李小会教授从脾肾治疗顽固性蛋白尿经验探析  

Experience of Professor LI Xiaohui in Treating Refractory Proteinuria from Spleen and Kidney

作　　者：杨怡 李小会(指导) 屈杰[1] 陈丽名[1] YANG Yi;LI Xiaohui;QU Jie(Shaanxi University of Chinese Medicine,Shaanxi,Xianyang(712000),China;Affiliated Hospital of Shaanxi University of Chinese Medicine)

机构地区：[1]陕西中医药大学,陕西咸阳712000 [2]陕西中医药大学附属医院

出　　处：《浙江中医药大学学报》2020年第10期986-990,共5页Journal of Zhejiang Chinese Medical University

基　　金：陕西省自然科学基金项目(2019JM-107);陕西中医药大学“伤寒学与经方辨治疑难病”创新团队项目(2019-QN04)。

摘　　要：[目的]探析李小会教授治疗顽固性蛋白尿的临证经验。[方法]通过查阅相关文献资料,以及跟师临诊及复习病案,学习李小会教授对顽固性蛋白尿病因病机的认识,总结探析李小会教授运用黄芪四君子汤联合水陆二仙丹、虫类药等治疗蛋白尿的经验,并列举典型案例加以佐证。[结果]李小会教授认为顽固性蛋白尿病机为本虚标实,治疗时重视整体观念,治病以求其本源,辨证以求其病因。根据临床经验,李师认为脾肾气虚为发病之本,宏观治疗从脾肾入手;微观辨证着眼于肾脏病理特点,重视清除湿热、瘀血、水湿、痰浊等病理因素。所举验案首诊辨为脾肾气虚、水湿内盛之证,予以健补脾肾、益气摄精、活血利水为法,应用黄芪四君子汤健脾益肾,"观前顾后、截源断流",联用水陆二仙丹"标本同治、酸收甘缓",配伍虫类药活血化瘀,"既防且治"。通过全方多角度、多维度治疗,使患者尿蛋白含量明显减少,水肿逐渐消退,腰困乏力等症状明显改善。[结论]李小会教授从脾肾论治顽固性蛋白尿,运用黄芪四君子汤联合水陆二仙丹及虫类药,见解独到,其丰富的临床经验值得学习推广。[Objective]To discuss the clinical experiences and unique views of Professor LI Xiaohui in treating refractory proteinuria. [Methods]Through consulting relevant literature,following the teacher’s clinical work,and reviewing medical records,Professor LI’s understanding about etiological factors and pathogenesis of refractory proteinuria were analyzed,and Professor LI’s academic point of treating proteinuria with Huangqi Sijunzi decoction combined Shuilu Erxian pill and insect drugs were summarized,one typical clinical case was presented as proof. [Results]Professor LI considers that the pathogenesis of refractory proteinuria is asthenia in origin and asthenia in superficiality,and pays attention to holistic concept in treatment,and treats the disease starting from its origin,seeking its etiology through syndrome differentiation. According to clinical experience,Professor LI holds the view that Qi deficiency of the spleen and kidney is the root of the disease,macroscopic treatment starts from the spleen and kidney;microcosmic syndrome differentiation starts from kidney pathologic feature,focusing on cleaning up damp-heat or blood stasis or dampness or phlegm damp and other pathological factors of the disease. The case was differentiated as Qi deficiency of the spleen and kidney,damp abundance in internal,the treatment was to invigorate the spleen and kidney,benefit Qi for consolidating semen,promote blood circulation and remove damp,and Huangqi Sijunzi decoction was adopted to invigorate the spleen and tonify the kidney,in order to "before and after the view,cut off the source flow";combined with Shuilu Erxian pill"treating both cause and symptoms,contracted with sour and relaxed with sweet";compatibility of insect drugs to promote blood circulation and resolve blood stasis,in order to achieve the aim of "prevention and treatment". Through the multi-angle and multi-dimensional treatment,the urine protein content of the patient was significantly reduced,the edema gradually subsided,and the symptoms such as lum

关 键 词：顽固性蛋白尿 黄芪四君子汤 水陆二仙丹 虫类药 李小会 医案 临证经验 

分 类 号：R692[医药卫生—泌尿科学]