泌尿系结石，为现代多发病，是肾结石、输尿管结石、膀胱结石、尿道结石的总称，常表现为腰部疼痛不适、排尿时尿流中断、尿道窘迫疼痛、小便淋漓不尽、点滴而出、小便黄或夹血块，或尿中夹有砂石。中医称其为“石淋”，多虚实夹杂，初期以湿热、气滞、血瘀实证为主，治疗以清热利湿、行气导滞、活血化瘀；日久病程迁延至脾肾两虚，膀胱气化无力，治疗以健脾益肾，助膀胱气化。本病致死率不高，但其产生的剧痛及其他不良反应会严重降低患者的生活质量，给患者带来极大的痛苦。李智杰教授从事中医临床和科研工作30余年，对石淋的诊治经验丰富，见解独特。根据石头的大小、部位、是否处于活动期运用不同的治法，配合饮食运动疗法，促进结石排出体外。 Urolithiasis, a common disease in modern times, is a general term for kidney stones, ureteral stones, bladder stones, and urethral stones. It is often manifested as pain and discomfort in the waist, interruption of urinary flow during urination, urethral distress, pain, dripping urine, yellow urine, or blood clots, or sand and stones in the urine. Chinese medicine calls it “urolithiasis”, which is often characterized by a mixture of deficiency and excess. At the initial stage, it is mainly characterized by dampness and heat, qi stagnation, and blood stasis. The treatment focuses on clearing heat and promoting dampness, promoting qi to guide stagnation, and promoting blood circulation and resolving stasis; the long-term course of the disease extends to the deficiency of both the spleen and kidney, and the inability of bladder gasification. The treatment is to strengthen the spleen, benefit the kidney, and assist bladder gasification. The mortality rate of this disease is not high, but the severe pain and other adverse reactions it produces can seriously reduce the quality of life of patients and bring great pain to them. Professor Li Zhijie has been engaged in clinical and scientific research in traditional Chinese medicine for more than 30 years, with rich experience and unique insights in the diagnosis and treatment of urolithiasis. According to the size, location, and whether the stone is in an active phase, different treatments are used, combined with diet and exercise therapy, to promote the removal of stones from the body.
泌尿系结石，为现代多发病，是肾结石、输尿管结石、膀胱结石、尿道结石的总称，常表现为腰部疼痛不适、排尿时尿流中断、尿道窘迫疼痛、小便淋漓不尽、点滴而出、小便黄或夹血块，或尿中夹有砂石。中医称其为“石淋”，多虚实夹杂，初期以湿热、气滞、血瘀实证为主，治疗以清热利湿、行气导滞、活血化瘀；日久病程迁延至脾肾两虚，膀胱气化无力，治疗以健脾益肾，助膀胱气化。本病致死率不高，但其产生的剧痛及其他不良反应会严重降低患者的生活质量，给患者带来极大的痛苦。李智杰教授从事中医临床和科研工作30余年，对石淋的诊治经验丰富，见解独特。根据石头的大小、部位、是否处于活动期运用不同的治法，配合饮食运动疗法，促进结石排出体外。
泌尿系结石，中医药，临床经验
Yali Cao1, Zhijie Li2*
1Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan Hubei
2Hall of Famous Doctors, Wuhan Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hubei
Received: Mar. 20th, 2023; accepted: May 2nd, 2023; published: May 12th, 2023
Urolithiasis, a common disease in modern times, is a general term for kidney stones, ureteral stones, bladder stones, and urethral stones. It is often manifested as pain and discomfort in the waist, interruption of urinary flow during urination, urethral distress, pain, dripping urine, yellow urine, or blood clots, or sand and stones in the urine. Chinese medicine calls it “urolithiasis”, which is often characterized by a mixture of deficiency and excess. At the initial stage, it is mainly characterized by dampness and heat, qi stagnation, and blood stasis. The treatment focuses on clearing heat and promoting dampness, promoting qi to guide stagnation, and promoting blood circulation and resolving stasis; the long-term course of the disease extends to the deficiency of both the spleen and kidney, and the inability of bladder gasification. The treatment is to strengthen the spleen, benefit the kidney, and assist bladder gasification. The mortality rate of this disease is not high, but the severe pain and other adverse reactions it produces can seriously reduce the quality of life of patients and bring great pain to them. Professor Li Zhijie has been engaged in clinical and scientific research in traditional Chinese medicine for more than 30 years, with rich experience and unique insights in the diagnosis and treatment of urolithiasis. According to the size, location, and whether the stone is in an active phase, different treatments are used, combined with diet and exercise therapy, to promote the removal of stones from the body.
Keywords:Urinary Calculi, Traditional Chinese Medicine, Clinical Experience
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“淋”之病名，始见于《内经》，书中指出淋证为小便淋漓不畅，甚或闭阻不通之病证。汉代张仲景在《金贵要略》中称其为淋秘，将其病机归为热在下焦。《中藏经》根据淋证临床表现不同，提出了淋有冷、热、气、劳、膏、砂、虚、实八种，乃为淋证临床分类雏形 [
泌尿系结石大小不一。中医治疗通常以0.8 cm与1 cm为界限。结石直径小于0.8 cm根据其症状、体征、舌脉辨别其证型属湿热型、气滞型、血瘀型或脾肾亏虚型，对证施治以清热利湿、行气导滞、活血化瘀、补脾益肾，使结石随尿液排出体外。结石直径0.8~1 cm之间则需根据病情谨慎使用中医疗法。若患者疼痛不甚，病情进展缓慢，其治疗可在上述辨证施治的基础上，通过扩张输尿管、增加输尿管蠕动排出沙石。李师根据多年临床经验运用地龙扩张输尿管、重用清热利湿药物增加输尿管蠕动以排泌尿系结石常可见良效。地龙属虫类药物，为血肉有情之品，性善走窜，搜风剔络。具有清热定惊、通络、平喘、利尿功效，归肝、脾、膀胱经 [
泌尿系结石根据位置分上尿路结石和下尿路结石。上尿路结石包括肾结石、输尿管结石，下尿路结石包括膀胱结石和尿道结石 [
泌尿系结石因肾与膀胱气化不利，湿热蕴结下焦，煎熬尿液日久聚沙成石。初起结石较小时多无明显不适症状，仅在体检中发现存在结石，此期可通过生活习惯的调整，运动饮食配合使结石排出体外，无需特殊治疗。当结石逐渐变大，阻滞尿道，则出现结石所处部位疼痛不适感，此时体内结石处于活动期，为结石治疗的最佳时期。
泌尿系结石成分主要以草酸钙为主 [
石淋之为病，因湿热蕴结下焦，肾与膀胱气化不利，煎熬尿液，日积月累结为沙石。其治疗以八正散为基础方加减。以八正散之瞿麦、萹蓄为君，清热利水通淋。臣以石淋要药“三金”——海金沙、金钱草、鸡内金清热利湿化石。根据现代药理研究证明，三金之金钱草、海金沙、鸡内金，具有清热利湿排石之功。而生鸡内金又兼具化石之效，如《医学衷中参西录》曰：“鸡内金为鸡之脾胃，中有瓦石铜铁皆能消化，其善化有形瘀积” [
初诊：患者李某，男性，50岁。2022.07.20首诊。正值大暑，自诉左侧腰部胀痛2周，加重2天。患者诉2周前无明显诱因出现左侧腰部胀痛，活动后加重，未予重视。2天前出现排尿涩痛感，尿道窘迫疼痛，大便秘结，纳一般，夜寐安，自诉既往肾结石病史。舌苔黄厚腻，脉滑。泌尿系彩超：双肾结石，左肾多发(0.4*0.8 cm)。处方：瞿麦10 g，萹蓄10 g，海金沙10 g，金钱草10 g，鸡内金10 g，泽泻10 g，桃仁6 g，地龙10 g，白茅根15 g，仙鹤草15 g，白及6 g，太子参10 g，桔梗10 g，枳实10 g，肉桂3 g，茵陈10 g，紫花地丁10 g。中药汤剂7付，日1付，水煎取汁400 mL，饭后代茶饮，频频温服。并嘱患者进行适当跳绳等运动。
复诊：2022.08.01复诊，自诉服药一周后，再未出现腰部疼痛及排小便不适感，大便每日一解，纳一般，夜寐安，舌红，苔黄厚，脉微滑。泌尿系彩超：未见异常。处方：上方去海金沙、金钱草、鸡内金、紫花地丁、仙鹤草、加巴戟天10 g。中药汤剂7付，日1付，水煎取汁400 mL，饭后分两次温服。嘱患者3个月后复查泌尿系彩超。
三诊：2022.10.28就诊，复查泌尿系彩超：未见异常。
按语：本案患者病发于暑热季节，又常年生活在武汉长江中游地区，气候湿润，夏季酷热，暑热蒸腾，湿热交结，侵袭人体，易导致湿热邪气蕴结下焦，肾与膀胱气化不利，津液排出不畅，尿液潴留膀胱，湿热之邪煎熬之而生砂石，发为石淋。又因石阻气机，气机不畅，血行淤滞，气滞血瘀，不通则痛。患者为中年男性，未见虚象，且腰部疼痛急迫，急则治标，故治以通淋化石，清热利湿。首诊以瞿麦、萹蓄为君药，清热利尿通淋；臣以三金——海金沙、金钱草、鸡内金通淋化石，泽泻、茵陈、白茅根助君药清热利湿通淋；佐以肉桂助膀胱气化，桔梗宣肺，取提壶揭盖之意，再以枳实行气导滞，桃仁活血化瘀，地龙舒筋通络以扩张输尿管，白及保护黏膜，仙鹤草收敛止血以防止出血，紫花地丁清热解毒，消炎止痛，太子参益气健脾，驱邪而不伤正，诸药合用共奏清热利湿，通淋化石之功。二诊时泌尿系彩超示结石已排出，故去排石药海金沙、金钱草、鸡内金；未见疼痛遂去消炎止痛之紫花地丁；未见出血，去收敛止血药仙鹤草；患者纳一般，舌苔黄厚，脉微滑，体内仍留湿热之邪，故留瞿麦、萹蓄、泽泻、白茅根、茵陈等清热祛湿之品，加巴戟天温补肾阳以巩固疗效。李教授以清热利湿，通淋化石为基本大法，随证加减，调理半月后，患者恢复健康。三个月后复查泌尿系彩超，未见结石。
随着生活方式的改变，石淋已成为现代常见病、多发病，本病致死率不高，但其产生的剧痛及不良反应严重降低了患者的生活质量。李教授结合自身多年临床经验，根据石头的大小、部位、是否处于活动期运用不同的治法。通过中医药治疗清热利湿、行气导滞、活血化瘀、健脾补肾；药食结合，适当运动，结合李师多年临床经验，运用地龙扩张输尿管，桔梗、杏仁宣肺以“提壶揭盖”，白及保护泌尿系黏膜，仙鹤草收敛止血，紫花地丁清热解毒止痛，诸药合用使气机顺畅、管道通利，砂石才可顺利排出。
曹亚丽,李智杰. 李智杰教授治疗泌尿系结石的经验Professor Li Zhijie’s Experience in Treating Urinary Calculi[J]. 中医学, 2023, 12(05): 919-923. https://doi.org/10.12677/TCM.2023.125136