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女子得怪病,看到水就小便失禁-
女子得怪病,看到水就小便失禁

女子得怪病,看到水就小便失禁

[病案]谢某,女,30岁。1979年9月26日初诊。二年前分娩,胞衣滞留,经处理约三小时胎盘下,汗出湿被,当时房间冷,自感身寒,此后感腰以下冷痛,如坐水中,少腹重坠,小便失禁。凡逢下雨,或闻水声,或见小儿撒尿,或洗手洗脸,或想到水,甚至别人议论水,则小便不能控制,即自行排出。病已二年,曾多次去医院检查未见异常,服药无效。患者神疲乏力,面目无华,形寒,经水、胃纳正常,苔薄白,脉沉虚弦。

[治则]温脾补肾祛湿。

[方药]云茯苓20克,炒白术60克,炙甘草20克,干姜15克,制附子20克。服3剂药后,腰以下冷痛除,尿意已能控制;原方加益智仁30克,乌药12克,又服3剂,病愈。随访未见复发。

[评析]患者产时受冷,下焦虚寒,寒湿着而下去,故腰以下冷痛;肾阳虚惫,膀胱失约故小便失禁。治疗宜甘姜苓术汤(又名肾着汤)治之。《金匮要略》云:“肾着之病,其人身体重,腰中冷,如坐水中,形如水状,反不渴,小便自利,饮食如故,病属下焦,身劳汗出,衣里冷湿,久久得之,腰以下冷痛,腹重如带五千钱,甘姜苓术汤主之。”病虽在肾腑,但治疗正如尤在泾云:“故其治法,不在温肾以散寒,而在燠土以胜水。”用炙甘草、干姜,茯苓,白术,制附子温脾以壮肾,取暖土缩泉以制水,脾肾兼顾,膀胱得以制约,功能恢复,故病愈。

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