应用肾风汤治疗免疫球蛋白A肾病机制探析  

A mechanism analysis of the application of treating immunoglobulin A nephropathy with the Shenfeng decoction

作　　者：张宇倩 郭玲[2] ZHANG Yuqian

机构地区：[1]辽宁中医药大学研究生学院,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110033

出　　处：《中医临床研究》2024年第5期115-120,共6页Clinical Journal Of Chinese Medicine

基　　金：辽宁省科学事业公益研究基金项目(2015001005);何学红全国名老中医药专家传承工作室。

摘　　要：免疫球蛋白A肾病是最常见的原发性肾小球疾病之一,文章将从卫气营血辨证及“因势利导”思想探讨何学红教授辨治免疫球蛋白A肾病的思路。何师认为该病感受邪气与温病相似,以风热、湿热为主,风为先导,风热最先侵袭人体形成卫分证,湿性黏滞,湿热胶结难分,致使病情迁延。发病过程与卫气营血传变过程相似,该病多由外感诱发,早期以卫分证表现为主;其后出现水肿、少尿、泡沫尿等气分证表现;邪气也可不经气分直入营血,在外感的同时即出现肉眼血尿。在治疗上,何师运用“因势利导”思想,结合“卫气营血”辨证理论,组方肾风汤应用于临床。其组方思路为首先顺疾病之势导邪外出,对于在上之风热,应用防风、荆芥炭,顺风性清扬之势而透发于外,对于在下之湿热,应用芦根、白茅根,顺湿性趋下之势而渗湿于下;其次要顺人体之势而护正利导,应用小剂量黄芩、川楝子清热保津、存阴护阳;应用丹参、茜草、金银花宣通气机、透热转气;同时警惕疾病传变,应用地榆、槐花、小蓟、水红花子、大黄、丹参凉血散血以防瘀滞;最后在饮食起居方面也应顺应自然之势预防调护。何师常以肾风汤为底方,根据患者临床表现及舌脉辨证调整用药,在临床治疗中,获效颇丰。Immunoglobin A nephropathy(IgAN)is one of the most common primary glomerular diseases,and this article will discuss Professor HE Xuehong’s ideas for the treatment of IgAN from the perspective of Weiqi Yingxue(卫气营血)syndrome differentiation and the idea of adapt to the situation.Teacher HE believes that the disease is similar to the warm disease,with wind heat and dampI heat as the main body,with wind as the forerunner,and wind heat is the first to invade the human body to form the Weifen syndrome(卫分证),which is wet and viscous,and it is difficult to distinguish between damp and heat,resulting in the prolongation of the disease.The pathogenesis process is similar to that of Weiqi Yingxue,which is mostly induced by external sense,and the early stage is mainly manifested by the Weifen syndrome,followed by edema,oliguria,foamy urine and other the Qifen syndrome(气分证)manifestations,evil Qi(气)can also directly enter the blood without Qifen,and macroscopic hematuria appears at the same time as external sensation.In terms of treatment,master HE used the idea of adapt to the situation,combined with the syndrome differentiation theory of Weiqi Yingxue,and applied the formula the Shenfeng decoction(肾风汤)to clinical practice.The idea of the Shenfeng decoction is elaborated as follows:firstly,follow the trend of the disease to guide the evil to go out,for the wind heat above,the application of Fangfeng(Radix Saposhnikoviae),Jingjietan(Herba Schizonepetae),the trend of the wind and the clear trend of the wind and penetrate the outside,for the damp heat below,the application of Lugen(Rhizoma Phragmitis),Baimaogen(Rhizoma Imperatae),along the trend of the dampness and infiltration of the downward,secondly,to follow the trend of the human body and protect the right guide,the use of small doses of Huangqin(Radix Scutellariae),Chuanlianzi(Fructus Toosendan)to clear heat and protect Jin(津),the Yin(阴)and protect the Yang(阳),the application of Danshen(Radix et Rhizoma Salviae Miltiorrhizae),Qiancao(Radi

关 键 词：免疫球蛋白A肾病 卫气营血辨证 因势利导 肾风汤 风热 湿热 

分 类 号：R692[医药卫生—泌尿科学]