节点文献
从肺论治慢性肾炎的文献研究
【作者】 刘红艳；
【导师】 蒋燕；
【作者基本信息】 北京中医药大学 ， 中医基础理论， 2008， 硕士
【摘要】 慢性肾小球肾炎(CGN)简称慢性肾炎,是一种常见病、多发病,是由多种原发性肾小球疾病所导致的,病程长(一至数十年),以水肿、蛋白尿、血尿、高血压为主要临床表现的疾病,部分病人尚有不同程度的肾功能损害。综合目前国内外文献资料来看,尚未有令人满意的防治措施,因而,本病严重危害着广大人民的身体健康。中医药对慢性肾炎的治疗具有一定的优势及疗效。综述部分,首先对慢性肾炎进行病名释义,它归属于古代“肾风”、“风水”、“水肿”、“尿血”、“关格”、“腰痛”等中医疾病的范畴,并对慢性肾炎的病因病机进行了文献整理总结,古代医家认为慢性肾炎以风邪袭肾为标,脾肾两虚为本,水湿瘀血兼夹为病。现代中医认为慢性肾炎病机复杂,风、寒、热、湿、毒外邪的入侵,肺脾肾虚弱,五脏的功能失调,三焦、膀胱的气化失司、以及血瘀、湿浊等病理产物的形成,均对本病有一定的影响。临证有本虚标实论、实邪为患论和伏邪发病论三种发病观点。其次,论述了慢性肾炎的中医药治疗方法,临床常见的有从五脏进行的脏腑辨证、分期辨证、审证求因、六经辨证、专方治疗、中成药治疗、对症治疗、单味药的应用、饮食运动疗法,针灸外治等方法。正文部分首先阐释肺在水液代谢中的生理病理意义,通过肺的宣发,水液向上、向外输布,布散全身,外达皮毛,代谢后以汗的形式由汗孔排泄;通过肺的肃降,水液向下、向内输送,而成为尿液生成之源,故有“肺主行水”、“肺为水之上源”之说。慢性肾炎的发病经常以水肿为首发症状和主要症状,因此,我们讨论肺在水液代谢中的生理病理意义为我们临证时从肺着手论治慢性肾炎提供了理论依据。其次阐述了肺与慢性肾炎发病的关系:肺卫受邪,宣肃失常、通调水道不利以及肺虚受邪与慢性肾炎的发病、发展、转归、预后有着密切关系。①慢性肾炎肇始于肺卫受邪。外邪袭人,往往首先犯肺,急、慢性肾炎发病常以链球菌感染为前驱,于上呼吸道感染或急性扁桃体炎感染后1～4周发病。多为风热火毒、湿毒之邪从皮毛内归于肺脾,下伤及肾,从而导致肺热气壅,外则皮毛腠理为之闭塞,水湿不能化为汗液,从毛窍排泄;内则肺失肃降,治节失司,致三焦气化不利,水湿泛滥肌肤而成水肿。外邪伤及脾肾,脾失固摄,肾失封藏,致精微外泄而成蛋白尿。②慢性肾炎水肿因于肺失通调,水道不利。慢性肾炎水肿与肺密切相关。肺主气,为水之上源,肺的宣发与肃降对体内津液的输布、运行和排泄有疏通和调节作用。③慢性肾炎迁延不愈缘于肺虚受邪。慢性肾炎常因感邪而复发或加重,而肺气亏虚,卫外不固,是患者易于感受外邪的主要原因。接着又整理总结了慢性肾炎从肺论治的古代、现代文献依据。《素问·汤液醪醴论》提出宣肺利水的“开鬼门”治疗水肿的方法,《素问·水热穴论》又指出“其本在肾,其末在肺,皆积水也”。尤其是东汉张仲景首用越婢加术汤治风水病,用小青龙汤治水饮蕴肺以来,从肺论论治急性肾炎理论一直有效地指导临床治疗。现代中医学认为慢性肾炎从肺论治的意义是多方面的,并结合临证认为似有调节体液代谢、抗变态反应、预防和控制感染,以及增强机体抗病能力促使病变脏器恢复等多种作用。最后,总结了慢性肾炎从肺论治的主要方法,包括疏风宣肺法、清肺解毒法、降肺理气法、补气固表法、养肺滋肾法、补气行水法六种。此外还有润肺通便法、祛风胜湿法、祛风活血法、温宣利水法、清宣利水法、补益肺脾法、益气摄精法等等从肺论治肾炎的理论。并列举了赵绍琴、岳美中、刘渡舟、邹燕勤、裘沛然等中医大家治疗慢性肾炎的典型病案并加以分析说明。总之,慢性肾炎从肺论治能驱散外邪,宣通肺气,使其通调水道,下输膀胱之职恢复正常,三焦水道通畅,有助于水肿的消退;同时又可加强肺气的作用,使其气化功能正常,宣发敷布卫气于肌表,卫外坚固,能有效地防御外邪入侵;另外,如肺脏功能正常,又助于肾之封藏功能,减少精微物质下泄,保护肾脏功能。在整体观点的主导思想指导下从肺论治慢性肾炎,临证还当按照辨病结合辨证的要求,根据不同的证候表现,分别采取各种具体治法。应用从肺论治慢性肾炎的成功经验给我们临床治疗提供了一个新的思路和方法,我们应该加以拓展应用和实验研究。
【Abstract】 The chronic glomerulus nephritis (CGN) is a common disease, frequently-occurring disease, which is caused by many kinds of primary renal glomerulus diseases and can continue from one to dozens of years, takes dropsy, the albuminuria, hematuria, hypertension as main clinical manifestation, the partial patients still had the varying degree kidney function harm. The synthesis present domestic and foreign literature materials, was still difficult to this sickness prevention satisfyingly, and it severely jeopardize general populace’s health. The Chinese medicine has certain superiority and the curative effect to CGN.The summary part explains CGN in ancient literature, which belonges to“the kidney wind”,“the geomancy”,“dropsy”,“the lumbago”,“the hematuria”and so on. In ancient times the medicine thought that CGN caused by common cold raiding the kidney, the spleen and kidney empty is a basical reason, the wet and ecchymosis moreover was a sickness. The modern Chinese medicine thought that CGN pathogenesis is complex, the wind, the cold, the hot, the wet, the poisonous external injuries, lung, spleen, kidney is weak, five viscera function being out of balance, the triple warmer, bladder’s gasification loses the department, as well as the blood stasis, wet muddy and so on pathology product formations, has certain influence to this sickness. There are three kind of morbidity viewpoints : asthenia in origin and asthenia in superficiality, sthenia pathogenic factors, sthenia pathogenic factors. Next, I elaborate the chronic nephritis’s methods of treatment.In clinic, common methods conclude differentiation of symptoms and signs according to five viscera, stages, cause of a disease,the six meridians,exclusive prescription,Chinese traditional patent medicine,symptomatic treatment,single medicine,drink and food,kinetotherapy,acupuncture and external treatment.The textual material first explains lung’s in water fluid metabolism physiological pathology significance, proclaims that the lung sends water fluid upward, outward circulation to spread the whole body, outside to reach the superficial fur, after the metabolism, draining by the perspiration form by the pore; the lung falls the water fluid downward, transports inward, becomes source of the urine production, therefore has“the lung runs water”,“the lung upper reaches of for the water”saying. Chronic nephritis’s morbidity frequently takes dropsy as first symptom and cardinal symptoms, therefore, we discuss lung’s in water fluid metabolism physiological pathology significance for us to provide the theory basis when we begin from the lung to discuss treats CGN.Next I elaborate the relations between lung and CGN morbidity: Lung Wei suffers evil, proclaims and austeres abnormally, the poker canal to be disadvantageous as well as the pulmonasthenia suffers evil, all above have the close relation with the chronic nephritis’s morbidity, the development, the extension turns over to, the prognosis.①CGN initiates lung wei suffering evil.The external injuries influences often first violates the lung, CGN morbidity often take the chain coccus infection as a forerunner, the latter 1~4 weeks morbidity in the upper respiratory tract infection or the acute amygdalitis.The wind、hot、fire, the internal poisoning caused by damp belongs to the lung spleen evilly from the superficial fur, gets down the kidney, thus causes the lung to obstruct to steam outside, the superficial fur. Wet cannot change into the sweat, drains from the superficial fur; the triple warmer gasification to be disadvantageous, is in flood the flesh to become dropsy wet. The external injuries influences the spleen and kidney, spleen loses absorbs firmly, the kidney loses the pickling, releases the albuminuria outside.②CGN dropsy has close relations with lung adjusting the canal. The lung charges gas, upper reaches of the water, the lung sends to vivo body fluids circulation, the movement and the excretion has the opening and the control action.③CGN procrastinates because of pulmonasthenia suffering evil. pulmonasthenia is the primary cause that the patient easily to suffer the external injuries influences.Then I summarize literature basis discussed from the lung to treat CGN both the ancient times and the modern. Ancient people proposed ventilates the lung hydragogue“opening pores”to treat dropsy’s method and pointed out“the cause of edema being fundamentally in the kidney and incidentally in the lung”in Suwen. Especially from Eastern Han Dynasty Zhang Zhongjing added yuebijiazhu tang to treat edema caused by wind-evil, discusses treat the acute nephritis from the lung theory instructed the clinical care effectively.The modern traditional Chinese medicine thought that treat CGN from lung have various significances, that seemed to be adjustment body fluid metabolism, the anti-allergy, the prevention and the control infection, as well as enhancement organism disease-resistant ability to urge the pathological change internal to restore and so on many kinds of functions.Finally I summarize the main method treat CGN from the lung, expelling wind open the inhibited lung-energy, the clear lung to neutralize poison, to fall the lung to regulate the flow of qi, invigorating qi for strengthening superficies, to raise the lung to incite the kidney, invigorate qi to run water. In addition there are many other methods, such as the benefit lung and spleen to discuss from the lung to treat nephritis’s theory. And I enumerate the typical medical records to analyze the explanation quoting cases of the particular disease from Zhao Shaoqin, Yue meizhong, Liu Duzhou, Zou Yanqin, Qiu peiran et al.In brief, treatment of CGN from the lung can scatter the external injuries influences, open the inhibited lung qi , promote it to adjust the canal, get down loses duty of the urinary bladder to restore normally, and the triple warmer canal is unobstructed, helpful to dropsy’s retrogression; Simultaneously it may strengthen the lung function, cause it gasified function to be normal, spread wei-energy to superficial fur , defend the external injuries influences effectively; Moreover, if the lung function is normal, it helps mounting function in the kidney, reduces the nutrient substance to excrete, protects the kidney function.In the discusses about treatment of CGN from the lung, according to distinguishes the sickness union dialectical request, according to the different symptoms, we should adopt each kind to govern the law specifically separately. The successful application experience during the clinical care provides a new mentality and the method to us, we should perform to develop the application and the experimental study.