从“因寒制宜”探析寒地劳淋的辨治思路

Exploring the Differentiation and Treatment Approach of Strangury Due to Strain in Cold Regions from the Perspective of “Treatment According to Cold”

摘要: 寒地具有高寒、多风、偏燥的地域气候特征，久居寒地之人形成了“寒藏阳潜、外寒内热”的特殊体质基础。劳淋(反复发作性尿路感染)为寒地女性的常见病、多发病，其发病与寒地气候密切相关，呈现“遇寒即发、缠绵难愈”的显著特点，与普通劳淋“遇劳即发”有所不同，具有鲜明的寒淋特征。本文基于寒地地域医学理论，结合196例寒地成年女性劳淋患者的临床资料分析及典型验案，系统探讨寒地劳淋的病因病机特点，提出“阳虚为本、湿热为标、寒热错杂、虚实夹杂”的病机认识，并总结“因寒制宜”的辨治思路，强调温阳与清利并用、寒热共投、升降相因的治法原则，以期为寒地劳淋的中医药辨治提供参考。

Abstract: Cold regions are characterized by a regional climate of severe cold, frequent wind, and relative dryness. People who have long resided in cold regions have developed a special constitutional foundation of “cold storing and yang concealed, external cold with internal heat”. Strangury due to strain (recurrent urinary tract infection) is a common and frequently occurring disease among women in cold regions. Its onset is closely related to the cold-region climate and shows the distinctive feature of “onset upon exposure to cold, protracted and difficult to cure”, which differs from the “onset upon fatigue” of ordinary strangury due to strain and bears clear characteristics of cold strangury. Based on the regional medical theory of cold regions, combined with an analysis of the clinical data of 196 adult female patients with strangury due to strain in cold regions and typical proven cases, this paper systematically explores the etiological and pathogenetic characteristics of strangury due to strain in cold regions, proposes the pathogenetic understanding of “yang deficiency as the root, damp-heat as the branch, intermingled cold and heat, intermingled deficiency and excess”, and summarizes the differentiation and treatment approach of “treatment according to cold”, emphasizing the treatment principles of combining warming yang with clearing and draining, administering cold and heat together, and coordinating ascent and descent, in order to provide a reference for the TCM differentiation and treatment of strangury due to strain in cold regions.