何立群分期辨治原发性免疫球蛋白A肾病  

He Liqun′s Experience in Treating Primary IgA Nephropathy with Staged Syndrome Differentiation and Treatment Method

作　　者：徐子灵 张亚亨 盛广宇 宋婷 俞菁鉴 杨雪军[1] XU Ziling;ZHANG Yaheng;SHENG Guangyu;SONG Ting;YU Jingjian;YANG Xuejun(Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai China 201203)

机构地区：[1]上海中医药大学附属曙光医院肾病科,上海201203

出　　处：《中医学报》2024年第11期2427-2431,共5页Acta Chinese Medicine

基　　金：上海市科学技术委员会基金项目(22Y31920200)。

摘　　要：早期原发性免疫球蛋白A肾病(immunoglobulin A nephropathy,IgAN)主要病位在肺,肺虚感邪而复发,肺失通调,三焦水道不通,祸及脾肾。脾气亏虚,无以运化水湿,肾阳不足,阳不化气,水液气化功能失调,久之阳损及阴,阴损及阳,阴阳俱虚。根据IgAN病因病机与肺脾肾三脏的关系,倡导“其本在肾、其末在肺、其制在脾”,究其源,治其本。临证应用清化祛瘀法清湿通窍、清热通淋,并创立了祛风清热通络的四蚕汤加味方,应用于难治性或反复不愈的IgAN治疗中,同时兼顾湿热、瘀血和风邪等兼证的治疗。临床上采用分期辨证治疗:早期以肺脾气虚证为主,应用黄芪消白冲剂;中期以肝肾阴虚证为主,采用肾病1号方;后期以脾肾阳虚证为主,采用益肾止衰冲剂。Early primary immunoglobulin A nephropathy(IgAN)is mainly located in the Lung.The lung deficiency plus evil factor causes the recurrence of the disease.The function of the Lung is dysregulated,and the waterways of the Three Jiao are blocked,which then affects the Spleen and Kidney.Deficiency of Spleen Qi leads to difficulty in transporting Water and Dampness.In addition,deficiency of Kidney Yang leads to the dysfunction of the Qihua of the Water.Long-term problem like this leads to Yang injuring Yin,Yin injuring Yang,and eventually Yin and Yang are further damaged.According to the relationship between the etiology and pathogenesis of IgAN and the Lung,Spleen and Kidney,it is advocated that"the cause of that is in the Kidney,the effect is in the Lung and the key is in the Spleen",and the root cause should be noted and treated.In clinical practice,the method of Heat cleaning,Dampness resolving and stasis removing method is applied to clear Dampness and dredge aperture as well as clear Heat and treat stranguria.The modified Sican Decoction functioning in dispelling Wind,clearing Heat and dredging collateral is created to treat refractory or recurrent IgAN.Clinically,staged syndrome differentiation treatment is adopted:In the early stage,the syndrome of Lung and Spleen Qi deficiency is the main case,and Huangqi Xiaobai Electuary can be used;In the middle stage,the Liver and Kidney Yin deficiency syndrome is the main case,and the No.1 Formula for kidney disease can be used;In the later stage,the Spleen and Kidney Yang deficiency syndrome is the main case,and Yishen Zhishuai Electuary for the kidney can be used.

关 键 词：原发性免疫球蛋白A肾病 清化祛瘀法 四蚕汤加味方 分期辨治 何立群 

分 类 号：R249.27[医药卫生—中医临床基础]