机构地区:[1]福建中医药大学,福建福州350122 [2]福建中医药大学附属人民医院,福建福州350004
出 处:《河南中医》2024年第11期1654-1659,共6页Henan Traditional Chinese Medicine
基 金:阮诗玮全国名老中医药专家传承工作室建设项目{国中医药人教函〔2022〕75号};福建省自然科学基金项目(2024J01762,2024J01769);福建中医药大学附属人民医院中医临床优秀人才研修培养项目{闽人院【2024】217号};福建中医药大学附属人民医院第二批科研团队建设项目{闽人院【2023】25号}。
摘 要:慢性肾脏病(chronic kidney disease,CKD)具有多虚多瘀的特点,瘀血贯穿病程始终,从瘀论治尤为关键,但临证不能见瘀即用活血化瘀药物,当辨机、辨位、辨势、辨体、辨时、辨象。辨机即辨病机,CKD瘀证形成原因为正虚、邪实,因虚致瘀者,宜补虚化滞,常依据气、血、阴、阳亏虚之偏颇,选用补阳还五汤、四物汤、一贯煎,或用黄芪、当归、鸡血藤等方药;因实致瘀者,当辨其邪气性质、兼夹等,选当归四逆汤、犀角地黄汤、瓜蒌薤白半夏汤合丹参饮等。辨位即辨病位,CKD病位多在肾,肾虚络瘀为其核心病机,治疗上常宗“菀陈者宜除之……络以辛为泄”原则,采取辛润宣通法治疗。辨势即辨病势,病势急者,当以祛除病邪为主,病势缓者,当以燮理阴阳,固护正气为要。辨体即辨体质,参照匡调元教授体质分类法,分为正常质、腻滞质、燥红质、迟冷质、倦[白光]质,分体论治。辨时即辨时令,治疗顺应“春生、夏长、秋收、冬藏”的规律,判别当前时令状态下瘀证之轻重偏颇,投以合适之方药。辨象即辨病象,根据患者的具体征象,包括症状、体征、现代理化检查等辨识瘀象,选方遣药。Chronic kidney disease(CKD)is characterized by a complex mix of deficiency and blood stasis,with blood stasis running throughout the disease progression.Treating CKD from the perspective of blood stasis is critical,but clinical practice should not rely solely on activating blood and removing stasis when signs of stasis appear.Instead,treatment should follow the principle of"six differentiations":differentiation of mechanism,location,tendency,constitution,timing,and manifestations.Differentiation of mechanism refers to understanding the disease mechanism.The formation of stasis in CKD is due to both deficiency and excess.When stasis arises from deficiency,treatment should focus on tonifying deficiency and resolving stagnation based on qi,blood,yin and yang deficiency conditon,using such formulas as Yang-Supplementing and Five-Returning Decoction,Four Substances Decoction,Effective Integration Decoction,or drugs such as Huangqi(Radix Scutellariae),Danggui(Radix Angelicae Sinensis),Jixueteng(Caulis Spatholobi),etc.When stasis arises from excess,the nature of the pathogenic factor and concurrent symptoms must be identified,using formulas such as Chinese Angelica Frigid Extremities Decoction,Rhinoceros Horn and Rehmannia Decoction,Trichosanthes and Chinese Chive and Pinellia Decoction combined with Salvia Beverage,etc.Differentiation of location identifies the site of the disease.In CKD,the primary location is the kidney,with kidney deficiency and collateral blood stasis as the core pathology.Treatment follows the principle that"old stagnation should be removed,and stasis in the collaterals is dispersed by acrid agents"and adopts the"acrid and moistening dispersion"method.Differentiation of tendency examines the prognosis of the disease.In acute cases,expelling the pathogen takes precedence,while in chronic cases,harmonizing yin and yang and strengthening healthy qi are emphasized.Differentiation of constitution refers to classifying body types based on Professor Kuang Diaoyuan′s typology,including normal,turbid-sti
关 键 词:慢性肾脏病 瘀证 “六辨” 辨机 辨位 辨势 辨体 辨时 辨象
分 类 号:R259.92[医药卫生—中西医结合]
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