从心肾相交理论出发探析小儿遗尿症的临床诊治

Analysis of the clinical diagnosis and treatment of infantile enuresis from the coordination between the heart and kidney

关键词:  小儿遗尿症  心肾相交  心肾失交  辨证论治

Key words:  infantile enuresis  coordination between the heart and kidney  disharmony between the heart and kidney  treatment according to syndrome differentiation

摘要:

遗尿是小儿时期以夜间尿床为主要临床表现的疾病，历代多数医家认为主要病机为膀胱虚冷，不能约束，然大量临床病例及文献提示心肾失交证为其主要病机之一。文章基于“心肾相交”理论，探讨小儿遗尿心肾失交的病因病机、辨证论治。其主要病机为心肾失交致遗尿频作，并与脾胃受损、肝肺气机升降失调密切相关。治疗上以交通心肾、水火既济之法为重，方选交泰丸加减清补并用，标本兼施；脾胃失和者，予保和丸加减以健运脾胃；脾气不足者，予补中益气汤加减以补气健脾；肝经湿热者，予龙胆泻肝汤加减以清肝泻火；肺气不宣者，予甘草干姜汤加减以益气温阳。

Abstract:

Enuresis is a disease with bedwetting at night as the main clinical manifestation in children. Most physicians in the past believe that the main pathogenesis is the deficiency and coldness of the bladder, which cannot be restrained. However, a large number of clinical cases and literature suggest that the heart and kidney failure is one of the main pathogenesis. Based on the theory of coordination between the heart and kidney, the theoretical basis, etiology, pathogenesis, syndrome differentiation and treatment of children with enuresis and disharmony between the heart and kidney are discussed. Its main pathogenesis is frequent enuresis caused by disharmony between the heart and kidney and it is closely related to spleen and stomach damage, liver and lung qi disorder. The treatment focuses on the method of improving the heart and kidney, fire and water being coordinated. The prescription is to choose Jiaotai Pills with addition, subtraction, clearing and tonic, and both specimens. For spleen and stomach disorders, Baohe Pills is added and subtracted to strengthen the spleen and stomach;for those with insufficient temperament, add Buzhong Yiqi Decoction to invigorate qi and invigorate the spleen;for liver meridian damp-heat, use Longdan Xiegan Decoction to clear the liver and relieve fire;for undeclared lung qi, use Gancao Ganjiang Decoction to benefiting qi and warming yang.