【作者】 仇玉夫；

【导师】 陶汉华；

【作者基本信息】 山东中医药大学 ， 中医临床基础， 2011， 硕士

【摘要】 肾病综合征属于《金匮》水气病范畴,《金匮》中特别重视气血水三者之间的关系。水进入人体要靠脏腑气化始能代谢,脏腑功能虚衰或失调,气不能行水,故过量水液停蓄而形成水气。肾病综合征即是水气内停以浮肿为主要特征的疾病。气病则血病,血不利则为水,水不利则病血,故《金匮》除按阴阳表里分为风水、皮水、正水、石水、黄汗:按五脏分为心水、肺水、肝水、脾水、肾水外,又按气、血、水之间的关系分为血分、水分、气分。根据肾病综合征的临床表现,按照中医辨证,特别根据《金匮》气血水并治的理论,对多数肾病综合征病人提出以益气利水活血为治疗大法,益气主要健脾气补肾气。根据临床经验精选药物黄芪、党参、生地、山萸肉、山药、茯苓、泽泻、丹皮、炒白术、桑白皮、大腹皮、陈皮、冬瓜皮、益母草、泽兰。组成益气消肿汤,方中黄芪、党参、山药、白术、茯苓健脾益气;生地黄、山萸肉、山药补肾气;桑白皮、大腹皮、陈皮、冬瓜皮,以皮治皮(善治皮水),利水消肿;益母草、泽兰既能活血又能利水。临床治疗肾病综合征,尤其西医用激素治疗效果不好时,此方在减轻症状、消除尿蛋白、降低血压等方面收到满意效果。“益气利水活血法”是治疗肾病综合征的基本治法,但由于病人体质不同、病变轻重差异,临床表现有别,还应根据辨证而加减用药。更多还原

【Abstract】 Nephrotic syndrome belongs to moisture disease category in《Jingui》,which values the relationships in QI、Blood and Water. The water in human body’s metabolism depends on viscera gasification. If visceral functions wake or disorder, Qi can’t carry water, the water deteriorates to form moisture disease. So does the Nephrotic syndrome, as the main characteristic with edema disease. Qi diseases cause blood diseases, blood disfluency causes water, water disfluency causes blood diseases, so there are fengshui、pishui、zhengshui、shishui、huanghan five types by Yinyangbiaoli; xinshui、ganshui、feishui、pishui、shenshi by five zang-organs; and the blood phase、the qi phase、moisture by the relationship in qi、blood and water.Based on the Nephrotic syndrome’s clinical conditions, according to TCM syndrome differentiation, especially the theory of qi -blood-water treated together in《Jingui yaolue》, this paper proposes the treatment principle of nourish qi-promote water-activate blood to Nephrotic syndrome patients, nourish qi majors in replenish the spleen-qi and tonifying the kidney-qi. According to the clinical experience, choices milkvetch root, asiabell/ dried rehmannia root/ pulp of dogwood fruit/ chinese yam/indian bread/ alismatis rhizome/ moutan bark/ parched white atractylodes rhizome/mulberry bark/ areca peel/ tangerine peel/chinese waxgourd peel/ leonurus heterophyllus/ lycopus herb to make up nourish qi- detumescent decoction. In this decoction, milkvetch root/ asiabell/ chinese yam/ parched white atractylodes rhizome/ indian bread strengthen the spleen and replenish qi; dried rehmannia root/ pulp of dogwood fruit/ chinese yam tonify the kidney-qi,;mulberry bark/ areca peel/ tangerine peel/chinese waxgourd peel are good at the pishui treatment, diuresis-promoting and detumescence; leonurus heterophyllus/ lycopus herb can activate blood and diuresis-promoting. On the clinical treatment of Nephrotic syndrome, especially when hormone therapy was not good, this decoction had satisfied results at abating symptom/ eliminating Upro/ lowering blood pressure and other aspects.“Nourish qi-promote water-activate blood law”is the basic rule to treat Nephrotic syndrome, but because of patients’constitutional difference and pathologic changes’difference, the clinical conditions are different, so the doctors have to modify dosage according to differentiation.更多还原