远方教授中西医结合治疗痛风性肾病经验总结
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摘要
随着人们生活水平的提高,痛风性肾病已成为常见疾病。远方教授从事临床治疗、科研、教学二十余年,在中西医结合治疗痛风性肾病方面积累了丰富的经验。本文着重从导师对痛风性肾病病因病机的认识及中西医结合治疗两个方面来进行总结。现代医学认为:痛风性肾病的基本病理变化为高尿酸所致不溶性尿酸结晶沉积于肾组织中,通过物理作用堵塞肾小管,影响细胞的正常生理功能;而且结晶被细胞摄取后会活化补体,启动炎症反应,使得肾脏功能受到影响。其发病机制复杂,至今尚未完全阐明。祖国医学认为:痛风性肾病发病缘于痛风,在中医学中无此病名,在不同的病理阶段可根据中医辨证治疗。远师认为:本病的病机主要为痛风日久,缠绵不愈,使脏腑功能失调虚衰而发病。病变脏腑在脾肾肝三脏,可涉及瘀血、湿邪等病理产物。在中医辨证上导师根据病人所处的不同病理阶段和临床表现,常将痛风性肾病分为:湿热下注,损伤肾络型;湿浊痹阻,瘀血内停型;脾肾气虚,水湿不化型;肝肾阴虚,血瘀痹阻型;脾肾虚衰,湿浊溜滞型五证型辨证论治。分别运用清热利湿,活血化瘀,健脾利湿,滋补肝肾,通腑泄浊等来治疗痛风性肾病,同时配合西药控制血尿酸、血压,纠正脂代谢紊乱等综合治疗方法取得满意疗效。
With the improvement of living standards, gouty nephropathy has become common diseases. Professor is engaged in scientific research, teaching far in more than 20 years, combining traditional Chinese and western medicine treatment gouty nephropathy have accumulated rich experience, this article emphatically from the tutor gouty nephropathy etiology and pathogenesis of combining traditional Chinese and western medicine treatment of knowledge, the two aspects were summarized in this paper. The modern medical science thinks: gouty nephropathy for the basic pathological changes caused by high uric acid of insoluble uric acid crystals deposited on renal tissues, through physical function jams renal tubular, affect the normal cell physiological function; And crystallization were cells will activate the complement intake, launching inflammatory reaction, make renal function affected. Its pathogenesis complex, have not yet fully understood. The motherland medicine thinks: gouty nephropathy in TCM pathogenesis from gout, without the disease in name, in different pathologic stage can according to TCM syndrome differentiation and treatment.Professor Yuan think the pathogenesis of this disease division mainly for gout day long, lingering not more, make viscera function disorder virtual failure and disease.Visceral lesions in the spleen ,kidney,liver three dirty, can involve blood stasis, dampness and other pathological product. In TCM syndrome differentiation in patients on the tutor according to different pathological phase and the clinical manifestations, often be gouty nephropathy is divided into hot and humid betting, damage renal winding type; Wet chaotic, blood stasis attack resistance within type; stop Spleen deficiency, water wet case kidney-qi don't turn type; Blood stasis liver-kidney Yin deficiency, attack resistance type; Spleen kidney failure, wet muddy sneak sluggish type differentiation type 5 evidence; Using concretion run smoothly respectively, promoting blood circulation to remove blood stasis, invigorating spleen, nourishing liver kidney, the benefit is to treat such discharge turbidity astringing gouty nephropathy, meanwhile wm could control blood uric acid, blood pressure, are able to correct the lipid metabolism disorders etc. Comprehensive treatment with satisfactory results.
With the improvement of living standards, gouty nephropathy has become common diseases. Professor is engaged in scientific research, teaching far in more than 20 years, combining traditional Chinese and western medicine treatment gouty nephropathy have accumulated rich experience, this article emphatically from the tutor gouty nephropathy etiology and pathogenesis of combining traditional Chinese and western medicine treatment of knowledge, the two aspects were summarized in this paper. The modern medical science thinks: gouty nephropathy for the basic pathological changes caused by high uric acid of insoluble uric acid crystals deposited on renal tissues, through physical function jams renal tubular, affect the normal cell physiological function; And crystallization were cells will activate the complement intake, launching inflammatory reaction, make renal function affected. Its pathogenesis complex, have not yet fully understood. The motherland medicine thinks: gouty nephropathy in TCM pathogenesis from gout, without the disease in name, in different pathologic stage can according to TCM syndrome differentiation and treatment.Professor Yuan think the pathogenesis of this disease division mainly for gout day long, lingering not more, make viscera function disorder virtual failure and disease.Visceral lesions in the spleen ,kidney,liver three dirty, can involve blood stasis, dampness and other pathological product. In TCM syndrome differentiation in patients on the tutor according to different pathological phase and the clinical manifestations, often be gouty nephropathy is divided into hot and humid betting, damage renal winding type; Wet chaotic, blood stasis attack resistance within type; stop Spleen deficiency, water wet case kidney-qi don't turn type; Blood stasis liver-kidney Yin deficiency, attack resistance type; Spleen kidney failure, wet muddy sneak sluggish type differentiation type 5 evidence; Using concretion run smoothly respectively, promoting blood circulation to remove blood stasis, invigorating spleen, nourishing liver kidney, the benefit is to treat such discharge turbidity astringing gouty nephropathy, meanwhile wm could control blood uric acid, blood pressure, are able to correct the lipid metabolism disorders etc. Comprehensive treatment with satisfactory results.
引文
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[2]中华中医药学会肾病分会.尿酸性肾病的诊断辨证分型及疗效评定[J].上海中医药杂志,2008.42(1):23-24
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[4]郭义恒,于改革.缬沙坦联合氟伐他汀治疗慢性尿酸性肾病临床观察[J].实用诊断与治疗杂志,2006,(20)12:892-893
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[6]孙劲松,蒋玉洁.加味地黄汤治疗痛风性肾病临床观察[J].中国康复理论与实践,2005,11(9):746-747
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[8]华琼,关明智.降酸饮治疗慢性尿酸性肾病30例[J].中医研究,2009,22(l2):22-23
[9]杨小梅,,张小玉,杨海俊,王艳.舒惠荃教授治疗慢性尿酸性肾病的经验[J].实用中西医结合临床,2010,10(3):67-68
[10]陈春平.袪湿活血通络法治疗痛风性肾病32例[J].中国现代药物应用,2009,3(5):122-123
[11]向少伟,赖申昌,蒙宇华.中西医结合治疗慢性尿酸性肾病47例临床观察[ J ].中国中西医结合肾病杂志,2009,l0(8):731-732
[12]李芳,徐大基.名中医黄春林教授治疗痛风及痛风性肾病之经验[J].中医药研究,1999,15(3):1-2
[13]金劲松.邵朝弟教授治疗慢性尿酸性肾病的经验[J].中国中西医结合肾病杂志,2005,6(4):191-192
[14]杜兰屏,张春崧,王琳.陈以平治疗痛风性肾病的经验[J].上海中医药杂志,2005,39(11):27-28
[15]张彤.叶景华治疗继发性肾脏病经验撷英[J].中国中医药信息杂志,2007,14(12):81-82
[16]付春梅,皮持衡治疗痛风性肾病经验[J]世界中医药,2008,3(增):65-66
[17]金俊佑.痛风性肾病的中医辨证论治[J].北京中医药,2009,28(4):278-279
[18]申海莉,王玉凤,刘国芬.酸脂清胶囊治疗尿酸性肾病20例[J].山东中医杂志,2005,24(4):216-217
[19]李华伟,李巨其.八正散加减治疗原发性痛风性肾病3O例临床观察[J].国医论坛,2006,21(4):31-32
[20]宋平.泄浊活血法治疗原发性痛风性肾病临床研究[J].辽宁中医杂志,2006,33(4):427-428
[21]高忠恩.清热化湿甘润通络中药治疗痛风性肾病30例分析[J].中国误诊学杂志,2007,7(3):592-593
[22]周珂,旷惠桃,龙华君.痛风克汤对痛风性肾病的临床疗效观察[J].中国中西医结合肾病杂志,2008,9(1):75-76
[23]毛荣霞,孙尚香,石春芳.痛风排毒汤治疗原发性痛风性肾病[J].山西中医,2008,24(5):58-59
[24]赵菁莉,杨洪涛.温肾化毒合剂治疗痛风性肾病3O例临床观察[J].中医药信息,2008,25(4):36
[25]张汉新.四四二合方"治疗原发性痛风性肾病(湿热痰浊瘀血内阻型)36例临床观察[J].四川中医,2008,26(9):70-71
[26]王艳玲,杨怀新,邱侠,张剑勇.护肾痛风泰冲剂治疗湿热瘀阻型痛风性肾病疗效观察[J].中国中医急症,2009,18(12):1974-1975
[27]高曼琳,朱为爱.“益肾清利和络方”治疗原发性痛风性肾病32例临床研究[J].江苏中医药,2010,42(8)18-19
[28]冯天保,冯瑞芳,谢桂权.健脾补肾活血泄浊法治疗慢性尿酸性肾病38例临床研究[J].天津中医药,2005,22(5):391-393
[29]刘爱霞.痛风益肾汤治疗痛风性肾病32例[J].中华实用中西医杂志,2005,18(7):1043-1044
[30]吴博文.中西医结合治疗痛风性肾病30例[J].中医中药,2006,3(5): 61
[31]张志忠,孙琳琳,徐升.健脾肾化瘀浊法治疗尿酸性肾病临床研究[J].中华中医药学刊,2007,25(80):1749-1750
[32]朱良伟,黄雪红,许文娟,陈继兴,李秋景.补肾通痹汤治疗慢性尿酸性肾病的临床观察[J].环球中医药,2008,1(5):4-5
[33]王波.培土固元逐瘀泄浊法治疗痛风性肾病32例[J].福建中医药,2008,39(2):34-35
[34]陈茂盛,吴宇红,徐业,王捷翔,赵俊清.利瘀结法治疗痛风性肾病36例[J].中医杂志.2O08,49(12):1100
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