基于中医“因地制宜”理论的肾性水肿辨治差异性研究

A Study on the Regional Variations in Syndrome Differentiation and Treatment of Renal Edema Based on the TCM Theory of “Adapting Treatment to Local Conditions”

摘要: 肾性水肿是多种原发性或继发性肾脏疾病发展过程中最为常见且缠绵难愈的核心临床表现。中医学历代医家对其病机认识不断深化，确立了肾性水肿的核心病机总属“脾肾亏虚、三焦气化失司”。在漫长的中医临床实践中，地域环境差异对该病的病理演变轨迹与中医临床决策产生了极其深远的影响。本研究通过系统梳理历代文献，融合中医“因地制宜”的等经典理论、现代环境科学观点，探讨南北方肾性水肿在病理演变规律、治法方药偏倚及流派经验传承上的异同。深度剖析了南方湿热地候下“气阴双补、清热化湿”与北方高寒地候下“重剂温阳、开玄化气”的显著地域辨治特色，构建南北方辨治差异的理论框架。

Abstract: Renal edema is a core clinical manifestation that is highly prevalent and refractory during the progression of various primary and secondary renal diseases. Successive generations of Traditional Chinese Medicine (TCM) physicians have continuously deepened their understanding of this condition, establishing that its core pathogenesis fundamentally lies in the “deficiency of the spleen and kidney, and the dysfunction of Qi transformation in the Sanjiao (Triple Energizer).” Throughout the extensive clinical practice of TCM, differences in regional environments have exerted a profound impact on the trajectory of pathological evolution and clinical decision-making for this disease. By systematically reviewing historical literature and integrating the classic TCM theory of “adapting treatment to local conditions” with modern environmental science perspectives, this study investigates the similarities and differences in pathological evolution patterns, therapeutic strategies, prescription preferences, and the inheritance of medical schools’ experiences regarding renal edema in northern and southern China. Furthermore, it provides an in-depth analysis of the distinct regional diagnostic and therapeutic characteristics—specifically, “supplementing both Qi and Yin, alongside clearing heat and resolving dampness” in the southern damp-heat climate, versus “warming Yang with heavy prescriptions, unblocking Xuanfu (sweat pores) and transforming Qi” in the northern frigid climate. Consequently, a theoretical framework for the North-South variations in syndrome differentiation and treatment is constructed.