摘要
特发性膜性肾病是常见肾脏疾病,以水肿为多发临床表现,中医多从水肿论治。随着现代诊疗技术的提高和对本病生理病理的不断认识,循证经验的积累,中医从传统的辨证论治、新兴的微观辨证、激素分段而治、单药成方的使用等方面出发,结合膜性肾病病程长、水肿反复难消等特点,认为本病属"阴水"范畴。阴水以扶正治疗为主,健脾温肾,辅以活血、利水、养阴、祛瘀等法。对于临床仅有蛋白尿表现的患者,往往无明确辨证,根据中医理论,可归结为脾不摄精,肾失封藏,进而精微下泄,从脾肾两脏辨证入手,配合激素分段而治:诱导阶段,使用温肾补气升阳之品;有效阶段,清热养阴是基本方略;撤减阶段,益气助阳渐行渐进;维持阶段,"温肾助阳缓图缓减",活血化瘀之法贯穿始终。同时,应重视微观辨证和单药、成药的应用。
Idiopathic membranous nephropathy is a common kidney disease with edema as usual clinical manifestation.Traditional Chinese medicine treats that usually from perspective of edema.With the improvement of modern diagnosis and treatment technology and the continuous understanding of the physiology and pathology of this disease,the accumulation of evidence-based experience,Chinese medicine treatment of the disease develops from the traditional dialectical treatment,emerging micro-dialectical,hormone segmentation and treatment and the use of single-agent prescription,etc.It is considered that the combination of membranous nephropathy has a long course of disease and edema is difficult to eliminate,and it belongs to the category of "Yin Shui".The treatment of Yin Shui is mainly by tonifying patients'Zheng Qi,tonifying Spleen and warm kidney,activating blood circulation,resolving Water,nourishing Yin and dispelling Phlegm.For patients with only clinical manifestations of proteinuria,there is often difficult in syndrome differentiation.According to the theory of traditional Chinese medicine,it can be attributed to the Spleen not controling the essence and the Kidney dysfunction in storing essence.Thus,the essence is lost by down-ward flowing.Therefore,the treatment should start from the syndrome differentiation and the combination of TCM with hormone treatment.In the inductive phase,methods of warming Kidney,tonifying Qi and tonifying Yang can be used.In the effective stage,clearing Heat and nourishing Yin is the basic strategy.In the withdrawal phase,benefit Qi and Yang can be gradually applied.In the maintenance stage, warming Kidney and tonifying Yang should be used to cure the disease.During the whole process,the method of promoting blood circulation and removing blood stasis should be used.At the same time,attention should be paid to the application of microscopic syndrome differentiation and single flavor as well as the patent TCM medicines.
作者
李超
LI Chao(Changshu TCM Hospital,Changshu Zhejiang China 215500)
出处
《中医学报》
CAS
2018年第12期2370-2373,共4页
Acta Chinese Medicine
关键词
特发性膜性肾病
辨证论治
微观辨证
中医药
idiopathic membranous nephropathy
syndrome differentiation
microscopic syndrome differentiation
traditional Chinese medicine
