredging collaterals method,this article summarizes the experience of Professor DAI Enlai in treating renal edema for providing new ideas for the clinical treatment of renal edema.