基于“阳虚三夺统于脾”理论论治Ⅳ型心肾综合征

Treatment of Type 4 Cardiorenal Syndrome based on the Theory of"Yang Deficiency with Three Lackings,Controlled by the Spleen"

汪绮石在《理虚元鉴》中提出“阳虚三夺统于脾”理论,认为阳虚成劳有夺精、夺气、夺火之变,治当从脾入手,急复中阳。总结基于“阳虚三夺统于脾”理论论治Ⅳ型心肾综合征经验,提出夺精为Ⅳ型心肾综合征发病之始,夺气为发病之渐,夺火为发病之变,最终形成肾亏气虚、阳虚水泛的复杂局面,变证丛生。临证夺火阶段主张温中健脾以急救中阳,常用保元汤合理中汤加减;进入夺气阶段,常加用桃仁、土鳖虫、茯苓、桂枝等活血利水以运复中气;进入夺精阶段,常加用枸杞子、菟丝子、杜仲、巴戟天等补虚消癥以固本填精。

WANG Qishi put forward the theory of"yang deficiency with three lackings,controlled by the spleen"in Lixu Yuanjian(《理虚元鉴》),which regarded that yang deficiency can lead to consumptive diseases with changes of lacking essence,lacking qi,and lacking fire,so the treatment should start from the spleen to restore the middle yang urgently.This article summarised the experience of treating type 4 cardiorenal syndrome based on the theory of"yang deficiency with three lackings,controlled by the spleen",and proposed that lacking essence is the beginning of the onset of type 4 cardiorenal syndrome,lacking qi is the gradual development of the disease,and lacking fire is the changes of the disease,and ultimately resulted in the complex situation of kidney and qi deficiency,and edema due to yang deficiency,combined with syndromes variation.In the clinical evidence,in the stage of lacking fire,therapies should warm the middle and strengthen the spleen in order to rescue the middle yang,prescribed with modified Baoyuan Decoction(保元汤)plus Lizhong Decoction(理中汤);in the stage of lacking qi,prescriptions can add Taoren(Juglans regia),Tubiechong(Eupolyphaga sinensis),Fuling(Smilax glabra),Guizhi(Neolitsea cassia)to activate blood and drain water to transport and restore the center qi;in the stage of lacking essence,prescriptions can add Gouqizi(Lycium barbarum),Tusizi(Cuscuta chinensis),Duzhong(Eucommia ulmoides),Bajitian(Gynochthodes officinalis)to supplement deficiency and resolve masses to consolidate the root and supplement essence.