CJI (Traditional Chinese Medicine)
檀金川论治特发性膜性肾病经验
王涛,指导:檀金川
河北医科大学,河北 石家庄 050017摘要:特发性膜性肾病是成人肾病综合征的主要原因之一,是一种以肾小球毛细血管袢上皮侧免疫复合物沉积为特征的肾小球疾病,目前西医治疗主要采用激素联合免疫抑制剂,但不良反应较大。檀金川教授根据多年临床经验,从脾肾亏虚、肾络瘀阻入手,以益肾通络方加减,扶正固本,脾肾同调,善用虫类药以搜剔经络,并注重综合调护,对中医药治疗特发性膜性肾病具有积极的参考意义。关键词:名医经验;檀金川;脾肾亏虚;肾络瘀阻;健脾益肾;化瘀通络;特发性膜性肾病
DOI:10.3969/j.issn.1005-5304.2017.10.026
中图分类号:R272.969.2 文献标识码:A 文章编号:1005-5304(2017)10-0105-04
Experience of TAN Jin-chuan in Treatment of Idiopathic Membranous Nephropathy
WANG Tao, Instructor: TAN Jin-chuan (Hebei Medical University, Shijiazhuang 050017, China)
Abstract: Idiopathic membranous nephropathy (IMN) is one of the main causes of nephrotic syndrome in adults, and is a kind of glomerular capillary loops epithelial side immune complex deposition of glomerular disease. At present, Western medicine treatment mainly uses hormone combined with immunosuppressive agent, but the adverse reactions are bigger. According to many years clinical experience, Professor TAN Jin-chuan starts from the spleen and kidney deficiency and blood stagnation in kidney meridian, and uses modified Yishen Tongluo Prescription to support right qi and regulate spleen and kidney at the same time. She is good at use of insect medicine to seize the meridians, and focuses on comprehensive care, which provides positive reference value for TCM treatment of IMN.
Key words: experience of famous doctors; TAN Jin-chuan; deficiency of spleen and kidney; blood stagnation in kidney meridian; invigorating spleen and kidney; removing stasis and dredging collaterals; idiopathic membranous nephropathy
膜性肾病是导致成人肾病综合征的一个常见病因,其特征性的病理改变是肾小球毛细血管袢上皮侧可见大量免疫复合物沉积,临床表现为肾病综合征(大量蛋白尿、低蛋白血症、高度水肿、高脂血症),或无症状、非肾病范围的蛋白尿。其病因未明者称为特发性膜性肾病(idiopathic membranous nephropathy, IMN)。目前西医治疗主要为针对原发病、防止并发症等,有一定的缓解率,但大剂量激素、细胞毒性药物和免疫抑制剂等不良反应较大。根据本病临床表现以水肿、蛋白尿、潜血为特征,可归属中医学“水肿” “尿浊”“肾风”等范畴。檀金川教授作为第二届河北省名中医、全国优秀中医临床人才,从事中西医结合肾脏病临床、科研工作 30 余载,治学严谨,博采众长,积累了丰富的临证经验,在治疗 IMN 方面有着丰富的临床经验,笔者有幸侍诊,获益匪浅,现将其治疗 IMN经验总结如下。 通讯作者:檀金川,E-mail:tanjinchuan@medmail.com.cn
1 病因病机
檀师认为,IMN病因多为先天禀赋不足,肾气亏虚,加之外邪侵袭,七情内伤,饮食不节,劳倦久病等,这些病因既可单独致病,也可相互作用,合而为病,日久累及脾肾,出现脾肾亏虚。本病属本虚标实之证,本虚多为脾肾亏虚,湿热痰瘀之邪为其标。肾为先天之本,藏精,主水液气化,肾虚则精微不固,开阖失司,精微物质从尿中流失,出现蛋白尿;尿中蛋白乃水谷之精微,大量蛋白从尿中下泄,正气耗损,脾肾愈加亏虚,从而形成恶性循环。脾乃后天之本,为气血生化之源,主运化水湿,脾虚则气血亏虚,水湿不化致水液泛溢肌肤而为水肿;脾肾亏虚,气血生化不足,加之精微蛋白外泄,形成低蛋白血症;脾虚则水液运行失常,水湿停留,日久又可酿生痰湿,加之患者久服激素及免疫抑制剂,内生湿热,痰湿阻塞脉络,血运不利,瘀血再生,瘀血痰湿痼结,从而形成高脂高黏血症。脾肾亏虚,加之湿热痰瘀互结,虚实夹杂,反复循环,导致病情迁延难愈。檀师以《内