基于“伏风-泄玄-络瘀”理论探讨子藤固肾方对肾性蛋白尿的辨治  

Discuss the Treatment of Renal Proteinuria by Ziteng Gushen Prescription Based on the Theory of“Latent Wind-Xuanfu Opened-Kidney Collateral Stasis”

作　　者：蒋东阳 卢俚利 李小军 张琼 王丽 粟宏伟 胡琼丹 JIANG Dongyang;LU Lili;LI Xiaojun(The Affiliated Traditional Chinese Medicine Hospital,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属中医医院,四川泸州646000 [2]西南医科大学中西医结合研究所

出　　处：《浙江中医药大学学报》2024年第10期1263-1268,共6页Journal of Zhejiang Chinese Medical University

基　　金：国家自然科学基金项目(82205002);四川省中医药管理局项目(2022NSFSC1459);四川省科技计划资助项目(2022YFS0621)。

摘　　要：[目的]基于“伏风-泄玄-络瘀”理论,探讨子藤固肾方对肾性蛋白尿的辨治。[方法]通过查阅古今文献,基于“伏风-泄玄-络瘀”理论来阐释肾性蛋白尿的形成机制,提出“祛风固玄通络”法治疗肾性蛋白尿的辨治思想,并结合临床经验创立子藤固肾方,阐释其治法特点、遣方特色,最后举隅医案加以佐证。[结果]“伏风-泄玄-络瘀”理论认为,伏风是肾性蛋白尿发生的关键病因,风泄玄府是产生蛋白尿的基本病机,肾络瘀阻既是肾性蛋白尿发生发展过程中的病理产物,又是助推疾病进展的致病因素。肾玄府因伏风而开,肾中精微闻风而泄,终致肾络瘀阻,风瘀又相互为患,因此治疗肾性蛋白尿当以祛风为要、固玄为本、通络为辅,“祛风固玄通络”三法同治。子藤固肾方由菟丝子、天木籽(山茱萸)、女贞子、忍冬藤、鸡血藤、海风藤等三子三藤组成,秉承“子擅填精固玄”“藤擅祛风通络”的治法特点,在遣方上具有辛酸相合、开阖相济、阴阳并补、补敛并具、扶正祛邪、寒温并用的特色。文末举隅IgA肾病医案辨证为风伏肾络、玄府失阖、正虚络阻证,治以祛风固玄、益气通络,方用子藤固肾方加减取效甚佳。[结论]“伏风-泄玄-络瘀”理论和“祛风固玄通络”法为临床治疗肾性蛋白尿提供了新的思路,子藤固肾方组方严谨,治疗肾性蛋白尿具有可观的疗效,可为中医药防治肾性蛋白尿提供更多选择,以优化临床疗效。[Objective]Based on the theory of“Latent Wind-Xuanfu Opened-Kidney Collateral Stasis”,to explore the treatment of renal proteinuria by Ziteng Gushen Prescription.[Methods]By consulting ancient and modern literatures,the formation mechanism of renal proteinuria was explained by the theory of“Latent Wind-Xuanfu Opened-Kidney Collateral Stasis”,and it put forward the idea of“Expelling Wind,Closing the Xuanfu and Dredging the Collaterals”to treat renal proteinuria.Ziteng Gushen Prescription was established based on clinical experience,and its treatment characteristics and prescription characteris-tics were explained.Finally,a medical case was cited to prove it.[Results]According to the theory of“Latent Wind-Xuanfu Opened-Kidney Collateral Stasis”,“Latent Wind”is considered as the key cause of proteinuria,“Xuanfu is Opened by Wind”is the basic pathogenesis of renal proteinuria,and“Kidney Collateral Stasis”is both a pathological product and a pathogenic factor to promote the disease.The kidney-Xuanfu opens because of the latent wind,and the latent wind in the kid-ney causes the kidney collateral stasis,and the wind and blood stasis are mutually harmful.Therefore,the treatment of renal proteinuria should be based on expelling wind and closing the Xuanfu for the foundation,dredging the collaterals fot the supplement arity,and the three methods of“Expelling Wind,Closing the Xuanfu and Dredging the Collaterals”should be taken together.Ziteng Gushen Prescription is composed of Semen Cuscutae,Tian Mu Seed(Cornus officinalis),Fructus Ligustri Lucidi,Caulis Lonicerae,Caulis Spatholobi and Caulis Piperis.It adheres to the therapeutic characteristics of“seed medicine which is good at filling essence and closing Xuanfu”and“rattan medicine is good at treating collateral diseases”,and has the functions of combining pungency and acid,opening and closing together,supplementing Yin and Yang,supplementing and converging together,strengthening the body resistance and eliminating evil,and combining

关 键 词：伏风 玄府 肾络 子藤固肾方 蛋白尿 填精固玄 祛风通络 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学]