张炳厚教授运用通法治疗慢性肾脏病经验
Professor Zhang Bing-hou's Experience in Treating Chronic Kidney Disease with Obstruction-removing Therapy
DOI:10.3969/j.issn.1673-7202.2022.14.011
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1.首都医科大学附属北京中医医院,北京,100010
2.首都医科大学附属北京友谊医院,北京,100050
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申子龙, 赵文景, 辛有清. 张炳厚教授运用通法治疗慢性肾脏病经验[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.3969/j.issn.1673-7202.2022.14.011
SHEN Zilong, ZHAO Wenjing, XIN Youqing. Professor Zhang Bing-hou's Experience in Treating Chronic Kidney Disease with Obstruction-removing Therapy[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.3969/j.issn.1673-7202.2022.14.011
申子龙, 赵文景, 辛有清. 张炳厚教授运用通法治疗慢性肾脏病经验[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.3969/j.issn.1673-7202.2022.14.011 DOI:
SHEN Zilong, ZHAO Wenjing, XIN Youqing. Professor Zhang Bing-hou's Experience in Treating Chronic Kidney Disease with Obstruction-removing Therapy[DB/OL].(2023-09-15)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails#10.3969/j.issn.1673-7202.2022.14.011 DOI:
慢性肾脏病患病率逐年升高,中医治疗有一定优势。“通”是机体的生理常态,“不通”则是机体病理常态,通法是中医的重要治法之一,通法的内涵包括泻通和补通,泻通指方药具有通滞功效,补通指为扶正作用而论。张炳厚教授认为慢性肾脏病病性为虚实夹杂,存在脾肾亏虚,肾络瘀阻的基本病机,主张在补肾的基础上,重视运用通法治疗慢性肾脏病,辨证使用祛风通络、搜风通络、清热化湿、活血通脉等治法。膜性肾病多表现为肾病综合征,高凝状态较为突出,容易形成血栓,治疗应重视活血通脉治法,药物常用桃仁、红花、鬼箭羽、三棱、莪术、水蛭等。乙肝相关性肾脏病湿热较为突出,多表现为脘腹痞满,身困乏力,大便黏滞不爽,泡沫尿,治疗重视清热化湿治法,药物常用生薏米、白蔻仁、藿香、佩兰、白花蛇舌草等。IgA肾病尤易感受外邪反复发作,治疗应该从风论治,药物常用荆芥炭、防风、金银花、连翘等。张炳厚教授擅长使用全蝎、蜈蚣、僵蚕、水蛭等虫类药治疗慢性肾脏病,同时注意结合辨病及分期论治。
The prevalence of chronic kidney disease (CKD) is rising every year, and traditional Chinesemedicine (TCM) has cer-tain advantages for treating CKD. "Unobstruction" is the physiological state while "obstruction" is the pathological state of human body. Obstruction-removing therapy is an essentialmethod in TCM treatment principles, which includes reductionmethod (xie-tong) and reinforcementmethod (bu-tong). The formermeans that the prescriptions have the effect of dredging stagnation, while the latter refers to the effect of reinforcing healthy qi. Professor Zhang Bing-hou considered the pathological factor of CKD was deficiency-ex-cess in complexity, with the basic pathogenesis of deficiency of spleen and kidney and kidney collateral stasis. He proposed the treatment of CKD should, on the basis of tonifying the kidney, emphasize the use of obstruction-removing therapy and themethod of dispersing wind, dredging collaterals, clearing heat, resolving dampness, promoting blood circulation and dredging meridians based on differentiation. Membranous nephropathy ismostlymanifested as nephrotic syndrome, especially under hypercoagulable state and easily contributed to thrombosis formation. Its treatment should focus on promoting blood circulation and dredging meridian with commonly used Persicae Semen, Carthami Flos, Ramulus Euonymi, Sparganii Rhizoma, Curcumae Rhizoma, and Hirudo. The promi-nent pathogenesis of HBV-associated renal disease is dampness-heat, which ismanifested as abdominal fullness and distention, fa-tigue and tiredness, poor stoolwith incomplete evacuation, and foamy urine. Its treatment should base on clearing heatand resolving dampness, with commonly used raw Coicis Semen, Amomum cardamomum, Pogostemonis Herba, Eupatorii Herba and Hedyotidis Herba. IgA nephropathy is easily being invaded by exogenous pathogen and tends to recur. Its treatment should base on dispelling wind, with commonly used Charred Schizonepeta, Saposhnikoviae Radix, Lonicerae Japonicae Flos and Forsythiae Fructus. Professor Zhang is good atusing insect drugs, such as Scorpio, Scolopendra, Bombyx Batryticatus, and Hirudo, in the treatmentof CKD. Addi-tionally, he pays attention to the combination of disease differentiation and stages.
慢性肾脏病膜性肾病糖尿病肾脏病通法活血通脉虫类药老中医经验@张炳厚
Chronic kidney diseaseMembranous nephropathyDiabetic kidney diseaseObstruction-removing therapyPromo-ting blood circulation and dredgingmeridianInsect drugsFamous TCM doctor's experience@ZHANG Binghou
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