慢性肾脏病的病性是本虚标实,虚实夹杂,其中脾肾阳气亏虚为本,风邪、湿浊、瘀血为标,虚实夹杂既有因虚致实,又有因实致虚,两者相互影响,以致恶性循环.阳气在人体内起着温煦、卫外、推动、固摄、气化的重要作用,故历代医家常常重视阳气,逐步形成"重阳思想"理论."重阳思想"理论源于《黄帝内经》,继承发展于张仲景、张景岳,推崇升华于郑钦安、祝味菊,是中医认识疾病、治疗疾病的重要思想理论之一,其核心内涵是强调阳气对生命活动和机体健康的主导作用.基于"重阳思想"理论,结合慢性肾脏病脾肾阳虚、湿浊瘀阻之病机关键,治以扶阳法为主,以固护人体之根本,包括温补阳气、顾护阳气、通达阳气,即临床上重视温补脾肾阳气固其本,祛风散邪固表、利水渗湿化浊、活血化瘀通络治其标,以顾护被损之阳气,通达被遏之阳气,恢复肾之开阖气化之机能,取得了较好临床效果.本文通过阐述"重阳思想"理论在治疗慢性肾脏病的应用体会,以供同道所参考.

"水郁折之"理论出自《黄帝内经》.肾在五行属水,因此水郁也可理解为肾郁,包括肾功能之郁和结构之郁两个方面.前者指肾中阴阳气血阻滞不通,导致功能受损;后者为玄府-肾络微观结构被有形之邪郁遏,二者相互影响,共同导致水饮、瘀血、痰浊等病理产物积聚,进一步加重"水郁",形成恶性循环."水郁折之"中的"折"有通的含义,具体治法包括通肾阳、通玄府、通肾络,即运用辛温宣散、化气利水法解决功能之郁;以升散通透、以清换浊法开玄府,濡润通补、化瘀通络法疏通肾络,解决结构之郁.诸法配合,随证治之,恢复肾主水、司开阖、主封藏等功能,则津液四布,精不外溢,气血通畅,肾性水肿自除.

传统卫气营血辨证将温病分为卫分证、气分证、营分证、血分证四个阶段,强调根据疾病的不同阶段进行治疗.本文通过阐述卫气同治理论,指出卫分证与气分证病机均属郁热在里,且温热之邪传变迅速,二者并无明确界限,因此温病初起常表现为卫气同病.治疗则不必拘泥于传统卫气营血序贯疗法而应用卫气同治理论,即在温病初起即采用辛散疏卫与清解气分合用的治疗方法,一方面应用辛散之品宣发郁热,透邪外出;另一方面要重视气分,疏卫同时配伍清气之品,截断病程进展.卫气同治理论指导温病诊疗具有药效力专,避免失治、误治;截断病程进展,未病先防;在外感热病治疗中贡献突出等优势.该理论包括火郁发之、分消走泄、抑邪扶正三个方面.

Objective: To study effects of radix bupleuri compound water extraction on prevention in rats with acute gastric ulcer.Methods: The model of acute gastric ulcer was established by indomethacin gavage(70mg/kg) to observe effects of radix bupleuri compound water extraction on prevention in rats with acute gastric ulcer.The ulcer index and inhibition ratio of ulcer were measured.The slices of gastric tissues were observed after HE staining.Nitric oxide(NO) and superoxide dismutase(SOD) in serum were measured by nitric oxide nitric oxide reductase assay and xanthine oxidase assay.Results: In Stillen group(100 mg/kg),low dose of radix bupleuri compound water extraction group(100 mg/kg) and high dose group(200 mg/kg),the ulcer indexs were decreased compared with those in model group(P<0.01).The ulcer inhibition ratios were 48 %,79 % and 80.9 %,and the activities of SOD in serum were decreased in drug-administrated groups(P<0.01).The content of NO of serum in radix bupleuri compound water extraction groups were diseased compared with those in model group(P<0.05).In model group,desquamated gastric mucosas were observed and necrosis in serious animals,hyperemia and edema with inflammatory cells infiltration in submucosa.Morphological changes were improved in drugs-administrated groups.Conclusions: Radix bupleuri compound water extraction can prevent for in rats with acute gastric ulcer.

Objective To study effects of radix bupleuri compound water extraction on prevention in rats with subacute gastric ulcer. Methods The model of subacute gastric ulcer was established by acetic acid to observe effects of radix bupleuri compound water extraction on therapeutical effect in rats with subacute gastric ulcer. The ulcer areas and healing ratio of ulcer were measured. The slices of gastric tissues were observed after HE staining. Nitric oxide (NO) and superoxide dismutase (SOD) in serum were measured by nitric oxide reductase assay and xanthine oxidase assay. Results In Stillen group (100 mg/kg), low dose of radix bupleuri compound water extraction group (100 mg/kg) and high dose group (200 mg/kg), the ulcer areas were decreased compared with those in model group (P<0.01). The ulcer inhibition ratios were 93.5%、40% and 92.9%, and the activities of SOD in serum were increased in drug-administrated groups (P<0.01). The content of NO of serum in radix bupleuri compound water extraction groups were increased compared with those in model group (P<0.05). In model group, deciduous and necrotic gastric mucosas with inflammatory cells infiltration were observed. Morphological changes were improved in drugs-administrated groups. Conclusion Radix bupleuri compound water extraction can be a therapeutical effect on the rats with subacute gastric ulcer.