王孟庸教授治疗尿酸性肾病临床经验总结

1，赵恒侠 1，李惠林 1，刘德亮 1，渠昕 1，李增英 1，吴慕莹 1，陈叶 2，张耀庭3，指导：王孟庸 1

1.深圳市中医院，广东 深圳 518033；2.深圳市龙华中心医院，广东 深圳 518000；

3.萍乡市中医院，江西 萍乡 337000摘要：本文总结王孟庸教授治疗尿酸性肾病的临床经验。王教授认为，本病主要以脾肾亏虚、三焦气化功能失调为本，痰湿瘀浊等机体代谢障碍形成的病理产物为标，故治疗上当分清标本虚实，从脾肾亏虚及痰湿瘀浊的病机和病理特点出发，灵活应用健脾益肾、化痰除湿、活血利水等方法，可极大地减少长期服用相关西药的毒副作用，减少痛风的发作而使疾病痊愈。

关键词：名医经验；王孟庸；尿酸性肾病

DOI：10.3969/j.issn.1005-5304.2017.10.024

中图分类号：R272.969.2 文献标识码：A 文章编号：1005-5304(2017)10-0099-03

Summary of Clinical Experience of Professor WANG Meng-yong in Treating Uric Acid Nephropathy

ZHOU Dao-cheng1, ZHAO Heng-xia1, LI Hui-lin1, LIU De-liang1, Qu Xin1, Li Zeng-ying1, WU Mu-ying1, CHEN Ye2, ZHANG Yao-ting3, Instructor: WANG Meng-yong1 (1. Traditional Chinese Medicine Hospital of Shenzhen, Shenzhen 518033, China; 2. Longhua Central Hospital of Shenzhen, Shenzhen 518000, China; 3. Traditional Chinese Medicine Hospital of Pingxiang, Pingxiang 337000, China)

Abstract: To summarize the clinical experience of Professor WANG Meng-yong in the treatment of uric acid nephropathy. Professor WANG believes that the disease is mainly caused by spleen and kidney deficiency, disorder of function of Sanjiao, and pathological products, such as phlegm dampness and blood stasis and other metabolic disorders. Therefore, the treatment should distinguish symptoms and essence. Starting from pathogenesis and pathological features of spleen and kidney deficiency and phlegm dampness and blood stasis, the treatment should flexibly apply the methods of nourishing spleen and kidney, reducing phlegm and dispelling humidity, and activating blood and using diuretic of hydragogue to alleviate water retention, which can greatly reduce side effects caused by the long-term use of Western medicine and the onset of gout, and then to help disease recovery.

Key words: experience of famous doctors; WANG Meng-yong; uric acid nephropathy

尿酸性肾病（亦称痛风性肾病）是指由于嘌呤代谢紊乱，血尿酸升高，引起尿酸及其结晶沉积于肾脏，造成肾损害的一类疾病。病变主要累及肾小管和间质，临床表现为慢性高尿酸血症、轻中度蛋白尿、酸性尿、肉眼或镜下血尿，多伴肥胖、高血压、血脂紊乱、水肿、关节肿胀不利等。

深圳市中医院王孟庸教授是国家名中医药专家、广东省名中医、深圳市首批名老中医药专家经验传承指导老师，早年师承近代名医姚正平先生，从事中医肾病临床、教学、科研已 60 年，承古而不泥古，注重创新，观点新颖，严谨客观，擅长治疗难治性肾病 综合征、肾功能不全、糖尿病肾病等肾内科疾病及糖尿病、甲状腺疾病等内分泌疾病。在治疗尿酸性肾病的过程中，对疾病的病因病机、发展演变形成了独特的学术见解，且临床疗效显著。笔者有幸跟师侍诊，获益匪浅。现将其治疗尿酸性肾病经验整理如下。

1 病因病机

中医古籍无“尿酸性肾病”病名，根据其临床特点可归属于中医学“痹证”“腰痛”“石淋”“水肿”“虚劳”“关格”等范畴。王师认为，本病的病因有内外之分：内因主要为内伤七情、饮食不节、嗜食肥甘厚味等，使脾胃运化失常，则湿浊内生，肾司二便，排泄湿浊失常，则湿浊内聚，肝失疏泄，则气机升降失调，气血津液等运行障碍；外因多为风、寒、湿、热等外邪侵袭，闭阻经络关节，气血运行不畅，湿凝则为痰。痰湿内阻，影响气血运行，且发病日久则多瘀。