基于六经伏邪理论治疗过敏性紫癜性肾炎初探  

Treating Henoch-Schonlein purpura nephritis based on the six-meridian hidden pathogen theory

作　　者：黄琪琪 王佳玉 李建英[3] HUANG Qiqi

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]即墨区中医医院,山东青岛266299 [3]青岛大学附属青岛市海慈医院/青岛市中医医院,山东青岛266033

出　　处：《中医临床研究》2024年第32期43-46,共4页Clinical Journal Of Chinese Medicine

基　　金：全国名老中医药专家传承工作室建设项目(国中医药人教发[2016]42号);2020年山东省卫生与健康领军人才培育计划(鲁卫人才字[2020]3号)。

摘　　要：过敏性紫癜性肾炎常反复发作,迁延难愈。中医认为本病与伏邪密切相关。笔者根据长期临证经验,基于六经辨证及伏邪理论,认为过敏性紫癜性肾炎病机要点在于邪伏厥阴,阴亏热伏,每感新邪易复发,并从厥阴经络、阴阳、脏腑三个方面论述过敏性紫癜性肾炎的病机特点:厥阴经络为邪之通路,厥阴“一阴”之性致邪伏,邪伏厥阴脏腑生风化火。厥阴伏邪成巢,易滞易瘀、易入难出、易积成形,易于发作。然少阳含生发之气,可托伏邪外出,引邪至此才有出路,故以祛邪扶正、化解透托为原则,补少阴之不足,清厥阴之邪,使邪出少阳而解为法。过敏煎为厥阴、少阳两经之方,可将邪托出少阳,边托边清邪,抽丝剥茧,直至托无所托。临床可以二至地黄汤合过敏煎为主方加减治疗,急性发作期,多因新感风热毒邪引触伏邪而发,可稍减滋阴之品,合升降散、银翘散等以增其清热散邪之力;临床缓解期,余毒瘀阻肾络,可稍加化瘀之品以止血,如茜草、紫草、赤芍、桃仁等;恢复期,应以扶正为要,病程日久,其气亦损,可合黄芪、党参、白术等补虚固表,以摄其血、御外风。临证病多复杂,常兼见他证,需灵活辨证加减。文末列验案一则,以期为临床过敏性紫癜性肾炎提供新的诊疗思路。Henoch-Schonlein purpura nephritis often recurs,is prolonged and difficult to heal,and TCM believes that this disease His closely related to hidden pathogen.Based on long-term clinical experience,the author believes that the pathogenesis of Henoch-Schonlein purpura nephritis lies in the pathogen hidden in Jueyin(厥阴),causing Yin(阴)deficiency and hidden heat,which is easy to relapse when infected with new pathogenic factors.The pathogenesis characteristics of Henoch-Schonlein purpura nephritis were discussed from three aspects:Jueyin meridians,Yinyang(阴阳),and Zangfu(脏腑).The Jueyin meridians are the pathways of pathogen.The nature of‘‘one Yin(阴)’’causes hidden pathogen.The pathogen lurks in Jueyin,and the wind and fire is formed.It is easy to stagnate and stasis,easy to enter and hard to exit,easy to accumulate and form,and easy to attack.However,Shaoyang(少阳)contains the Qi(气)of germination,which can be entrusted to dispel the pathogen,and there is a way to attract the pathogen out here.Therefore,the principle of dispelling pathogenic factors and strengthening the healthy Qi is applied to nourish Shaoyin(少阴)meridians and clear Jueyin meridians,so that the pathogenic factors can be removed from Shaoyang meridians.Guomin Jian(过敏煎)is the prescription for treating the diseases of the two meridians of Jueyin and Shaoyang,which can hold out and clear the pathogen at same time.In clinic,the Erzhi Dihuang decoction(二至地黄汤)plus Guomin Jian can be applied.In the acute attack period,pathogen is mostly caused by the new wind,heat,and poison,the products nourishing Yin can be slightly reduced,and Shengjiang San(升降散)with Yinqiao San(银翘散)can be given to increase its power of clearing heat and dispelling pathogen.During the clinical remission period,the residual pathogen obstructs the kidney veins,and removing blood stasis products such as Qiancao(Radix Rubiae),Zicao(Radix Arnebiae),Chishao(Radix Paeoniae Rubra),Taoren(Semen Persicae)can be added.During the recovery perio

关 键 词：伏邪 厥阴 过敏性紫癜性肾炎 过敏煎 二至地黄汤 

分 类 号：R554.6[医药卫生—血液循环系统疾病]