马鸿斌主任医师辨治肾性水肿经验探析

Chief Physician MA Hongbin’s experience in treating renal edema

水肿是肾脏病的常见症状与经典临床表现之一,可导致头面部、眼睑、四肢肿胀,严重时甚至可发展为全身浮肿,属于中医学“水肿”“胕肿”“水气病”等疾病范畴,具有病程缠绵、虚实夹杂、容易反复、数症并发的临床特点,治疗相当棘手。中医药在肾性水肿的诊治方面有独特优势,采取的针对性治疗有利于扭转病程。马鸿斌主任医师认为,肾性水肿为本虚标实之候,病位关乎肺、脾、肾三脏,气、血、水、虚贯穿疾病始终,病理因素不离风、湿、热邪,治疗上提出“顾护脾肾是大法,宣肺利窍不可废”的治疗宗旨,善于健脾温阳利水兼清热、祛湿、化瘀,提倡用药以补益为主、祛邪为辅,清热祛湿治其标,温阳健脾治其本,临证根据患者正虚与邪实的程度灵活选择方药,辨证论治。如肾虚湿热证采用程氏萆薢分清饮健脾益肾、清热利湿,脾虚湿热证运用肾炎四味汤益气健脾、清热利湿,气虚湿阻证运用行湿补气养血汤益气健脾、利水渗湿,痰热内扰证采用黄连温胆汤清热化痰、利湿泄浊。马鸿斌主任医师治疗肾性水肿时标本兼治,同时不忘顾护脾胃正气,在临床肾性水肿的治疗方面颇有心得。本研究介绍马鸿斌主任医师治疗肾性水肿的相关经验,为临床提供参考。

Edema is one of the common symptoms and classic clinical manifestations of kidney diseases.It can cause swelling in the head,face,eyelids,and limbs,and in severe cases,it can develop into generalized edema.It falls under the categories of edema,swelling,and hydropneumatosis in traditional Chinese Medicine.It is characterized by a protracted course,a mix of deficiency and excess,a tendency to relapse,and concurrent multiple symptoms,making it quite challenging in clinical treatment practice.Traditional Chinese Medicine has its unique advantages in the diagnosis and treatment of nephrotic edema,and targeted treatment is beneficial for the reversal of the disease course.Chief Physician MA Hongbin considers that nephrotic edema is a a condition of both fundamental deficiency and superficial excess,involving the lung,spleen,and kidney,that Qi(vital energy),blood,water,and deficiency are present throughout the disease,and that the pathogenic factors are wind,dampness and heat.In terms of treatment,the chief physician has put forward the fundamental treatment principle of‘protecting the spleen and kidney is the main strategy,and promoting the lung to facilitate the flow of Qi is indispensable.’The chief physician excels at strengthening the spleen,warming Yang(阳),and promoting diuresis,while also focusing on clearing heat,eliminating dampness,and resolving blood stasis.The chief physician advocates the medication primarily for tonification and secondarily for dispelling pathogenic factors.Clearing heat and eliminating dampness are used to address the symptoms,while warming Yang and strengthening the spleen are used to treat the root cause.In clinical practice,Chief Physician MA Hongbin adjusts the treatment according to the degree of deficiency and excess of the patient’s condition,treating it flexibly and choosing the appropriate formulas.For the condition of kidney deficiency and damp-heat,Chengshi Bixie Fenqing Yin(程氏萆薢分清饮)is used to strengthen the spleen and benefit the kidney,as well as to clear heat and promote diuresis;for the condition of spleen deficiency and damp-heat,the Shenyan Siwei decoction(肾炎四味汤)is used to boost energy and strengthen the spleen,as well as to clear heat and promote diuresis;for the syndrome of Qi deficiency with damp obstruction,the Xingshi Buqi Yangxue decoction(行湿补气养血汤)is used to boost Qi,strengthen the spleen,and promote diuresis;for the syndrome of phlegm-heat disturbing the interior,the Huanglian Wendan decoction(黄连温胆汤)is applied for clearing heat,resolving phlegm,and promoting diuresis and detoxification.The treatment on renal edema by Chief Physician MA Hongbin addresses both the root cause and the symptoms,while also protects the spleen and stomach’s healthy Qi.There is considerable experience in the clinical treatment of nephrotic edema.The article aims to introduce Chief Physician MA Hongbin’s experience in treating nephrotic edema,hoping to provide a reference for clinical practice.