[1]王禹霖,刘梦超,郑冰洁,等.名中医张炳厚从瘀论治慢性肾脏病经验撷英[J].陕西中医,2023,(11):1602-1605.[doi:DOI:10.3969/j.issn.1000-7369.2023.11.026]
　WANG Yulin,LIU Mengchao,ZHENG Bingjie,et al.Experience of famous Chinese doctor Zhang Binghou treating chronic kidney disease by Yu[J].,2023,(11):1602-1605.[doi:DOI:10.3969/j.issn.1000-7369.2023.11.026]
点击复制

名中医张炳厚从瘀论治慢性肾脏病经验撷英
分享到：

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2023年11期
页码:
1602-1605
栏目:
名中医经验
出版日期:
2023-11-05

文章信息/Info

Title:
Experience of famous Chinese doctor Zhang Binghou treating chronic kidney disease by Yu
作者:
王禹霖1; 刘梦超2; 郑冰洁1; 李欣玥1; 赵婧文1; 毕聪玥1; 孟 元2; 赵文景2
(1.北京中医药大学,北京 100029; 2.首都医科大学附属北京中医医院,北京 100010)
Author(s):
WANG Yulin; LIU Mengchao; ZHENG Bingjie; LI Xinyue; ZHAO Jingwen; BI Congyue; MENG Yuan; ZHAO Wenjing
(Beijing University of Chinese Medicine,Beijing 100029,China)
关键词:
慢性肾脏病;  从瘀论治;  补虚祛瘀;  以通为用;  分层论治
Keywords:
Chronic kidney disease;  Treatment by stasis;  Buxu Quyu;  Yitong Weiyong;  Stratified therapy
分类号:
R 692
DOI:
DOI:10.3969/j.issn.1000-7369.2023.11.026
文献标志码:
A
摘要:
慢性肾脏病患病率高、治疗难度大,张炳厚认为肾为阴络,亦为血脏。CKD早期即存在肾络受损,肾虚为CKD瘀血之本,肾气虚则血液不行,肾阳虚则阴络不温,肾阴虚则火灼阴络。CKD瘀血的表现繁杂,可分为有形瘀血与无形瘀血,面色黧黑、水肿、视物模糊、肌肤甲错等为有形瘀血征象,血液高凝状态、微循环障碍则提示为无形瘀血。张炳厚认为,血瘀证在CKD中极为常见。瘀血可生热、痰、湿、水、浊毒、风等实邪,诸邪亦可促进瘀血产生,加速CKD进展,瘀血日久治疗难度愈大,预后愈差。因此治瘀之要在于补虚化瘀,生新血以祛瘀血; 泄浊排毒,给瘀血以出路; 以通为用,巧用藤类与虫蚁药以搜伏风、通结络; 对于合并出血者应化瘀止血。在选用活血药时,应根据病情轻重分层论治,早期宜和血活血、中期宜破血逐瘀、晚期宜养血活血。
Abstract:
Chronic kidney disease has high prevalence and difficult to treat.Zhang Binghou believes that the kidney is Yin collaterals and also blood.In the early stage of CKD,there is damage to kidney collaterals.Kidney deficiency is the root of CKD Xueyu.Kidney Qi deficiency is blood failure.Kidney Yang deficiency is Yin collaterals not warm.Kidney Yin deficiency is burning Yin collaterals.The manifestations of CKD Xueyu are complicated,which can be divided into tangible Xueyu and intangible Xueyu.Black complexion,edema,blurred vision,and skin nails are signs of tangible Xueyu.Blood hypercoagulability and microcirculation disorders can indicate invisible Xueyu.Zhang Binghou believes that Xueyu is very common in CKD.Xueyu can produce heat,phlegm,dampness,water,turbidity toxin,wind and other excess pathogens.All pathogens can also promote the production of Xueyu and accelerate the progress of CKD.The longer the Xueyu is,the more difficult the treatment is,and the worse the prognosis is.The treatment of Xueyu is to tonify deficiency and remove Xueyu,and to generate new blood to remove Xueyu.Discharging turbidity and detoxification,giving Xueyu to the way out.In order to use,clever use of vines and insect ant drugs to search ambush wind,dredging collaterals.For patients with bleeding,Xueyu should be stopped.In the selection of blood-activating drugs,the treatment should be stratified according to severity of the disease.In the early stage Hexue Huoxue should be used,in the middle stage Poxue Zhuyu used,and in the late stage Yangxue Huoxue should be used.

参考文献/References:

[1] 董晋舟,孙雪艳,申子龙,等.从风邪内伏探讨膜性肾病的中医病机及治疗[J].环球中医药,2022,15(4):649-652.
[2] 刘光珍,赵文景,魏连波,等.从瘀论治慢性肾脏病的思路与方法[J].中国中西医结合肾病杂志,2021,22(7):656-658.
[3] 刘宇娜,苏衍进,司海龙,等.国医大师张学文瘀血理论治疗顽固性肾性水肿经验[J].陕西中医,2021,42(4):506-509.
[4] 杨赞章,张 越,毛爱玲,等.基于目络学说探讨糖尿病视网膜病变辨证思路与治疗[J].中华中医药杂志,2023,38(6):2672-2675.
[5] 王 佳,李青伟,杨映映,等.仝小林防治早期糖尿病视网膜病变经验[J].北京中医药,2017,36(6):512-515.
[6] 赵文景.张炳厚学术思想与临床经验总结及应用虫类药治疗痛证与慢性肾炎蛋白尿的临床研究[D].北京:北京中医药大学,2011.
[7] 桑红灵,戴天木.《金匮要略》干血病的病机浅析[J].中华中医药杂志,2021,36(6):3673-3675.
[8] 王耀献,刘尚建,付天昊,等.肾络微型癥瘕探微[J].中医杂志,2006,47(4):247-249.
[9] 王亚伟,张炳厚,刘志强,等.赵文景教授治疗狼疮性肾炎经验撷英[J].四川中医,2021,39(6):9-13.
[10] 赵文景,蔡 朕,孟 元,等.张炳厚滋补肾阴法在治疗慢性肾脏病中的应用[J].北京中医药,2016,35(4):341-343.
[11] 董佳慧,范文涛.张锡纯运用黄芪-当归药对配伍经验[J].山东中医药大学学报,2023,47(2):154-158.
[12] 吴思弦,袁 浩,周毅峰,等.血栓弹力图评估慢性肾脏病患者凝血功能及其高凝状态的危险因素[J].南方医科大学学报,2020,40(4):556-561.
[13] 申子龙,赵文景,孟 元,等.运用张炳厚导赤通淋汤治疗复杂性尿路感染经验[J].北京中医药,2020,39(9):950-952.
[14] 张 阳,王 琴,朱 勤,等.陈洪宇基于“乙癸同源,肝肾共治”理论治疗糖尿病肾病的经验[J].浙江中医药大学学报,2022,46(1):28-32.
[15] 吴长怡,张华东.张华东教授运用五皮五藤饮治疗银屑病关节炎合并带状疱疹后遗症的经验介绍[J].中国医药导报,2021,18(10):125-128.
[16] 梁健芬,董少龙,窦维华,等.水蛭注射液对大鼠脑缺血再灌注后TNF-α、IL-lβ和ICAM-1蛋白表达的影响[J].陕西医学杂志,2006,35(12):1605-1607.
[17] 莫 超,史 伟,王夏青,等.中药水蛭对肾病血瘀证的研究及应用[J].中华中医药学刊,2018,36(1):130-132.
[18] 许炉欢,陈洪宇.陈洪宇从肺肾相关论治IgA肾病经验[J].浙江中医杂志,2023,58(6):456-458.
[19] 赵盛杰,黄 海,金劲松.青藤碱治疗糖尿病肾病机制的研究进展[J].湖北民族大学学报:医学版,2021,38(3):77-80,85.
[20] 《慢性肾脏病3～5期非透析中西医结合诊疗专家共识》编写组.慢性肾脏病3～5期非透析中西医结合诊疗专家共识[J].中国中西医结合杂志,2022,42(7):791-801.

相似文献/References:

[1]屈 凯,王悦彤,王漱非,等.基于文献研究探讨益肾散结法防治肾小球硬化的理论内涵*[J].陕西中医,2019,(7):919.
　QU Kai,WANG Yuetong,WANG Shufei,et al.Based on literature research to explore the theoretical connotation of Kidney-reinforcing and Mass-disintegrating for prevention and treatment of glomerulosclerosis[J].,2019,(11):919.
[2]任永朋,华 琼,刘彦妍,等.中医“治未病”思想在防治肾脏病中的应用*[J].陕西中医,2019,(8):1101.
　REN Yongpeng,HUA Qiong,LIU Yanyan,et al.The application of the thought of “preventive treatment of disease” in the prevention and treatment of kidney disease in traditional Chinese medicine[J].,2019,(11):1101.
[3]杨丹丹,杜光信,冯其美,等.冯群虎教授从瘀论治慢性肛周湿疹经验[J].陕西中医,2020,(4):528.
[4]张宏强,李桂霞,章彩凤,等.许筠治疗慢性肾病临床药对举隅*[J].陕西中医,2020,(6):808.[doi:DOI:10.3969/j.issn.10007369.2020.06.031]
[5]陈紫薇,陈 明△.从脾论治慢性肾脏病的生物学基础探讨*[J].陕西中医,2020,(11):1627.[doi:DOI:10.3969/j.issn.1000-7369.2020.11.029]
　CHEN Ziwei,CHEN Ming..Discuss the biological foundation for chronic disease therapy from treatment through the spleen[J].,2020,(11):1627.[doi:DOI:10.3969/j.issn.1000-7369.2020.11.029]
[6]董 怡,马 静,余楠楠,等.大黄复方保留灌肠辅助治疗慢性肾脏病疗效及对患者生活质量的影响[J].陕西中医,2021,(7):910.[doi:DOI:10.3969/j.issn.1000-7369.2020.07.026]
　DONG Yi,MA Jing,YU Nannan,et al.Effect analysis of rhubarb compound retention enema adjuvant treatment of chronic kidney disease and its impact on patients' quality of life[J].,2021,(11):910.[doi:DOI:10.3969/j.issn.1000-7369.2020.07.026]
[7]齐 宁,宋姝西,刘香玉,等.参芪延肾方治疗慢性肾脏病疗效及对患者半乳糖缺陷IgA1、晚期糖基化终产物和微炎性反应状态的影响[J].陕西中医,2022,(5):596.[doi:DOI:10.3969/j.issn.1000-7369.2022.05.012]
　QI Ning,SONG Shuxi,LIU Xiangyu,et al.Effects of Shenqi Yanshen recipe on the levels of Gd-IgA1,AGEs and micro inflammatory response in patients with chronic kidney disease[J].,2022,(11):596.[doi:DOI:10.3969/j.issn.1000-7369.2022.05.012]
[8]麦芳雄,张香兰,朱德礼.温肾健脾清化汤辅助治疗脾肾气虚型慢性肾脏病疗效及对患者血清转化生长因子β1、纤维连接蛋白水平的影响[J].陕西中医,2022,(8):1068.[doi:DOI:10.3969/j.issn.1000-7369.2022.08.019]
　MAI Fangxiong,ZHANG Xianglan,ZHU Deli.Clinical efficacy of Wenshen Jianpi Qinghua decoction in the treatment of chronic kidney disease with spleen-kidney qi deficiency and its effect on serum transforming growth factor β1 and fibronectin levels[J].,2022,(11):1068.[doi:DOI:10.3969/j.issn.1000-7369.2022.08.019]
[9]杨淑彬,李 婷,李晓妮,等.不同中药结肠透析模式对慢性肾脏病患者胃肠道症状和营养状态的影响[J].陕西中医,2022,(12):1698.[doi:DOI:10.3969/j.issn.1000-7369.2022.12.010]
　YANG Shubin,LI Ting,LI Xiaoni,et al.Effects of different colon dialysis modes of traditional Chinese medicine on gastrointestinal symptoms and nutritional status in patients with chronic kidney disease[J].,2022,(11):1698.[doi:DOI:10.3969/j.issn.1000-7369.2022.12.010]
[10]陈 曦,董凯旋,周 荣,等.中药调控p38丝裂原活化蛋白激酶/核因子κB通路治疗肾纤维化研究进展[J].陕西中医,2023,(7):980.[doi:DOI:10.3969/j.issn.1000-7369.2023.07.036]
　CHEN Xi,DONG Kaixuan,ZHOU Rong,et al.Research progress of traditional Chinese medicine regulating p38MAPK/NF-κB pathway in treatment of renal fibrosis[J].,2023,(11):980.[doi:DOI:10.3969/j.issn.1000-7369.2023.07.036]

备注/Memo

备注/Memo:
基金项目:国家重大研发项目(2018YFC1704100,2018YFC1704102); 北京市属医院科研培育计划项目(PZ2022022); 张炳厚全国名中医传承工作室建设项目
更新日期/Last Update: 2023-11-09