张敏从瘀论治慢性肾炎综合征蛋白尿经验介绍  

Experience of ZHANG Min in Treating Chronic Nephritis Syndrome Proteinuria Theory of Stasis

作　　者：庞茜 张敏 PANG Xi;ZHANG Min(Guangdong Hospital of Integrated Traditional and Western Medicine Affiliated to Guangzhou University of Chinese Medicine,Foshan Guangdong 528000,China;Department of Nephrology and Rheumatology,Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine,Foshan Guangdong 528000,China)

机构地区：[1]广州中医药大学附属广东中西医结合医院,广东佛山528000 [2]广东省中西医结合医院肾病风湿科,广东佛山528000

出　　处：《新中医》2024年第5期216-220,共5页New Chinese Medicine

摘　　要：蛋白尿是慢性肾炎综合征常见临床症状,严重影响患者健康及生活质量。张敏教授认为脾肾亏虚是蛋白尿产生的根本病机,瘀是蛋白尿形成的致病因素,“虚、湿、热”是致瘀的常见病理因素。张教授临床以自拟消蛋白方为主方进行加减化裁治疗,主张分期论治,将从瘀论治理念贯穿整个治疗过程。张教授认为早期脾肾亏虚,久虚成瘀,治以补益脾肾、益气活血;中期由虚蕴久化湿,湿浊瘀阻脉络,以祛风除湿、活血化瘀法治疗;晚期因湿瘀郁而化热,阻滞肾络,治以化瘀消癥、清热通络。张教授强调疾病到了晚期或是经激素、免疫抑制剂等治疗后往往是虚、湿、热兼杂,应在自拟消蛋白方基础上灵活加减用药。张教授临床常用黄芪、白术等大量补气药以补肾健脾,巧用三七、鱼腥草及地龙等虫类药活血化瘀,重视祛风除湿、活血通络,使治疗达到事半功倍,缩短病程,直达病所,减轻患者痛苦。Proteinuria is a common clinical symptom of chronic nephritis syndrome,which seriously affects the health and quality of life of patients.Professor ZHANG Min believes that spleen and kidney deficiency is the fundamental pathogenesis of proteinuria,blood stasis is the pathogenic factor of proteinuria,and"deficiency,dampness,and heat"are common pathological factors causing stasis.Professor ZHANG's clinical approach is to use a self-made Xiaodanbai Prescription as the main prescription for modified treatment,advocating staged treatment and integrating the concept of treating stasis throughout the entire treatment process.Professor ZHANG holds that,in the early stage,the spleen and kidney deficiency lasts long and results in stasis,and the treatment should focus on supplementing and benefiting the spleen and kidney,replenishing qi,and activating blood;in the middle stage,the deficiency accumulates for a long time and promote the generation of dampness,and dampness turbidity obstructs the vessels and collaterals,which can be treated with methods of dispelling wind,removing dampness,promoting blood circulation,and removing blood stasis;in the late stage,due to dampness,stasis,and stagnation,heat grows and obstructs the kidney meridians,and the treatment is to remove blood stasis,eliminate signs,clear heat,and unblock collaterals.Professor ZHANG emphasizes that in the late stage of the disease or after treatment of hormones,immunosuppressive agents,etc.,patients are often in a combined situation of deficiency,dampness,and heat,and the modified medication based on self-made Xiaodanban Prescription is necessary.In clinical practices,Professor ZHANG often uses a large amount of Astragali Radix,Atractylodis Macrocephalae Rhizoma,and other qi-replenishing medicinals to supplement the kidney and fortify the spleen;he also skillfully uses Notoginseng Radix et Rhizoma,Houttuyniae Herba,Pheretima,and other insect medicinals to promoting blood circulation and removing stasis,and attaches great importance to dispelling wind and da

关 键 词：慢性肾炎综合征 蛋白尿 脾肾亏虚 瘀 消蛋白方 

分 类 号：R249[医药卫生—中医临床基础]