高祥福教授运用药对治疗慢性肾脏病经验总结  

Summary of Professor GAO Xiangfu’s Experience in Treating Chronic Kidney Disease with Drug Pairs

作　　者：黄哲昊 陈周祺 钱佳文 高祥福[2] 瞿中洁[3] HUANG Zhehao;CHEN Zhouqi;QIAN Jiawen(The First Clinical Medical School of Zhejiang Chinese Medical University,Hangzhou(310053),China)

机构地区：[1]浙江中医药大学第一临床医学院,杭州310053 [2]浙江中医药大学附属第一医院 [3]浙江中医药大学附属第三医院

出　　处：《浙江中医药大学学报》2025年第1期46-53,共8页Journal of Zhejiang Chinese Medical University

基　　金：浙江省中医药优秀青年基金项目(2020ZQ028);高祥福名老中医专家传承工作室项目(GZS2020027)。

摘　　要：[目的]总结高祥福教授运用药对和角药治疗慢性肾脏病的经验。[方法]通过侍诊学习,以及整理病案、查阅文献,总结高师对慢性肾脏病的病机认识、辨治特点以及常用药对和角药的组成、配伍原理、临床应用、常用剂量、配伍意义,并附典型病案加以佐证。[结果]高师认为慢性肾脏病的病理状态属本虚标实,“正虚毒伏,精血外溢,正衰毒胜”是疾病进展的核心病机,正虚以脾肾亏虚为主,伏毒以浊毒、瘀毒、热毒多见。治疗上首辨标本缓急,遵循“急则治卒病,缓则治痼疾”的原则。本病属急性进展型者常用祛除伏毒之药对与经典方配伍,属慢性迁延型者则多以药对组方化裁。具体而言,常用“黄芪-当归”“黄芪-白术”“黄芪-升麻-柴胡”补脾气、健中州,“生地黄-山药-茯苓”“淫羊藿-肉苁蓉”滋肾阴、补肾阳,“车前草-大黄”“丹参-积雪草”祛浊瘀、清郁热,“白茅根-仙鹤草”“金樱子-芡实”宁血络、摄精微。所附医案用“黄芪-当归”“生地黄-山药-茯苓”“车前草-大黄”“丹参-积雪草”“白茅根-仙鹤草”等药对组成主方并进行化裁以治疗慢性肾脏病患者,终获良效。[结论]高师常以药对和角药组方治疗慢性肾脏病,用药平和,配伍层次鲜明,疗效显著,值得总结推广。[Objective Objective]To summarize Professor GAO Xiangfu’s experience in treating chronic kidney disease with drug pairs and triangular drugs.[Methods Methods]By following the Professor during clinical consultations,organizing medical cases and reviewing literature,this paper summarized Professor GAO’s understanding of the pathogenesis and the characteristics of diagnosis and treatment of chronic kidney disease,and the composition,compatibility principles,clinical applications,common doses,and compatibility significance of Professor GAO’s commonly using drug pairs and triangular drugs in treatment chronic kidney disease and a medical case was attached for evidence.[Results Results]Professor GAO believes that the pathological condition of chronic kidney disease is deficient in origin and excess in superficiality.The core pathogenesis of disease progression is characterized by“vital Qi is deficient and toxins are hiding,essence and blood are leaking,vital Qi is attenuating and toxins are enhancing”.The deficiency of vital Qi is mainly manifested as deficiency of the spleen and kidney,while the hidden toxins are mainly turbid toxins,blood stasis toxins and heat toxins.In treatment,the priorities should be put on the origin and the superficiality of the pathogenesis,and a case being acute or chronic should be distinguished first,following the principle of treatment that“treating acute cases as the emerging diseases and treating the chronic cases as the primary disease”.For acute progressive cases of this disease,drug pairs for eliminating hidden toxins are commonly combined with classic prescriptions.For chronic protracted cases,drug pairs are often used to formulate prescriptions directly.Particularly,Professor GAO commonly uses“Astragalus membranaceus-Angelica sinensis”“Astragalus membranaceus-Atractylodes macrocephala”and“Astragalus membranaceus-Cimicifuga foetida-Bupleurum chinense”are used to tonify spleen Qi and invigorate middle-Jiao;he uses“Radix rehmanniae-Dioscorea opposita-Poria

关 键 词：慢性肾脏病 伏毒 药对 角药 医案 高祥福 临床经验 

分 类 号：R692[医药卫生—泌尿科学]