通因通用法治疗膜性肾病蛋白尿  

Discussion About Treating Membranous Nephropathy Proteinuria from the Perspective of Purging for the Diarrhetic

作　　者：胡樱丽 唐阁[1] HU Ying-li;TANG Ge(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin,China,300381)

机构地区：[1]天津中医药大学第一附属医院,天津300381

出　　处：《河南中医》2022年第2期190-194,共5页Henan Traditional Chinese Medicine

摘　　要：瘀阻肾络,精气下泄是膜性肾病蛋白尿的主要病机,活血化瘀通络是治疗膜性肾病蛋白尿的基本原则。膜性肾病初期,风挟湿邪,风湿扰络,气血运行不畅,瘀滞脉络,致肺失宣散,脾失运化,肾失封藏,遂见蛋白尿,治疗当活血化瘀,祛风通络,方用身痛逐瘀汤加减。水病可致血瘀,瘀血可致水肿,治疗需利水渗湿,祛瘀通络,临床用真武汤加减化裁。膜性肾病中期,肺脾肾失司,水道不通,水湿不化,聚湿成浊,浊邪凝滞,瘀浊损络,精气下泄,湿浊毒瘀不解,复损肾脏,日久致肾脏衰竭,治疗需分清泄浊、活血化瘀,临床常选萆薢分清方加减化裁。气运则血行,气滞则营血不通,气虚则运血无力,气血不通,精气不行,肾络瘀阻,肾失开阖,精逆肾络而致蛋白尿,治疗需益气祛风,化瘀利水,方用防己黄芪汤加减。膜性肾病后期,肾阳亏虚,命门火衰,不能温煦,令脾之运化失调,肺之宣肃失职,少阳枢机不利,三焦水道失司,膀胱气化失司,发为水肿,治疗需温肾助阳,活血化瘀,方用金匮肾气丸加减化裁。除以上通因通用治法外,临床亦可加藤类药、虫类药以活血化瘀通络。Blood stasis blocking the kidney collaterals and essence qi drainage are the main pathogenesis of membranous nephropathy proteinuria,so promoting blood circulation,removing blood stasis and dredging collaterals is the basic principle for the treatment.In the early stage of membranous nephropathy,wind mixes dampness,wind-dampness disturbs collaterals,operation of qi and blood is poor,blood stasis blocks collaterals,resulting in the lung failing to disperse,and the spleen failing to transport and transformation,and the kidney failing to store,then proteinuria occurs,so the treatment should focus on activating blood circulation and removing blood stasis,dispelling wind and dredging collaterals,and Modified Generalized Pain Stasis-Expelling Decoction can be used.Water disease can cause blood stasis,and blood stasis can cause edema.The treatment should focus on inducing diuresis to drain dampness,removing blood stasis and dredging collaterals.So True Warrior Decoction can be used in clinical practice.In the middle stage of membranous nephropathy,the lung,spleen and kidney fail to work properly;the water channels are blocked;water dampness does not melt,accumulating into turbidity;turbid pathogen coagulates;blood stasis damages the collaterals;essence and qi drain;dampness,turbidity,toxin and blood stasis do not melt,damage the kidney,and lead to renal failure over time.The treatment needs to distinguish between discharging and turbidity,promote blood circulation and remove blood stasis.So Bixie Fenqing Decoction(萆薢分清方,BXFQD)can be used in clinical practice.Qi circulation leads to blood circulation;qi stagnation leads to nutrient blood stagnation;qi deficiency leads to weak blood circulation,qi and blood stagnation,insufficient essence qi,kidney collateral obstruction,kidney′s failure in opening and closing,adverted essence of kidney collateral,which causes proteinuria.The treatment needs to replenish qi,dispel wind,remove blood stasis and induce diuresis,so Modified Stephania Root and Poria Decoction can b

关 键 词：膜性肾病 蛋白尿 通因通用法 身痛逐瘀汤 真武汤 萆薢分清方 防己黄芪汤 金匮肾气丸 

分 类 号：R259.92[医药卫生—中西医结合]