武汉解放大道肾病科老中医门诊部：糖尿病肾病尿路感染双下肢水肿尿频急痛中药怎么治？

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武汉解放大道肾病科老中医门诊部：糖尿病肾病尿路感染双下肢水肿尿频急痛中药怎么治?糖尿病肾病合并尿路感染西医多予皮下注射胰岛素、口服火把花根片、马来酸依那普利等，然不少仍尿常规提示蛋白阳性，逐渐出现血肌酐升高，多有：精神较差，双下肢水肿，尿频、尿急，伴尿痛、尿灼热，乏力、皮肤瘙痒。大便先干后溏。双下肢中度水肿。舌红，苔黄腻，脉弦滑。中医认为这类人群久病伤津耗气，气血生化不足，则面色少华、乏力。久病入肾病，精微外邪而致肾精亏损，最终肾气衰败，清浊不分而逆乱，水湿毒潴留，故见血肌酐升高。患者多食辛热肥甘之品，或嗜酒过度，酿成湿热，故舌红、苔黄腻。湿热下注膀胱，或下阴不洁，湿热秽浊毒邪侵入膀胱，湿热蕴结膀胱，而致气化不利，出现尿频、尿急、尿痛、尿灼热，发为热淋。


中医诊断：这类糖尿病肾病合并尿路感染属气阴两虚兼湿热之证。
治法：清热利湿通淋。
处方：柴芩汤加减。
方药组成：柴胡、黄芩、石苇、车前草、律草、木香、黄柏、苍术、茯苓、泽泻、太子参、黄芪、小蓟、白茅根、银花藤、马齿苋、川芎、熟大黄。可开中药7剂，水煎服，日一剂，分早中晚饭后30分钟温服。
若方证相合，一般药后尿路刺激征、下肢水肿等会有改善，若仍觉乏力，时有头昏、腰部酸痛。大便稀。舌暗，苔黄，脉弦细。中医诊断：属热像消退而见血瘀征象，治法：益气养阴、活血化瘀。处方：归芪地黄汤加减，方药组成：当归、黄芪、茯苓、泽泻、熟地黄、山药、山茱萸、牡丹皮、苍术、石苇、律草、白茅根、丹参、川芎、莪术，可开中药7剂，煎服法同前。
方解：
方中柴胡、黄芩共为君药，柴胡入少阳经，疏肝行气泄热，同时配伍黄芩，清少阳热邪。西南环境湿热，其民多有嗜食辛辣的习惯，故患者湿热体质居多，湿热蕴久成毒，非用重剂清热解毒利湿之剂方可显效[6]，故予石苇、车前草、律草、小蓟、白茅根、马齿苋、银花藤等，并加入木香、川芎，一者行气调畅气机，助郁热从外疏解，二者木香、川芎性温，避免过用清热利湿药，导致气机郁滞、邪气留恋，以上共为臣药。佐以黄柏、苍术燥湿，茯苓、泽泻淡渗利湿，熟大黄从肠腑泄热祛湿。若素体气阴两虚，可加太子参、黄芪益气养阴。
地址：武汉诚顺和中医门诊部(诚顺和中医馆)
咨询预约：027-87878466，微信(手机同号)：15607131150

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