肾性水肿的中医治法研究

A study on the treatment of renal edema in traditional Chinese medicine

水肿是慢性肾脏病临床最常见的表现之一,常见于急慢性肾小球肾炎、肾病综合征、尿毒症等疾病。肾性水肿可表现为凹陷性水肿,通常由眼睑累及全身,其发病机制复杂,目前认为主要分为“充盈不足”和“充盈过度”两种情况。西医治疗肾性水肿,通常在评估患者血容量的基础上直接或者扩容后使用利尿剂,初期效果明显,但长期使用可能导致利尿剂抵抗现象,进而引起肾血管收缩和疾病反复,加重肾功能损害。中医学并无“肾性水肿”这一病名,多将其归类于“水病”“水胀”“跗肿”等范畴。中医药在治疗肾性水肿方面,展现出缓解症状、降低复发率等显著优势。近年来关于肾性水肿的中医药研究取得显著进展,不同医家持有不同观点,对肾性水肿采用不同的方法进行治疗,临床上常辨病与辨证相结合,不拘于一方一药。研究对近年来中医药治疗肾性水肿的思路进行了梳理,总结出从风论治、从毒论治、从脏腑论治、从三焦论治和从六经论治等5个方面,并进行了深入探讨,旨在为中医药治疗肾性水肿提供新的方法。

Edema is one of the most common clinical manifestations of chronic kidney disease,commonly seen in acute and chronic glomerulonephritis,nephrotic syndrome,uremia and other diseases.Renal edema is characterized by concave edema,usually involving the whole body from the eyelid,and its pathogenesis is complex.Currently,its pathogenesis mainly includes insufficient filling and excessive filling.In terms of the treatment of renal edema,diuretics are administered directly or after volume expansion on the basis of assessing the patient’s blood volume in Western medicine.The initial effect is obvious,but long-term use may lead to diuretic resistance,and then cause renal vasoconstriction and disease recurrence,aggravating renal function damage.There is no such name as renal edema in traditional Chinese medicine,but it is classified as the categories of water disease,water swelling,and foot back edema.Traditional Chinese medicine has shown obvious advantages in the treatment of renal edema,such as relieving symptoms and reducing the recurrence rate.In recent years,traditional Chinese medicine research on renal edema has made remarkable progress.Different doctors hold their own views and adopt different treatment methods to treat renal edema.In clinical practice,disease differentiation and syndrome differentiation are often combined,not limited to a certain prescription or a certain drug.In this paper,the treatment thoughts of renal edema in traditional Chinese medicine in recent years are reviewed,and five aspects are summarized and discussed in depth,including treating from wind,treating from poison,treating from Zang-fu organs(脏腑),treating from triple energizer,and treating from six meridians,aiming at providing new methods for traditional Chinese medicine treatment of renal edema.