The pattern differentiation method is the most representative part of the inheritance of the experience of renowned practitioners of traditional Chinese medicine, reflecting their clinical thinking characteristics. Among them, Professor LYU Renhe proposed and developed the theory of abdominal masses in the long-term diagnosis and treatment of kidney diseases. Based on his clinical experience, he formed the method of differentiation of Shenluozhengjia (tangible or intangible abdominal masses of kidney collaterals). This differentiation method is characterized by its simple and easy clinical application. Tangible or intangible abdominal masses of kidney collaterals refer to chronic kidney disease, which is based on the basic cause of kidney deficiency. External or internal pathogenic factors cannot be eliminated, and prolonged illness invades the kidney collaterals, causing pathological products, such as qi stagnation, blood stasis, phlegm dampness, heat toxin, and turbid toxin to stagnate in the kidney collaterals, resulting in damage to the kidney body and loss of kidney function. The basic pathogenesis is a deficiency of kidney qi and the formation of tangible or intangible abdominal masses of the kidney collaterals. During pattern differentiation, the type is determined by the deficiency, which is fixed, and the pattern is determined by the excess, which is constantly changing with the condition and can be combined. Furthermore, he summarized the dietary principles as having more essence and less coarseness, more milk and less meat, a phased diet, and the selection of the symptomatic diet. To inherit and improve the theory and clinical practice of the pattern differentiation theory of tangible or intangible abdominal masses of kidney collaterals, this article reviews and summarizes the unique pattern differentiation method of the kidney collateral pattern from the aspects of definition, theoretical origin, etiology and pathogenesis, differentiation and treatment, and regulation, providing a basis for forming suitable diagnosis and treatment method for clinical promotion.

摘要

中医治疗慢性肾脏病具有明显优势,但不同中医流派的临床辨证方法存在较大差异.其中,在对肾脏疾病的长期诊疗过程中,吕仁和教授提出并发展了癥瘕学说,并结合临床经验形成了肾络癥瘕辨证方法.辨证方法,是名老中医经验传承中最能体现其临床思辨特点的部分.慢性肾脏病在肾元亏虚的基础上,外感或内生邪气稽留不去,久病入络,造成气滞、血瘀、痰湿、热毒、浊毒等病理产物瘀滞于肾络,造成肾体受损、肾用失司,出现肾络癥瘕.慢性肾脏病基本病机为肾本虚、肾气不足,肾络癥瘕形成.辨证时重视虚损劳衰本虚证和八郁证标实证的变化及组合应用,在此基础上分别用主证候和兼证候辨本虚与标实,主证候固定不变,兼证候随病情不断变化可合并出现.总结患者饮食原则为多精少粗、多奶少肉、分期施膳和对症选膳.本文从定义、理论渊源、病因病机、辨证分治及调护方面,对独特的肾络癥瘕辨证方法进行了梳理和总结,为形成可供临床推广的适宜诊疗方法提供依据.