The method of distributing, eliminating and draining is developed by therapeutic therapists on the basis of inheriting the academic ideas of the Nei Jing and the clinical experience of the ancients. There are principle hints in the Nei Jing on the characteristics and principles of action of medicines for damp-warm diseases, such as the Su Wen Zhi Zhen Yao Da Lun, which says: “When dampness is lewd within, the treatment is bitter-heat, accompanied by acid and light, with bitter dryness and light drainage.” Zhang Zhongjing applied the theories of the Nei Jing to clinical practice, such as the combination of Feng Sheng, Qing Hua, and Seepage methods to treat a variety of dampness, with formulas such as Ma Huang Jia Jie Tang, Ma Xing Coixi Gan Tang, and Ma Huang Lian Qiao Chiaotou Tang, etc., in which the combination of formulas contains the prototype of the method of dispersing and draining. The formula of Xiao Chai Hu Tang was established as a representative formula for reconciling half of the surface and half of the interior of Shao Yang, and Ye Tianshi said in the chapter on warmth and fever in external sensation: “He is reconciling half of the surface and interior of the body, but this is dividing and eliminating the upper and lower potentials, changing the method with the evidence, or as in the case of warm gall bladder soup, the drainage.” The academic idea of “dividing and eliminating the up and down potential and changing the method according to the evidence” was put forward, which pioneered the trend of using the method of dividing and eliminating and draining to treat damp-heat illnesses, and was followed by many doctors, such as Yu Genchu and Wu Jutong, who played a lot in clinical treatment prescriptions. In fact, the method of division, elimination and drainage is not only applicable to the treatment of external damp-heat disease, kidney disease can also be its method of application and adaptations. We talk about our personal experience on the application of the method of kidney disease.
First, the concept of the method of treatment
The connotation of division and elimination, division: that is, separate, separate; elimination: that is, eliminate, dissipate. The division of elimination, that is, the division of the disease evil dissipation, or separate the method of dissipation. Specifically, the method of division and elimination includes two aspects. At present, the main methods commonly used in clinical practice are the front and back (two bowels) method of elimination, the method of elimination of tables and lining, the method of elimination of up and down, the method of elimination of three jiao, the method of elimination of internal organs, etc. As long as the method of eliminating evil from different parts of the body at the same time, it can be considered the method of elimination of division. The second is the method of elimination of the disease, such as wind-heat bifurcation method, moisture-heat bifurcation method, Ye has dispersed wind in the heat outside, penetrate moisture in the heat of the theory, which is particularly important to moisture-heat bifurcation method. Because wet is Yin, stagnant and tangled, combined with heat, difficult to separate and difficult to solve. Ye Tianshi in the “clinical guide to medical cases” wet door a case pointed out: “When the first aromatic awakening, light penetration of the orifice, the scourge of dampness and turbidity can be divided and eliminated.” It can be seen, Ye’s words also include the division and division of disease elimination of evil methods. The connotation of walk and drainage, walk refers to walking, flow does not live; drainage refers to make the real evil outwardly leaking, outwardly dispersed. The meaning of “walk” is to make the disease and evil out of the body through the means of “moving” and “passing”. Specifically, it also includes the promotion of unrestricted qi flow, opening up the stagnation, clearing the three jiao, clearing heat and directing stagnation, so that on the one hand, the path of discharge of the evil is smooth and the evil is dispelled; on the other hand, to remove its attachment, so that the evil is thin and easy to dissipate.
Therefore, the word “elimination” and “drainage” in the method of division of elimination and drainage refers to the elimination of evil qi, so that it can be leaked out of the body. The method of elimination and drainage is to point out that the method of elimination of evil is not one way, but to take advantage of the situation, the application of mobile products from different parts of the evil to give a way out.
Second, the treatment of damp-heat in kidney disease and the method of “division and elimination of drainage
The pathogenesis of kidney disease is complex, there is a combination of internal and external evil caused by the disease, there are organs and Qi and blood together by the evil, but always inseparable from the damp-heat. With the continuous in-depth study of Chinese medicine on kidney disease, the relationship between kidney disease and damp-heat has received more and more attention, damp-heat as the main pathogenesis throughout the development of kidney disease, has been unanimously agreed, many doctors, including many famous Chinese medicine nephrologists believe that damp-heat stagnation is the main pathogenesis of kidney disease, kidney disease damp-heat evidence is no longer regarded as the standard evidence, mixed evidence, but as one of the main types of evidence. However, how to remove the damp-heat evil in kidney disease is an important clinical problem. The treatment of damp-heat disease is based on the general principle of resolving dampness and clearing heat, and the application of the method of “division, elimination and drainage” can remove the evil of damp-heat in multiple ways, according to the method of “division, elimination and drainage” by Ye Tianshi, which can be used to open up, promote the middle and guide the lower method. Although the damp-heat pathogenesis through the whole process of kidney disease, but in different periods should be based on the damp-heat focus on the invasion of the internal organs, damp and heat which is lighter or heavier, such as evidence-based treatment.
Damp-heat bias in the upper jiao, available to dredge the wind to promote the lung, aromatic dampness medicine such drugs to promote the lung gas, dredge the muscle coup, so that the coup is open, the evil from the table solution. Commonly used drugs are patchouli, dahurica, sage, Elsholtzia, etc. Almonds have the function of propagating the lung and can also be included in this category, with the addition and reduction of poria, zedoary, adzuki bean, motherwort, cicada molasses and other lightly permeable dampness and wind dispelling products.
Damp-heat favoring the middle jiao, with the pungent open bitter method to remove the evil of damp-heat. Commonly used pungent, bitter warm drugs are: half summer, dry ginger, thick park, atractylodes, sand, cardamom kernel, grass fruit, Chen Pi, large belly skin, etc.. Commonly used bitter-cold drugs include: Scutellaria baicalensis, Huanglian, Lianjia, Gardenia, etc. Because there are differences between dampness and heat, dampness and heat, and heat over dampness, so the clinical selection of drugs should be based on the severity of the dampness and heat. Dampness is heavier than heat, should take the pungent and bitter warmth of the product, open the dampness, dampness to go then heat does not exist alone. Fang can be used Huo Xiang Zheng Qi San, flat stomach, San Ren Tang, etc.; damp-heat and heavy, should be pungent warm, bitter warm, bitter cold and use. This type of symptoms although wet and heat, but should consider the invisible heat easy to clear and sticky wet difficult to get rid of, the group should still be hard to warm drugs and discretionary use of bitter cold, can choose Gan Lu disinfectant Dan. Heat is heavier than damp, you can reuse bitter cold, or even pungent cold gypsum, salty cold cold cold water stone can also be added, you can choose white tiger plus atractylodes, etc.
Damp-heat in the lower jiao with light percolation of damp products, so that the damp evil downward, from the urine and relief. Commonly used drugs are: talc, tongcao, pig ling, zedoary, carthamus, poria, coix seeds, etc. If the heat evil is heavy, then you should add the bitter cold and clear products to enhance its power to drain the heat, commonly used drugs such as gardenia. Sifu Wan and Gentian Diarrhea Liver Soup are both important prescriptions for the treatment of damp-heat in the lower jiao.
Damp-heat disease lesion site although there is a difference between the upper, middle and lower three Jiao part, but because of its dense gas, generally speaking, more diffuse three Jiao potential, so the treatment should be its central part and take into account the three Jiao, that is, the above three methods and use, in order to make the damp-heat evil and eliminate.
Kidney disease damp-heat, often damp and spleen trapped state, so the treatment of kidney disease damp-heat disease in the group formula, the spleen medicine is essential. Commonly used drugs are atractylodes, poria, coix seeds, etc. If the symptoms of damp-heat disease appear in the stomach dullness and cachexia, you can add discretion to wake up the stomach and eliminate the products, commonly used drugs are sand, cardamom, hawthorn, Shen Qu, malt, etc.. Dampness is sticky, most likely to block the three jiao qi, so commonly used to regulate qi and move stagnant products. Commonly used drugs are Hou Pu, Citrus aurantium, Daji Pi, Su Stem, Huo Xiang Stem and other drugs with the flow of this is the meaning of walking away from the drainage.
The method of division and elimination is the basic method of treatment of kidney disease damp-heat disease, no more than the pungent Xuan Fang Hua, pungent open bitter down, light percolation of damp three types of drugs used in combination to take into account the three jiao, and at the same time with the spleen to wake up the stomach, regulate qi and promote stagnation of the product. With the right method, the dampness and heat will be eliminated, the spleen will be restored, and the Qi of the three jiao will be naturally smooth and the kidney disease will be improved.
Third, the treatment of dampness in kidney disease and the method of “eliminating and draining”
1, the role of dampness in the process of kidney disease suffering from edema Guange (modern medicine of nephrotic syndrome, kidney failure), etc., can appear drowning turbid stay and not go to the state. The “Nei Jing” points out that “turbid Yin to the six provinces, out of the lower orifices.” Weakness of the spleen and kidneys, unfavorable qi-chemistry of the three jiao, water and dampness stop inside, the clear does not rise and leak, the turbid does not descend and gather inside, the clear and turbid interdependence, for a long time, the breeding and dampness and turbidity of the problem. Originally when the urine from the excretion of turbid yin, but not from the lower orifice and out, stay and for harm, is damp turbidity. Dampness and turbidity are obscene and turbid in nature, the patient often has a dull complexion and a cloudy tongue; dampness and turbidity are poisonous and can lead to nausea, vomiting, sticky mouth, and even bad breath or urine smell; dampness and turbidity trap the middle jiao and block the qi flow, then you can see nausea and vomiting, dullness and anorexia, constipation or loose abdomen; if dampness and turbidity carry phlegm to disturb the clear orifices, then you can see restlessness, photophobia and drowsiness, or even convulsions; if dampness and turbidity turn into heat and enter the camp and move blood, then you can see dizziness and tantalizing speech, or even nose If dampness and turbidity turn into heat and enter the camp and move the blood, you will see dullness and tampering, or even nose, teeth, blood in urine, etc.; if dampness and turbidity overflow the skin, you will see itchy skin and dander. A number of animal tests and clinical reports show that treatment with prescriptions such as drainage of turbidity can cause a significant decrease in blood creatinine and urea nitrogen, and the symptoms such as turbidity upstream and clear turbidity are also reduced, and the two are positively correlated. Therefore, dampness and turbidity in the development of chronic kidney disease is an important factor in the deterioration of kidney function, but also as a result of its development.
2, chronic kidney disease dampness treatment method chronic kidney disease dampness as an important pathogenic factors and pathological products, although often formed on the basis of the weakness of the internal organs, but after all, belong to the real evil, so should be based on the Suwen. Yin and Yang Ying Xiang Dazheng” said: “…… its high, and thus crossed; its lower, led and exhausted; full, diarrhea in the internal; …… in fact, dispersed and diarrhea” principle of treatment. The treatment principle of “take advantage of the situation” to get rid of the evil out. The specific includes “chemistry”, “dispersion”, “drainage” and “benefit”.
Aromatic dampness: that is, the use of aromatic and pungent drugs to dispel dampness, eliminate turbidity, harmonize the stomach and subdue rebelliousness, transform dampness and turbidity, and smooth the qi flow. Commonly used formulas: Huanglian Wenzhi Tang, Xiao Hanxia plus Fu Ling Tang, Huopu Xia Ling Tang, Ganlu Disinfectant Dan, etc. Others: If dampness is blocking the clear orifices, use Suhexiang Pill and Yushu Dan to aromatize dampness and open the orifices and awaken the mind.
Pungent open and bitter descend, promote the flow of Qi: cold, warm and hard are used together to get rid of the evil of cold and heat in the body, and restore the normal order of the body’s ascending and descending. For example, Su Ye and Wu Zhu Li with Huang Lian can lower the turbidity and stomach, treating nausea and acid swallowing; Shi Calamus with Yu Jin can transform dampness and open the heart, treating dampness and clouding the heart and dullness of the mind. Commonly used formulas: Han Xia Di Xuan Xin Tang, Huang Lian Tang, San Ren Tang, Calamus Yu Jin Tang, etc.
Percolating and dipping dampness: applying lightly percolating and clearing drugs to facilitate the flow of dampness and turbidity out of the body by distributing the urine. Commonly used formulas: Stomach Ling Tang, Dioscorea and Clear Drink, Wu Ling San, etc.
To lower dampness and turbidity in the internal organs: use drugs with laxative and laxative effects to promote the release of turbid evil from the stool. For the treatment of chronic renal failure, the treatment of the bowels is commonly used in clinical practice. Commonly used formulas: Da Chai Hu Tang, Da Huang and Zi Tang, Wen Shen Tang, etc. Commonly used drugs: rhubarb, mangosteen, cassia, etc.
In the application of the elimination of dampness and turbidity at the same time, but also three factors, pay attention to the combination, according to the consideration of the common nature of turbidity, the appropriate combination of complementary adjuvant drugs, etc., to improve the effectiveness. Such as turbid evil has heavy turbidity difficult to dispel, astringent stagnation difficult to remove the nature, can be appropriately matched with moving drugs to move, drainage drugs to drain the benefit of. For example, chronic kidney disease patients, often have spleen and kidney deficiency evidence, not a single drainage, when the turbid evil at the same time to cultivate the spleen and kidney, to remove evil and help.
In fact, kidney disease clinical these methods are often used at the same time, in order to achieve the purpose of different parts of the body at the same time to get rid of the dampness of the evil, suggesting that the elimination of dampness is not a way, but to take advantage of the situation, the application of flowing products from different parts of the dampness to the way out, such as before and after the division of the benefit, facilitate urination, pass stool, before and after the division of elimination, aromatic pungent open bitter down and use, support the right to drive away evil, or even several methods applied at the same time. Other scholars proposed the treatment of chronic renal insufficiency “three maintenance of the kidney” treatment ideas, divided into up and down with the same treatment, table with the same treatment, before and after the same treatment, in fact, are the application of the method of “division and elimination of drainage” in kidney disease.
In short, although the method of division and elimination and drainage is one of the important treatment methods of warm diseases, it is not only applicable to the treatment of external damp-heat diseases, but also can be applied to kidney diseases. Not only applied to the treatment of damp-heat in kidney disease, but also can be applied to the treatment of dampness and turbidity in chronic kidney disease, so it should attract our further attention and research.