真武汤加味治疗肾病之临床应用研究
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摘要
目的：随着人们生活方式的改变、生活压力的增大和我国老龄化步伐的加快,肾病的发病率在逐渐升高。肾病综合征是由于多种疾病的过程中肾小球基膜通透性增加伴肾小球滤过率降低而发生的一组临床症候群,治疗极其不易,西医主要采用糖皮质激素和细胞毒药物进行治疗,但其治疗毒副作用大,且效果不佳。因此,在中医药中寻找疗效可靠的治疗肾病综合征的方药有重要意义。本文通过探讨真武汤加味在治疗肾病方面的临床疗效及机制,希望对于肾病的治疗有一定的参考价值。
方法：将符合来台湾台中市弘春堂中医诊所门诊进行治疗的肾病综合征脾肾阳虚证患者100例进行临床观察,按照入院的前后顺序随机分为治疗组和对照组,每组50例,两组患者在年龄、性别、病程、临床表现、病情、生化指标检查等一般资料方面具有可比性,P>0.05。对照组患者在署立丰原医院采用西药常规治疗方法,治疗组采用真武汤加味进行加减治疗,治疗观察8周以后对其进行访视,比较临床疗效及各项实验室指标在治疗前后的变化,观察安全性及疗效性。安全评价标准分为：1级：安全,无任何不良反应。2级：比较安全,不良反应较为轻微,不需做任何处理,未中断服用。3级：有安全性问题,出现有中等程度的不良反应,进行对症处理后,未中断服用药物。4级：不良反应较为严重,因不良反应中止治疗。临床症状记分参照2002年颁布的《中药新药临床研究指导原则》,将无、轻、中、重记为0、1、2、3四个等级,舌脉具体描述不记分。将各项观察指标积分按尼莫地平法以百分数表示。中医证候疗效评定分为显效、有效和无效,疾病疗效评定分为完全缓解、基本缓解、有效和无效。
结果：临床总疗效：总有效率86.0%,治疗后的中医症候积分为13.74±7.62,显著低于治疗前的20.41±10.41,P<0.05。经过实验室诊断,发现此组患者的24h尿蛋白、血浆白蛋白、uNAG、uRPB、SG治疗后的指标均优于治疗前,P<0.05。肾功能：治疗组治疗前后的血尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(Ccr)均显著改善,P<0.05。治疗组治疗前后的甘油三脂(TG)、总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL—c)、低密度脂蛋白胆固醇(LDL—c)的改善显著,P<0.05。治疗组治疗前后的收缩压、舒张压均显著改善,P<0.05。此组患者在治疗期间没有出现不良事件,治疗组无痤疮、向心性肥胖等副作用,其副作用发生率为6.0%,低于文献中研究的发生率。
结论：真武汤加味治疗肾病综合征脾肾阳虚证有较好的疗效,有利于改善临床症状,保护肾功能,其作用机理可能在于降低尿蛋白、增加血浆白蛋白、改善血脂、降低血压,从而延缓和阻止病情的进展、恶化,且在应用中未发现明显副作用,具有较高的临床价值。
Objective:as changing of the people's life style, the increasing pressure of life in China and speeding up of the aging, the incidence of kidney disease was gradually increasing. Nephrotic syndrome is incident bacause of Glomerular basement membrane permeability with glomerular filtration rate in a variety of diseases in the process, treatment is not easy, western medicine mainly using the sugar cortical hormone and cytotoxic drugs, but its side effects after treatment was big, and the effective not very good. Therefore, in traditional Chinese medicine for the treatment of reliable in effect of nephrotic syndrome formulas to have the important meaning. This paper discusses zhenwu tonga taste in the clinical curative effect of the treatment of kidney disease and mechanism, and hope for kidney disease's treatment has the certain reference value.
Methods:collected the100patients of nephrotic syndrome spleen and kidney with clinical observation to Taiwan taichung city hong spring hall TCM clinic outpatient clinic treatment,according to the sequence was divided into the treatment group and control group, each group of50cases, two groups of patients with age, sex, and the course, clinical manifestation, illness, biochemical index inspection general information to comparable, P>0.05. Patients in the department made by western medicine hospital routine therapy bbca method, the treatment group using zhenwu tonga on taste and treatment, the treatment after eight weeks to observe the supervision, compare clinical curative effect and the laboratory in the change of index before and after treatment, observe safety and efficacy sex. Safety evaluation standards are divided into:grade1:safety, without any adverse reactions. Level2: safe, and adverse reaction relatively minor, and don't need to do anything, not interrupt taking. Level3:a security problem, a moderate adverse reactions, to treat, did not interrupt the drug. The levels is:adverse reactions are serious, because of adverse reactions to suspend the treatment. Clinical symptom scores refer to2002"issued by the Chinese herbal medicine new medicine clinical research guiding principle", will not, light, medium, heavy notes for0,1,2,3four ranks, tongue description will not be graded pulse. Will the outcome by nimodipine method expressed as a percentage. Syndromes curative effect evaluation of blood, effective and divided into invalid, disease curative effect evaluation into complete remission, basic ease, effective and invalid.
Results:the total clinical curative effect:the total effective rate was arrived the86.0%, the traditional Chinese medicine treatment for symptomatic integral13.74+/-7.62, much lower than the20.41±10.41before treatment, P<0.05. After laboratory diagnosis, found this group of patients with24h urine protein, plasma albumin, uNAG, uRPB, SG after treatment were superior to the index before treatment, P<0.05. Kidney function:treatment group and blood urea nitrogen (BUN), serum creatinine (Scr), endogenous creatinine clearance (Ccr) were significantly improve, P<0.05. Before and after treatment group triglycerides (TG), total cholesterol (CHOL), high-density lipoprotein cholesterol (hdl-c), low density lipoprotein cholesterol (LDL)-c) improve significantly, P<0.05. Before and after treatment group is the systolic pressure, diastolic pressure were significantly improve, P<0.05. This group of patients did not appear during treatment of adverse events, no acne treatment group and centripetal obesity side effect, its side effects rate was6.0%, lower than in the incidence of literature research.
Conclusion:zhenwu tong treatment nephrotic syndrome had good effective, to improve the clinical symptoms, protect the renal function, its mechanism may lie in lower urine protein, increase albumin, improve blood plasma, lower blood pressure, delaying and stop the progress of the disease, and worse, and application in found no obvious side effects, had high clinical value.
方法：将符合来台湾台中市弘春堂中医诊所门诊进行治疗的肾病综合征脾肾阳虚证患者100例进行临床观察,按照入院的前后顺序随机分为治疗组和对照组,每组50例,两组患者在年龄、性别、病程、临床表现、病情、生化指标检查等一般资料方面具有可比性,P>0.05。对照组患者在署立丰原医院采用西药常规治疗方法,治疗组采用真武汤加味进行加减治疗,治疗观察8周以后对其进行访视,比较临床疗效及各项实验室指标在治疗前后的变化,观察安全性及疗效性。安全评价标准分为：1级：安全,无任何不良反应。2级：比较安全,不良反应较为轻微,不需做任何处理,未中断服用。3级：有安全性问题,出现有中等程度的不良反应,进行对症处理后,未中断服用药物。4级：不良反应较为严重,因不良反应中止治疗。临床症状记分参照2002年颁布的《中药新药临床研究指导原则》,将无、轻、中、重记为0、1、2、3四个等级,舌脉具体描述不记分。将各项观察指标积分按尼莫地平法以百分数表示。中医证候疗效评定分为显效、有效和无效,疾病疗效评定分为完全缓解、基本缓解、有效和无效。
结果：临床总疗效：总有效率86.0%,治疗后的中医症候积分为13.74±7.62,显著低于治疗前的20.41±10.41,P<0.05。经过实验室诊断,发现此组患者的24h尿蛋白、血浆白蛋白、uNAG、uRPB、SG治疗后的指标均优于治疗前,P<0.05。肾功能：治疗组治疗前后的血尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(Ccr)均显著改善,P<0.05。治疗组治疗前后的甘油三脂(TG)、总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL—c)、低密度脂蛋白胆固醇(LDL—c)的改善显著,P<0.05。治疗组治疗前后的收缩压、舒张压均显著改善,P<0.05。此组患者在治疗期间没有出现不良事件,治疗组无痤疮、向心性肥胖等副作用,其副作用发生率为6.0%,低于文献中研究的发生率。
结论：真武汤加味治疗肾病综合征脾肾阳虚证有较好的疗效,有利于改善临床症状,保护肾功能,其作用机理可能在于降低尿蛋白、增加血浆白蛋白、改善血脂、降低血压,从而延缓和阻止病情的进展、恶化,且在应用中未发现明显副作用,具有较高的临床价值。
Objective:as changing of the people's life style, the increasing pressure of life in China and speeding up of the aging, the incidence of kidney disease was gradually increasing. Nephrotic syndrome is incident bacause of Glomerular basement membrane permeability with glomerular filtration rate in a variety of diseases in the process, treatment is not easy, western medicine mainly using the sugar cortical hormone and cytotoxic drugs, but its side effects after treatment was big, and the effective not very good. Therefore, in traditional Chinese medicine for the treatment of reliable in effect of nephrotic syndrome formulas to have the important meaning. This paper discusses zhenwu tonga taste in the clinical curative effect of the treatment of kidney disease and mechanism, and hope for kidney disease's treatment has the certain reference value.
Methods:collected the100patients of nephrotic syndrome spleen and kidney with clinical observation to Taiwan taichung city hong spring hall TCM clinic outpatient clinic treatment,according to the sequence was divided into the treatment group and control group, each group of50cases, two groups of patients with age, sex, and the course, clinical manifestation, illness, biochemical index inspection general information to comparable, P>0.05. Patients in the department made by western medicine hospital routine therapy bbca method, the treatment group using zhenwu tonga on taste and treatment, the treatment after eight weeks to observe the supervision, compare clinical curative effect and the laboratory in the change of index before and after treatment, observe safety and efficacy sex. Safety evaluation standards are divided into:grade1:safety, without any adverse reactions. Level2: safe, and adverse reaction relatively minor, and don't need to do anything, not interrupt taking. Level3:a security problem, a moderate adverse reactions, to treat, did not interrupt the drug. The levels is:adverse reactions are serious, because of adverse reactions to suspend the treatment. Clinical symptom scores refer to2002"issued by the Chinese herbal medicine new medicine clinical research guiding principle", will not, light, medium, heavy notes for0,1,2,3four ranks, tongue description will not be graded pulse. Will the outcome by nimodipine method expressed as a percentage. Syndromes curative effect evaluation of blood, effective and divided into invalid, disease curative effect evaluation into complete remission, basic ease, effective and invalid.
Results:the total clinical curative effect:the total effective rate was arrived the86.0%, the traditional Chinese medicine treatment for symptomatic integral13.74+/-7.62, much lower than the20.41±10.41before treatment, P<0.05. After laboratory diagnosis, found this group of patients with24h urine protein, plasma albumin, uNAG, uRPB, SG after treatment were superior to the index before treatment, P<0.05. Kidney function:treatment group and blood urea nitrogen (BUN), serum creatinine (Scr), endogenous creatinine clearance (Ccr) were significantly improve, P<0.05. Before and after treatment group triglycerides (TG), total cholesterol (CHOL), high-density lipoprotein cholesterol (hdl-c), low density lipoprotein cholesterol (LDL)-c) improve significantly, P<0.05. Before and after treatment group is the systolic pressure, diastolic pressure were significantly improve, P<0.05. This group of patients did not appear during treatment of adverse events, no acne treatment group and centripetal obesity side effect, its side effects rate was6.0%, lower than in the incidence of literature research.
Conclusion:zhenwu tong treatment nephrotic syndrome had good effective, to improve the clinical symptoms, protect the renal function, its mechanism may lie in lower urine protein, increase albumin, improve blood plasma, lower blood pressure, delaying and stop the progress of the disease, and worse, and application in found no obvious side effects, had high clinical value.
引文
[1]张喜奎,李灵辉.桃核真武汤防治慢性肾功能衰竭的实验研究[J].福建中医学院学报,2008,22(03)：52-55
[2]熊曼琪,梅国强,林安钟.伤寒论[M].北京：人民卫生出版社,2003,639-642.
[3]刘小菊,叶玉珠补阳还五汤加减治疗早期糖尿病肾病58例[J].浙江中医药大学学报,2009,33(1)：75-76.
[4]阮诗玮,叶彬华,吴竞,等.益肾降浊冲剂治疗慢性肾衰竭的临床观察及对血清瘦素的影响[J].中国中西医结合肾病杂志,2007,8(2)：84.
[5]孙松生,孙梅生.孙朝宗临床应用真武汤举隅[J].中国民间疗法,2009,17(9)：5
[6]郭巍,吕焱红,刘凤荣.肾康注射液治疗轻中度慢性肾衰竭44例临床观察[J].中国医药导刊,2009,11(2)：334.
[7]王立成.真武汤治验二则[J].检验医学与临床,2009,59(20)：93
[8]王付.肾病综合征妙方真武萆薜汤[J].家庭医学,2009,60(10)：58
[9]孙灵芝,相修平.真武汤治验举隅[J].山西中医,2009,30(05)：36
[10]谭万初.真武汤加味治疗慢性肾衰IV期1例[J].中医药临床杂志,2009,04(02)：11
[11]刘奇,远方.真武汤治慢性肾衰阳虚水泛证浅析[J].辽宁中医药大学学报,2009,24(04)：43-44
[12]余锟.真武汤临床应用举隅[J].浙江中医杂志,2009,30(02)：44
[13]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10—-12.
[14]司徒宝珍,罗陆一.罗陆一教授运用真武汤的临证经验[J].内蒙古中医药,2008,02(21)：7-8
[15]樊志明.真武汤合生脉散加味治疗慢性心力衰竭30例[J].福建中医药,2008,25(05)：37
[16]华传金.难治性水肿治验3则[J].北京中医药大学学报(中医临床版),2008,21(04)：49-50
[17]董扬洲.真武汤加味治疗原发性肾病综合征18例临床观察[J].湖南中医杂志,2008,14(04)：26-28
[18]李砚民.慢性肾炎中医治疗四法[J].河南中医,2010,29(03)：54-56
[19]蒲纪.真武汤治验四则[J].实用中医内科杂志,2008,70(06)：86-87
[20]顾武军,耿建国,王松.真武汤对人肾小球系膜细胞外基质作用的实验研究[J].中医杂志,2000,41(11)：686
[21]刘芳,李明哲,李巍.真武汤对肾阳虚型慢性肾功衰竭模型大鼠肾组织AQP1表达的影响[J].实用中医内科杂志,2010,24(6)：25-26.
[22]汪军.真武汤加味对慢件肾功能阳虚型患者尿中微量蛋白的影响[J].巾国 中医药科技,1995,2(4)：46
[23]李慧灵.加味真武汤治疗肾病综合症的体会[J].中国民族民间医药,2010,19(12)：242.
[24]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10
[25]蔡宏宇.中医途径治疗持续性肾病蛋白尿临床探讨[J].航空航天医药,2010,21(1)：126.
[26]周英,加味真武汤治疗糖尿病肾病的临床与实验研究[D]广州中医药大学,2007,4
[27]Ruilope LM,Luno J. Angiotensin blockade in type 2 diabetic renal disease..2002
[28]UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes..1998
[29]American Diabetes Association. Diabetic nephropathy..2003
[30]Pahor M,Psaty BM,Alderman MH, et al. rherapeutic benefits of ACE inhibitors and other antihypertensive drugs inpatients with type 2 diabetes..2000
[31]王吉耀,廖二元,胡品津.内科学[M].北京：人民卫生出版社,2005：580 582.
[1]张喜奎,李灵辉.桃核真武汤防治慢性肾功能衰竭的实验研究[J].福建中医学院学报,2008,22(03)：52-55
[2]熊曼琪,梅国强,林安钟.伤寒论[M].北京：人民卫生出版社,2003,639-642.
[3]刘小菊,叶玉珠补阳还五汤加减治疗早期糖尿病肾病58例[J].浙江中医药大学学报,2009,33(1)：75-76.
[4]阮诗玮,叶彬华,吴竞,等.益肾降浊冲剂治疗慢性肾衰竭的临床观察及对血清素的影响[J].中国中西医结合肾病杂志,2007,8(2)：84.
[5]孙松生,孙梅生.孙朝宗临床应用真武汤举隅[J].中国民间疗法,2009,17(9)：5
[6]郭巍,吕焱红,刘凤荣.肾康注射液治疗轻中度慢性肾衰竭44例临床观察[J].中国医药导刊,2009,11(2)：334.
[7]王立成.真武汤治验二则[J].检验医学与临床,2009,59(20)：93
[8]王付.肾病综合征妙方真武萆薢汤[J].家庭医学,2009,60(10)：58
[9]孙灵芝,相修平.真武汤治验举隅[J].山西中医,2009,30(05)：36
[10]谭万初.真武汤加味治疗慢性肾衰Ⅳ期1例[J].中医药临床杂志,2009,04(02)：11
[11]刘奇,远方.真武汤治慢性肾衰阳虚水泛证浅析[J].辽宁中医药大学学报,2009,24(04)：43-44
[12]余锟.真武汤临床应用举隅[J].浙江中医杂志,2009,30(02)：44
[13]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10—12.
[14]司徒宝珍,罗陆一.罗陆一教授运用真武汤的临证经验[J].内蒙古中医药,2008,02(21)：7-8
[15]中华中医药学会肾病分会.原发性肾病综合征的诊断、辨证分型及疗效评定试行方案[J].上海中医药杂志,2006,40(10)：51-52
[16]叶任高,陆再英.内科学(第6版)[M].北京：人民卫生出版社,2004,514
[17]中华人民共和国卫生部制定发布.中药新药研究指导原则[M].第1辑,1993,153-157
[18]李砚民.慢性肾炎中医治疗四法[J].河南中医,2010,29(03)：54-56
[19]付玲,于淼.茯苓研究的新进展.新疆中医药.2005,23(3)：79
[20]冯文茹,孙向军,胡人杰.中药茯苓的药理研究及临床应用[J].天津医科大学学报,1995,1(2)：95-97
[21]胡南,许惠玉,陈志伟,芍药苷的药理学研究进展.齐齐哈尔医学院学报[J].2007,28(9)：1093
[22]上海中医学院,中草约学[M].商务印书馆,2002,9；520
[23]刘晓,刘克武,江琰,等.部分中药材及调味料对小肠蔗糖酶活性的影响[J].中国生化药物杂志,2003,24(5)：229
[24]孙伟,何伟明.糖尿病肾病蛋白尿的中医药治疗体会[J].江苏中医药,2002,23(5)：18
[25]上海中医学院,中草药学[M].商务印书馆,2002,9；42
[26]顾武军,耿建国,王松.真武汤对人肾小球系膜细胞外基质作用的实验研 究[J].中医杂志,2000,41(11)：686
[27]刘芳, 李明哲,李巍.真武汤对肾阳虚型慢性肾功衰竭模型大鼠肾组织AQP1表达的影响[J].实用中医内科杂志,2010,24(6)：25-26.
[28]汪军.真武汤加味对慢件肾功能阳虚型患者尿中微量蛋白的影响[J].巾国中医药科技,1995,2(4)：46
[29]李慧灵.加味真武汤治疗肾病综合症的体会[J].中国民族民间医药,2010,19(12)：242.
[30]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10
[31]蔡宏宇.中医途径治疗持续性肾病蛋白尿临床探讨[J].航空航天医药,2010,21(1)：126.
[32]何怀明.《伤寒杂病论》在治疗糖尿病肾病中的指导作用[J].江苏中医药,2004；25(6)：5
[33]李珊珊.真武汤临床及实验研究概况[J].河南中医药学刊,1998；13(2)：12
[34]刘晓,刘克武,江琰,等.部分中药材及调味料对小肠蔗糖酶活性的影响[J].中国生化药物杂志,2003；24(5)：229
[35]Eddy AA.interstitial nephritis incrued by protein overload proteinunria[J].Am J Pathol, 1989,135:719-733
[36]陈强,胡伟新,王生余,等.尿视黄醇结合蛋白判断肾小管-间质损伤的临床意义[J].肾脏病与透析肾移植杂志,2001,5(10)：406-410
[37]Attman PO, Alaupovic P, Samuelsson 0, et al.Lipoprotein abnormalities as a risk factor for progressive nondiabetic renal diseases[J].kidney Int,1999,56 (Suppl.71):14-17
[38]Keane WF.Lipids and the kidney [J]. Kidney Int,1994,46(3):910-920
[39]王水华,邓宏韬,王国斌,等.排毒保肾丸治疗慢性肾功能衰竭的临床观察[J].中国中西医结合杂志,2008,28(8)：736-738.
[40]伍新林,李志坚,张伟君,等.肾衰方治疗慢性肾功能衰竭的临床研究[J].中药材,2008,31(5)：796-798.
[41]傅贵平,古容芳,郭一民,等.益肾活血升清泄浊法治疗慢性肾功能衰竭临床研究[J].上海中医药杂志,2008,42(5)：42-43.
[2]熊曼琪,梅国强,林安钟.伤寒论[M].北京：人民卫生出版社,2003,639-642.
[3]刘小菊,叶玉珠补阳还五汤加减治疗早期糖尿病肾病58例[J].浙江中医药大学学报,2009,33(1)：75-76.
[4]阮诗玮,叶彬华,吴竞,等.益肾降浊冲剂治疗慢性肾衰竭的临床观察及对血清瘦素的影响[J].中国中西医结合肾病杂志,2007,8(2)：84.
[5]孙松生,孙梅生.孙朝宗临床应用真武汤举隅[J].中国民间疗法,2009,17(9)：5
[6]郭巍,吕焱红,刘凤荣.肾康注射液治疗轻中度慢性肾衰竭44例临床观察[J].中国医药导刊,2009,11(2)：334.
[7]王立成.真武汤治验二则[J].检验医学与临床,2009,59(20)：93
[8]王付.肾病综合征妙方真武萆薜汤[J].家庭医学,2009,60(10)：58
[9]孙灵芝,相修平.真武汤治验举隅[J].山西中医,2009,30(05)：36
[10]谭万初.真武汤加味治疗慢性肾衰IV期1例[J].中医药临床杂志,2009,04(02)：11
[11]刘奇,远方.真武汤治慢性肾衰阳虚水泛证浅析[J].辽宁中医药大学学报,2009,24(04)：43-44
[12]余锟.真武汤临床应用举隅[J].浙江中医杂志,2009,30(02)：44
[13]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10—-12.
[14]司徒宝珍,罗陆一.罗陆一教授运用真武汤的临证经验[J].内蒙古中医药,2008,02(21)：7-8
[15]樊志明.真武汤合生脉散加味治疗慢性心力衰竭30例[J].福建中医药,2008,25(05)：37
[16]华传金.难治性水肿治验3则[J].北京中医药大学学报(中医临床版),2008,21(04)：49-50
[17]董扬洲.真武汤加味治疗原发性肾病综合征18例临床观察[J].湖南中医杂志,2008,14(04)：26-28
[18]李砚民.慢性肾炎中医治疗四法[J].河南中医,2010,29(03)：54-56
[19]蒲纪.真武汤治验四则[J].实用中医内科杂志,2008,70(06)：86-87
[20]顾武军,耿建国,王松.真武汤对人肾小球系膜细胞外基质作用的实验研究[J].中医杂志,2000,41(11)：686
[21]刘芳,李明哲,李巍.真武汤对肾阳虚型慢性肾功衰竭模型大鼠肾组织AQP1表达的影响[J].实用中医内科杂志,2010,24(6)：25-26.
[22]汪军.真武汤加味对慢件肾功能阳虚型患者尿中微量蛋白的影响[J].巾国 中医药科技,1995,2(4)：46
[23]李慧灵.加味真武汤治疗肾病综合症的体会[J].中国民族民间医药,2010,19(12)：242.
[24]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10
[25]蔡宏宇.中医途径治疗持续性肾病蛋白尿临床探讨[J].航空航天医药,2010,21(1)：126.
[26]周英,加味真武汤治疗糖尿病肾病的临床与实验研究[D]广州中医药大学,2007,4
[27]Ruilope LM,Luno J. Angiotensin blockade in type 2 diabetic renal disease..2002
[28]UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes..1998
[29]American Diabetes Association. Diabetic nephropathy..2003
[30]Pahor M,Psaty BM,Alderman MH, et al. rherapeutic benefits of ACE inhibitors and other antihypertensive drugs inpatients with type 2 diabetes..2000
[31]王吉耀,廖二元,胡品津.内科学[M].北京：人民卫生出版社,2005：580 582.
[1]张喜奎,李灵辉.桃核真武汤防治慢性肾功能衰竭的实验研究[J].福建中医学院学报,2008,22(03)：52-55
[2]熊曼琪,梅国强,林安钟.伤寒论[M].北京：人民卫生出版社,2003,639-642.
[3]刘小菊,叶玉珠补阳还五汤加减治疗早期糖尿病肾病58例[J].浙江中医药大学学报,2009,33(1)：75-76.
[4]阮诗玮,叶彬华,吴竞,等.益肾降浊冲剂治疗慢性肾衰竭的临床观察及对血清素的影响[J].中国中西医结合肾病杂志,2007,8(2)：84.
[5]孙松生,孙梅生.孙朝宗临床应用真武汤举隅[J].中国民间疗法,2009,17(9)：5
[6]郭巍,吕焱红,刘凤荣.肾康注射液治疗轻中度慢性肾衰竭44例临床观察[J].中国医药导刊,2009,11(2)：334.
[7]王立成.真武汤治验二则[J].检验医学与临床,2009,59(20)：93
[8]王付.肾病综合征妙方真武萆薢汤[J].家庭医学,2009,60(10)：58
[9]孙灵芝,相修平.真武汤治验举隅[J].山西中医,2009,30(05)：36
[10]谭万初.真武汤加味治疗慢性肾衰Ⅳ期1例[J].中医药临床杂志,2009,04(02)：11
[11]刘奇,远方.真武汤治慢性肾衰阳虚水泛证浅析[J].辽宁中医药大学学报,2009,24(04)：43-44
[12]余锟.真武汤临床应用举隅[J].浙江中医杂志,2009,30(02)：44
[13]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10—12.
[14]司徒宝珍,罗陆一.罗陆一教授运用真武汤的临证经验[J].内蒙古中医药,2008,02(21)：7-8
[15]中华中医药学会肾病分会.原发性肾病综合征的诊断、辨证分型及疗效评定试行方案[J].上海中医药杂志,2006,40(10)：51-52
[16]叶任高,陆再英.内科学(第6版)[M].北京：人民卫生出版社,2004,514
[17]中华人民共和国卫生部制定发布.中药新药研究指导原则[M].第1辑,1993,153-157
[18]李砚民.慢性肾炎中医治疗四法[J].河南中医,2010,29(03)：54-56
[19]付玲,于淼.茯苓研究的新进展.新疆中医药.2005,23(3)：79
[20]冯文茹,孙向军,胡人杰.中药茯苓的药理研究及临床应用[J].天津医科大学学报,1995,1(2)：95-97
[21]胡南,许惠玉,陈志伟,芍药苷的药理学研究进展.齐齐哈尔医学院学报[J].2007,28(9)：1093
[22]上海中医学院,中草约学[M].商务印书馆,2002,9；520
[23]刘晓,刘克武,江琰,等.部分中药材及调味料对小肠蔗糖酶活性的影响[J].中国生化药物杂志,2003,24(5)：229
[24]孙伟,何伟明.糖尿病肾病蛋白尿的中医药治疗体会[J].江苏中医药,2002,23(5)：18
[25]上海中医学院,中草药学[M].商务印书馆,2002,9；42
[26]顾武军,耿建国,王松.真武汤对人肾小球系膜细胞外基质作用的实验研 究[J].中医杂志,2000,41(11)：686
[27]刘芳, 李明哲,李巍.真武汤对肾阳虚型慢性肾功衰竭模型大鼠肾组织AQP1表达的影响[J].实用中医内科杂志,2010,24(6)：25-26.
[28]汪军.真武汤加味对慢件肾功能阳虚型患者尿中微量蛋白的影响[J].巾国中医药科技,1995,2(4)：46
[29]李慧灵.加味真武汤治疗肾病综合症的体会[J].中国民族民间医药,2010,19(12)：242.
[30]杜雨茂.真武汤为主治疗慢性肾衰的临床与实验研究[J].中国医药学报,1991,6(4)：10
[31]蔡宏宇.中医途径治疗持续性肾病蛋白尿临床探讨[J].航空航天医药,2010,21(1)：126.
[32]何怀明.《伤寒杂病论》在治疗糖尿病肾病中的指导作用[J].江苏中医药,2004；25(6)：5
[33]李珊珊.真武汤临床及实验研究概况[J].河南中医药学刊,1998；13(2)：12
[34]刘晓,刘克武,江琰,等.部分中药材及调味料对小肠蔗糖酶活性的影响[J].中国生化药物杂志,2003；24(5)：229
[35]Eddy AA.interstitial nephritis incrued by protein overload proteinunria[J].Am J Pathol, 1989,135:719-733
[36]陈强,胡伟新,王生余,等.尿视黄醇结合蛋白判断肾小管-间质损伤的临床意义[J].肾脏病与透析肾移植杂志,2001,5(10)：406-410
[37]Attman PO, Alaupovic P, Samuelsson 0, et al.Lipoprotein abnormalities as a risk factor for progressive nondiabetic renal diseases[J].kidney Int,1999,56 (Suppl.71):14-17
[38]Keane WF.Lipids and the kidney [J]. Kidney Int,1994,46(3):910-920
[39]王水华,邓宏韬,王国斌,等.排毒保肾丸治疗慢性肾功能衰竭的临床观察[J].中国中西医结合杂志,2008,28(8)：736-738.
[40]伍新林,李志坚,张伟君,等.肾衰方治疗慢性肾功能衰竭的临床研究[J].中药材,2008,31(5)：796-798.
[41]傅贵平,古容芳,郭一民,等.益肾活血升清泄浊法治疗慢性肾功能衰竭临床研究[J].上海中医药杂志,2008,42(5)：42-43.