五苓散治疗IgA肾病理论探讨
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摘要
IgA肾病属本虚标实,本虚多为阴虚、气虚或气阴两虚,其中又以气阴两虚为主;标实是水湿与瘀血互结。临床上主要表现以肉眼或显微镜下血尿、血尿伴蛋白尿、水肿和高血压为主,最后进展为肾功能衰竭,是导致终末期肾病(ESRD)的重要病因。但国内报道IgA肾病表现肾病综合征者明显高于国外报道,约为10%～20%,大量蛋白尿和水肿为主要表现。近现代医家及临床学者应用五苓散加减化裁治疗IgA肾病报道较少,现将五苓散加减化裁治疗IgA肾病理论作以探讨。
IgA nephropathy belongs to deficiency and excess,most of the deficiencies are Yin deficiency, Qi deficiency or Qi-Yin deficiency, among which Qi-Yin deficiency is the main one;The excess is the combination of water and dampness and blood stasis. The main clinical manifestations are hematuria under naked eye or microscope,hematuria with proteinuria,edema and hypertension,and finally progression to renal failure,which is an important cause of end-stage nephropathy(ESRD). However,the number of IgA nephropathy with nephrotic syndrome in China was significantly higher than that in foreign countries,about 10%-20%,with large proteinuria and edema as the main manifestations. There are few reports on the treatment of IgA nephropathy by Wuling Powder plus or subtractive cutting,so the theory of Wuling Powder in the treatment of IgA nephropathy is discussed in this paper.
IgA nephropathy belongs to deficiency and excess,most of the deficiencies are Yin deficiency, Qi deficiency or Qi-Yin deficiency, among which Qi-Yin deficiency is the main one;The excess is the combination of water and dampness and blood stasis. The main clinical manifestations are hematuria under naked eye or microscope,hematuria with proteinuria,edema and hypertension,and finally progression to renal failure,which is an important cause of end-stage nephropathy(ESRD). However,the number of IgA nephropathy with nephrotic syndrome in China was significantly higher than that in foreign countries,about 10%-20%,with large proteinuria and edema as the main manifestations. There are few reports on the treatment of IgA nephropathy by Wuling Powder plus or subtractive cutting,so the theory of Wuling Powder in the treatment of IgA nephropathy is discussed in this paper.
引文
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[3]姬彦兆,曹明满,杨乐斌,等.中西医结合诊疗IgA肾病的研究进展[J].辽宁中医杂志,2018,45(4):872-874.
[4]王庆国.伤寒论选读[M].北京:中国中医药出版社,2016:55-58.
[5]张琦,林昌松.金匮要略讲义[M].北京:人民卫生出版社,2016:142,158.
[6]佚名.黄帝内经素问[M].田代华,整理.北京:人民卫生出版社,2015:17-18,45-46.
[7]王骞,龚学忠.研读中医经典论治水肿经方[J].辽宁中医药大学学报,2013,15(11):189-191.
[8]张国骏.成无己医学全书[M].北京:中国中医药出版社,2015:188-189.
[9]吕震名.伤寒寻源[M].王琳,姜枫,叶磊,校注.北京:中国中医药出版社,2015:140.
[10]李志庸.张景岳医学全书[M].北京:中国中医药出版社,2015:1152-1154.
[11]柯琴.伤寒来苏集[M].北京:中国医药科技出版社,2014:56-58.
[12]周澍撰.本草疏证[M].张金鑫,点校.北京:学苑出版社,2016:126.
[13]许红.金镜内台方议[M].李飞,点校.南京:江苏科学技术出版社,1984:121-122.
[14]高尔鑫.汪石山医学全书[M].北京:中国中医药出版社,2015:555-556.
[15]贾俊丽.马进教授治疗慢性肾炎血尿的经验[J].广西中医药,2016,39(4):51-52.
[16]许正锦,徐明,张倩,等.肾性血尿的中医治疗思路与评价[J].中华中医药杂志,2017,32(8):3361-3364.
[17]洪郭驹.五苓散组方及化用[J].河南中医,2013,33(7):1009-1012.
[18]徐慕鸽,魏凯峰.桂枝活血机理及配伍规律探析[J].中医药导报,2013,19(8)12-14.
[19]李媛丽.从“久病入络”论治肾性血尿[J].河南中医,2009,29(3):303-304.
[20]张锡驹.伤寒论直解[M].姜建国,孙鸿昌,校注.北京:中国中医药出版社,2015:68-69.
[21]中国中医研究院西苑医院.赵锡武医疗经验[M].北京:人民卫生出版社,2005:15-18.
[22]金兰花,汤小虎,杨芳,等.五苓散化裁内科应用概况[J].辽宁中医药大学学报,2011,13(9):86-88.