慢性肾病从络论治的理论探讨与临床研究
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摘要
络病理论是中医理论体系中的一个重要组成部分,其蕴藏着深刻的理论内涵。春秋战国时期的《黄帝内经》首次提出络脉的概念,初步论述了络脉的循行、生理及病理,为络病理论奠定了基础。汉代张仲景进一步发展了络病理论,他论述了部分络脉病证及与络脉有关病证的病机、诊法和方药。至清代,叶天士在《临证指南医案》中明确提出“久病入络”、“久痛入络”,强调“初为气结在经,久则血伤入络”,总结出较为完整的络病辨治理法,从而发展了前人的学术成果,使络病理论初成体系。至现代,络病理论得到充分重视,日益完善。深入分析络脉的生理病理机制,分析络病发生的原因,对于诊治慢性肾病有重要临床价值。
目的:理论方面:搜集整理历代医家络病有关论述及当代关于络病文献,探讨络病学说的形成与发展;进而结合肾脏的生理及病理特点,应用络病学说探讨慢性肾病的中医病机,阐述肾络理论,研制出中药复方肾络通。临床方面:观察中药复方肾络通对系膜增生性肾小球肾炎(MsPGN)患者的肾脏保护作用,探讨其对MsPGN的肾脏保护作用及相关机制,为络病学说诊治慢性肾病提供临床依据,反证肾络通组方的科学性,进一步佐证络病学说的科学价值。
方法:1理论探讨:在搜集整理历代医家络病有关论述及当代关于络病文献的基础上,探讨络病学说的形成与发展,进而结合肾脏的生理、病理特点慢性肾病临床表现,活血化瘀药治疗肾脏病的疗效等,探讨慢性肾病中医病因病机,指出其病因病机多为气虚、血瘀、络阻。确立“益气通络、活血化瘀”的治法,并据此制定中药复方肾络通。2临床研究:参照1985年9月中华肾脏病学会全国第二次肾脏病学术会议肾脏病协作组确定的《关于原发性肾小球疾病的病理类型及命名的建议》,我们选择了178例经肾穿刺确诊为系膜增生性肾小球肾炎患者,随机分为肾络通治疗组104例和雷公藤多甙对照组74例,肾络通组给以肾络通(黄芪30g,丹参15g,川芎10g,乌梢蛇10g,地龙12g,茯苓15g)或肾络通胶囊(每次4粒,日3次)口服,并根据临床症状加减用药,如血尿加侧柏叶,大、小蓟,茜草,花蕊石;气虚加党参、太子参等。45天为一疗程,观察2个疗程。对照组给以雷公藤多甙片(湖南省株洲市制药厂),每日公斤体重1毫克,分3次服用。进行对比观察。1985年第二次全国中医肾病会议制定的疗效判定标准分为:(1)完全缓解:症状体征消失,尿蛋白定量<0.2g /24h,肾功能、血脂恢复正常,尿红细胞不超过0-3个/HP;(2)基本缓解:症状体征消失,尿蛋白定量和实验室检查均无好转或病情恶化。并根据此标准对两组患者的疗效进行判定。
结果:
临床研究表明,肾络通能明显改善MsPGN患者的主要症状、治疗组104例中完全缓解25例(24%),基本缓解47例(45%),部分缓解14例(13%),无效18例(17%),总有效86例(83%)。对照组完全缓解14例(19%),基本缓解17例(23%),部分缓解12例(16%),无效31例(41%),总有效43例(58%)。完全缓解率和总有效率与对照组相比有显著性差异。
具体指标显示:
1 24h尿蛋白定量治疗前与治疗后相比p<0.05,治疗组与对照组治疗后相比p<0.05,有显著性差异。
2尿红细胞计数治疗前与治疗后相比p<0.05,治疗组与对照组治疗后相比p<0.05,有显著性差异。
3尿β2-MG治疗前与治疗后相比p<0.05,治疗组与对照组治疗后相比p<0.05,有显著性差异。
4仅血β2-MG,同组治疗前后相比p>0.05,治疗组与对照组治疗后相比p>0.05,无显著性差异。
结论:
1首先运用络病学说探讨慢性肾病的中医病机,指出慢性肾病是在肾脏病变日久,由于肾气亏虚、络脉瘀阻、终至络息成积的结果,其络息成积的病理基础与MsPGN肾脏ECM成分及其调控机制具有内在相关性。确立“益气通络、活血化瘀”的治法并据此制定肾络通组方,具有理论创新性。
2肾络通具有益气通络、活血化瘀的功效,是治疗系膜增生性肾小球肾炎的有效方药。本研究从临床角度已证实肾络通具有降低尿蛋白,降低尿红细胞、尿β2-MG的作用。
Collateral disease theory is an important part of the traditional Chinese medicine. Inner Canon of Huangdi had firstly offered the concept of collaterals. It has discussed collaterals distribution、physiology and pathology. It has settled the foundation for collateral disease theory. Zhang Zhongjing developed collateral disease theory furtherly, He has expounded a part of collateral disease and pathogenesis、technique of diagnosis、prescription of some disease concerned with collaterals. In Qing Dynasty, the book of《Linzheng zhinanyian》introduced“protracted disease intruding into collateral”、”protracted pain intruding into collateral”definitely, emphasized that Initial disease“Qi”stagnated in“Jing”and protracted disease blood wound intruded into collateral. It has summaried that the theory and methods of discriminate and treat collateral disease fairly complete, thus developed the scholarship of the ancients well, making the theory a system firstly. And nowadays, we pay more attention to the theory of collaterals disease, making it more perfect day and day. We analyzed the pathological mechanism of collaterals and the reason why collateral disease happens, then gave clinical importance to the treatment of chronic nephropathy.
Objective: Study of theory, in order to approach the form and the development of the collaterals disease, we collect and arrange the collaterals disease treatment of the doctors’during past dynasties and the present age; next we combine together the physiology and pathology of the kidney to use collateral disease theory to approach the traditional Chinese medical pathogenesis, and then manufacture the traditional Chinese medical compound recipe called“Shenluotong”.
Clinical study: In order to provide clinical proof which is used to treat the chronic nephrosis, we observe the protective action of the collateral disease theory which is used to the patients who are suffering the mesangial proliferative glomerulonephritis (MsPGN), and probe the protection and the correlative mechanism of the“MsPGN”, We also disprove the nature of science in the composed of shenluotong to move forward a single step the value of the collaterals disease theory.
Method: 1 Probing the theory: On the base of compiling and sorting the collaterals disease treatment of doctors, during past dynaties and the present age. We approach the form and the development of collaterals disease, and then integrate the clinical manifestation of the chronical nephrosis, pathological feature of the renal, and the nephrosis rapeutic effect which we use to treat the nephrosis. We also probe the etiopathogenisis and the pathogenisis of the chronic nephrosis, and point out that etiopathogenisis and the pathogenisis most likely can be seen are the deficiency of vital energy, blood stasis and rein locked. According to the methods which are benefiting vital energy and communicating vein, promoting blood flow, we formulate the traditional Chinese medical compound recipe called“Shenluotong”. 2 Clinical research: Referencing the《the proposition of the MsPGN pathological type and its name》in the second nephrological meeting in September 1985, we chose 178 patients who had been made a definite diagnosis through renal needle biopsy, and divided stochastically them into treating group that is 104 people and controlling group that is 74 people, we use“Shenluotong”or tripterygium glycosides to each of them.“Shengluotong”include Radix Astragali 30g、Salvia Miltrorrhiza 15g Szechwan Lovage Rhizome 10g、Zaocys 10g、Pheretima 12g、Poria 15g, capsules have been taken in the type of oral administration (4pills tid po) . We must plus or minus the medicine with the change of the patient's condition. Every course of treatment is 45 days, we observed 2 courses, control group are given tripterygium glycosides which is made in zhuzhou pharmaceutical factory in Hubei province,and direction is 1mg/kg·d, tid po. We contrast and observe in this process.
According to the second nationwide conference about assessing therapeutic effect in nephrosis of traditional Chinese medicine, its standards can be divided into:
1 Complete remission: symptom and signs are both vanished, the quantitation of urine protein is less than 0.2g/24h, renal function and lipid are recovery to normal, red blood cell count in urine are not so many as 0-3 /HP.
2 Essentially remission: symptom and signs are both vanished, the quantitation of urine protein is less than lg/24h, red blood cell count in urine is from a little to (+).
3 Partially remission: symptom and signs are improved, the experimental examination is improved, but are under the standard of essentially remission.
4 Ineffective: to cure a patient more than 2 month in this method, symptom, signs and the experimental examination do not improve or the condition aggravates.
Use these standards to assess the two groups of the patients’therapeutic effect.
Result:
The clinical study showed that kidney rutosids could improve the cardinal symptoms of MsPGN patients. There were 25(24%) patients completed remission、47(45%) patients basic remission、14(19%) patients partial remission、18(17%) patients inefficacy, 86 (83%)patients total utility in the treatment group. There were 14(13%) patients completed remission、47(45%) patients basic remission、17(23%) patients partial remission、12(16%) patients inefficacy, 43(58%) patients total utility in the control group. The total remission rate and total effect rate compared between control group with treatment group had significant difference.
Specific index showed:
1 Compared to the prior treatment, the 24h urine protein quantitation decreased significantly after treatment (p<0.05). Compared treatment group with post-treatment of control group, the 24h urine protein quantitation also had significant difference (p<0.05).
2 Compared to prior treatment, the urine red blood cell count decreased significantly after treatment (p<0.05). Compared treatment group with post-treatment of control group, the urine red blood cell count also had significant difference (p<0.05).
3 Compared to prior treatment, the urineβ2-MG decreased significantly after treatment (p<0.05). Compared treatment group with post-treatment of control group, the urineβ2-MG also had significant difference (p<0.05).
4 Compared prior treatment with post treatment only the bloodβ2-MG had no-significant difference (p>0.05), there was the same result compared treatment group with post-treatment of control group (p>0.05).
Conclusion:
1 Use collateral theory to discuss the pathogenesis of chronic nephropathy by Chinese traditional medicine first, point out that chronic nephropathy is the consequence of kidney-Qi deficiency and collaterals lock and accumulation in final when nephropathy exist a long time, which pathology theory have internality pertinence with ECM in MsPGN and regulate mechanism. Establish the theory of benefiting vital energy with dredge collaterals and activating blood circulation to dissipate blood stasis, and to formulate schema on these ground will bring new ideas.
2“Shenluotong”has efficacy of benefiting vital energy with dredge collaterals and activating blood circulation to dissipate blood stasis, is an available medicine to treat mesangial proliferative glomerulonephritis. This research has confirmed that ShenLuoTong has the ability of degrade Urine protein and urin-akaryocyte and urin-β2-MG, more over, it can protect the renal function.
目的:理论方面:搜集整理历代医家络病有关论述及当代关于络病文献,探讨络病学说的形成与发展;进而结合肾脏的生理及病理特点,应用络病学说探讨慢性肾病的中医病机,阐述肾络理论,研制出中药复方肾络通。临床方面:观察中药复方肾络通对系膜增生性肾小球肾炎(MsPGN)患者的肾脏保护作用,探讨其对MsPGN的肾脏保护作用及相关机制,为络病学说诊治慢性肾病提供临床依据,反证肾络通组方的科学性,进一步佐证络病学说的科学价值。
方法:1理论探讨:在搜集整理历代医家络病有关论述及当代关于络病文献的基础上,探讨络病学说的形成与发展,进而结合肾脏的生理、病理特点慢性肾病临床表现,活血化瘀药治疗肾脏病的疗效等,探讨慢性肾病中医病因病机,指出其病因病机多为气虚、血瘀、络阻。确立“益气通络、活血化瘀”的治法,并据此制定中药复方肾络通。2临床研究:参照1985年9月中华肾脏病学会全国第二次肾脏病学术会议肾脏病协作组确定的《关于原发性肾小球疾病的病理类型及命名的建议》,我们选择了178例经肾穿刺确诊为系膜增生性肾小球肾炎患者,随机分为肾络通治疗组104例和雷公藤多甙对照组74例,肾络通组给以肾络通(黄芪30g,丹参15g,川芎10g,乌梢蛇10g,地龙12g,茯苓15g)或肾络通胶囊(每次4粒,日3次)口服,并根据临床症状加减用药,如血尿加侧柏叶,大、小蓟,茜草,花蕊石;气虚加党参、太子参等。45天为一疗程,观察2个疗程。对照组给以雷公藤多甙片(湖南省株洲市制药厂),每日公斤体重1毫克,分3次服用。进行对比观察。1985年第二次全国中医肾病会议制定的疗效判定标准分为:(1)完全缓解:症状体征消失,尿蛋白定量<0.2g /24h,肾功能、血脂恢复正常,尿红细胞不超过0-3个/HP;(2)基本缓解:症状体征消失,尿蛋白定量
结果:
临床研究表明,肾络通能明显改善MsPGN患者的主要症状、治疗组104例中完全缓解25例(24%),基本缓解47例(45%),部分缓解14例(13%),无效18例(17%),总有效86例(83%)。对照组完全缓解14例(19%),基本缓解17例(23%),部分缓解12例(16%),无效31例(41%),总有效43例(58%)。完全缓解率和总有效率与对照组相比有显著性差异。
具体指标显示:
1 24h尿蛋白定量治疗前与治疗后相比p<0.05,治疗组与对照组治疗后相比p<0.05,有显著性差异。
2尿红细胞计数治疗前与治疗后相比p<0.05,治疗组与对照组治疗后相比p<0.05,有显著性差异。
3尿β2-MG治疗前与治疗后相比p<0.05,治疗组与对照组治疗后相比p<0.05,有显著性差异。
4仅血β2-MG,同组治疗前后相比p>0.05,治疗组与对照组治疗后相比p>0.05,无显著性差异。
结论:
1首先运用络病学说探讨慢性肾病的中医病机,指出慢性肾病是在肾脏病变日久,由于肾气亏虚、络脉瘀阻、终至络息成积的结果,其络息成积的病理基础与MsPGN肾脏ECM成分及其调控机制具有内在相关性。确立“益气通络、活血化瘀”的治法并据此制定肾络通组方,具有理论创新性。
2肾络通具有益气通络、活血化瘀的功效,是治疗系膜增生性肾小球肾炎的有效方药。本研究从临床角度已证实肾络通具有降低尿蛋白,降低尿红细胞、尿β2-MG的作用。
Collateral disease theory is an important part of the traditional Chinese medicine. Inner Canon of Huangdi had firstly offered the concept of collaterals. It has discussed collaterals distribution、physiology and pathology. It has settled the foundation for collateral disease theory. Zhang Zhongjing developed collateral disease theory furtherly, He has expounded a part of collateral disease and pathogenesis、technique of diagnosis、prescription of some disease concerned with collaterals. In Qing Dynasty, the book of《Linzheng zhinanyian》introduced“protracted disease intruding into collateral”、”protracted pain intruding into collateral”definitely, emphasized that Initial disease“Qi”stagnated in“Jing”and protracted disease blood wound intruded into collateral. It has summaried that the theory and methods of discriminate and treat collateral disease fairly complete, thus developed the scholarship of the ancients well, making the theory a system firstly. And nowadays, we pay more attention to the theory of collaterals disease, making it more perfect day and day. We analyzed the pathological mechanism of collaterals and the reason why collateral disease happens, then gave clinical importance to the treatment of chronic nephropathy.
Objective: Study of theory, in order to approach the form and the development of the collaterals disease, we collect and arrange the collaterals disease treatment of the doctors’during past dynasties and the present age; next we combine together the physiology and pathology of the kidney to use collateral disease theory to approach the traditional Chinese medical pathogenesis, and then manufacture the traditional Chinese medical compound recipe called“Shenluotong”.
Clinical study: In order to provide clinical proof which is used to treat the chronic nephrosis, we observe the protective action of the collateral disease theory which is used to the patients who are suffering the mesangial proliferative glomerulonephritis (MsPGN), and probe the protection and the correlative mechanism of the“MsPGN”, We also disprove the nature of science in the composed of shenluotong to move forward a single step the value of the collaterals disease theory.
Method: 1 Probing the theory: On the base of compiling and sorting the collaterals disease treatment of doctors, during past dynaties and the present age. We approach the form and the development of collaterals disease, and then integrate the clinical manifestation of the chronical nephrosis, pathological feature of the renal, and the nephrosis rapeutic effect which we use to treat the nephrosis. We also probe the etiopathogenisis and the pathogenisis of the chronic nephrosis, and point out that etiopathogenisis and the pathogenisis most likely can be seen are the deficiency of vital energy, blood stasis and rein locked. According to the methods which are benefiting vital energy and communicating vein, promoting blood flow, we formulate the traditional Chinese medical compound recipe called“Shenluotong”. 2 Clinical research: Referencing the《the proposition of the MsPGN pathological type and its name》in the second nephrological meeting in September 1985, we chose 178 patients who had been made a definite diagnosis through renal needle biopsy, and divided stochastically them into treating group that is 104 people and controlling group that is 74 people, we use“Shenluotong”or tripterygium glycosides to each of them.“Shengluotong”include Radix Astragali 30g、Salvia Miltrorrhiza 15g Szechwan Lovage Rhizome 10g、Zaocys 10g、Pheretima 12g、Poria 15g, capsules have been taken in the type of oral administration (4pills tid po) . We must plus or minus the medicine with the change of the patient's condition. Every course of treatment is 45 days, we observed 2 courses, control group are given tripterygium glycosides which is made in zhuzhou pharmaceutical factory in Hubei province,and direction is 1mg/kg·d, tid po. We contrast and observe in this process.
According to the second nationwide conference about assessing therapeutic effect in nephrosis of traditional Chinese medicine, its standards can be divided into:
1 Complete remission: symptom and signs are both vanished, the quantitation of urine protein is less than 0.2g/24h, renal function and lipid are recovery to normal, red blood cell count in urine are not so many as 0-3 /HP.
2 Essentially remission: symptom and signs are both vanished, the quantitation of urine protein is less than lg/24h, red blood cell count in urine is from a little to (+).
3 Partially remission: symptom and signs are improved, the experimental examination is improved, but are under the standard of essentially remission.
4 Ineffective: to cure a patient more than 2 month in this method, symptom, signs and the experimental examination do not improve or the condition aggravates.
Use these standards to assess the two groups of the patients’therapeutic effect.
Result:
The clinical study showed that kidney rutosids could improve the cardinal symptoms of MsPGN patients. There were 25(24%) patients completed remission、47(45%) patients basic remission、14(19%) patients partial remission、18(17%) patients inefficacy, 86 (83%)patients total utility in the treatment group. There were 14(13%) patients completed remission、47(45%) patients basic remission、17(23%) patients partial remission、12(16%) patients inefficacy, 43(58%) patients total utility in the control group. The total remission rate and total effect rate compared between control group with treatment group had significant difference.
Specific index showed:
1 Compared to the prior treatment, the 24h urine protein quantitation decreased significantly after treatment (p<0.05). Compared treatment group with post-treatment of control group, the 24h urine protein quantitation also had significant difference (p<0.05).
2 Compared to prior treatment, the urine red blood cell count decreased significantly after treatment (p<0.05). Compared treatment group with post-treatment of control group, the urine red blood cell count also had significant difference (p<0.05).
3 Compared to prior treatment, the urineβ2-MG decreased significantly after treatment (p<0.05). Compared treatment group with post-treatment of control group, the urineβ2-MG also had significant difference (p<0.05).
4 Compared prior treatment with post treatment only the bloodβ2-MG had no-significant difference (p>0.05), there was the same result compared treatment group with post-treatment of control group (p>0.05).
Conclusion:
1 Use collateral theory to discuss the pathogenesis of chronic nephropathy by Chinese traditional medicine first, point out that chronic nephropathy is the consequence of kidney-Qi deficiency and collaterals lock and accumulation in final when nephropathy exist a long time, which pathology theory have internality pertinence with ECM in MsPGN and regulate mechanism. Establish the theory of benefiting vital energy with dredge collaterals and activating blood circulation to dissipate blood stasis, and to formulate schema on these ground will bring new ideas.
2“Shenluotong”has efficacy of benefiting vital energy with dredge collaterals and activating blood circulation to dissipate blood stasis, is an available medicine to treat mesangial proliferative glomerulonephritis. This research has confirmed that ShenLuoTong has the ability of degrade Urine protein and urin-akaryocyte and urin-β2-MG, more over, it can protect the renal function.
引文
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12 胡仲仪,唐利群,陈以平.益气活血系列方对膜性肾炎模型基底膜影响的实验研究.中国中西医结合杂志,1999,19 (2):96～99
13 卢玲,梁冰.中医药抗肾纤维化的研究进展.广西中医药,2001, 24(6):315
14 肖相如.肾病中的瘀血.辽宁中医杂志,2003,2, 30(2):85～86
15 余江毅.肾病湿热病理的临床分析和实验研究.中国中西医结合杂志,1992,12(8):458
16 熊宁宁.家兔肾炎湿热模型的实验研究.辽宁中医杂志,1991,18(4):42
17 朱戎.活血中药干预肾纤维化的实验研究进展.江苏中医药,2005,26(6):57～59
18 王颖航,潘志,王耀献.肾络癥瘕分子病理基础的诠释.北京中医药大学学报,2006,5, 29(5),301~303
19 Iwano M,Neilson EG Mechanisms of tubulointerstitial fibrosis Curr Opin Nephrol Hyperteng 2004, 13,279～284.
20 Liu Y.Epithelial to mesenchymal transition in renal fibrogenesis pathologic significance,molecular mechanism, and therapeutic intervention J Am Soc Nephrol,2004,15 1～12
21 Eddy AA.Molecular basis renal fibrosis.Pediatr Nephrol, 2000,15(34):290～301
22 王永钧,张敏鸥.痰瘀互结与肾内微型癥积.中国中西医结合肾病杂志,2003,4(1):1～3
23 于秀辰,吕仁和.糖尿病肾病的中西医结合治疗.中国医刊,2000,35(8):42～43
24 王耀献,周建华,赵进喜. 止消通脉宁对糖尿病大鼠肾小球细胞外基质成分的影响.北京中医药大学学报 2000,11, 23(6):38～40
25 刘萱争,邵国强.络病论治慢性肾病初探.中外健康文摘,2007(10)97～98
26 王明杰,黄淑芬,张琼.蛋白尿从络病论治探讨.四川中医,2004,22(11):10～11
27 李崇瑞,孟农.复方丹参注射液治疗慢性肾病疗效观察.新疆中医药,2002(3):22～23
28 刘宏伟,时振声.中医治疗原发性系膜增生性肾小球肾炎的临床与实验研究.中医杂志,1992,3(1):25～27
29 许建中.黄芪地龙汤与丹参改善高凝状态作用异同的实验研究.中成药,1994,16(1):34～35
30 王浴生,邓文龙,薛春生.中药药理与应用.北京:人民卫生出版社,2000:191～193
31 张雪梅,舒贵杨,严晓华等.中西医结合治疗系膜增生性 肾小球肾炎 85 例的临床分析.中华肾脏病杂志,1997,13 (4):225～228
32 宁英远,王俭勤,屈隧林.大黄素对人肾成纤维细胞增殖的影响.中国中西医结合杂志,2000,20(2):105～107
33 檀金川,段慧杰,白亚玲.赵玉庸教授运用通肾络法治疗慢性肾小球肾炎的经验.陕西中医,2005,26(4):346～347
1 茅晓.通络法历史沿革剖析.中医杂志,2002,43(7):485
2 吴以岭.中医络病理论研究的“三维立体网络系统”.首都医药,2003,1(2):48～50
3 仝小林.络病研究及治疗进展.首都医药.2005(16):45～47
4 徐光福.络病的内涵及其外延释义.中医药学刊,2005, (1):96～98
5 王永炎,常富业,杨宝琴.病络与络病对比研究.北京中医药大学学报,2005,28(3):1～6
6 丁元庆.从“百病生于气”探讨络病病机与治法.络病学基础与临床研究,2006(6):42～43
7 雷燕,王永炎,黄启福.络病理论探微.北京中医药大学学报,1998,21(2):18～24
8 郁保生.中医的络病理论与通络法.中国康复,2005,2, 20,(1):61～62
9 常富业,王永炎.浅谈急病入络.现代中西医结合杂志,2004, 13(9): 1152
10 周小青,刘建新,宁晓然.论初病入络.湖南中医学院学报,1997,17(3):4～5
11 汤铁城.络病学说临床运用举隅.江西中医药,2001,2,32 (1):16～17
12 周水平,仝小林,徐远.络病的基本概念与病理特点探析.中医药学刊, 2002,12, 20(6):724～726
13 徐光福.络病的内涵及其外延释义.中医药学刊 2005,(1): 96～98
14 刘绍能,刘为民.络脉病证治探讨.中医药研究, 2002, 18(4):2
15 仝小林,李洪皎,华传金.糖尿病络损的成因及治疗.第八次全国中医糖尿病学术大会论文汇编,2005,192～194
16 颜德馨.颜德馨临床经验辑要.北京:中国医药科技出版社,1998,(1):29～32
17 曾志勇等.中医络病研究现状的思考.成都中医药大学学报,2005,(6):1～2
18 雷燕,黄启福,王永炎.论瘀毒阻络是络病形成的病理基础.北京中医药大学学报,1999,22(3):8～11
19 雷燕,黄启福,王永炎.中医络病理论及相关实验研究.(学 位论文)北京中医药大学,1998
20 雷燕,王蕴红,黄启福.复圣散对高脂大鼠脑缺血再灌后红细胞变形性和血浆内皮素的影响.北京中医药大学学报,1998,21(5):20～22
21 李民,张旭,朱平.麦冬、生地药血清对血管内皮细胞增殖的影响.国医论坛, 2001,9, 16(5):43～44
22 李岩,赵雁,黄启福.中医络病的现代认识.北京中医药大学学报,2002,25(3):1～5
23 雷燕,郝钰,邱全瑛.等复圣散对中性粒细胞与血管内皮细胞粘附作用的影响.中国中西医结合杂志,1998,18(10): 612～615
24 王昌郁,王英丽,刘琦.通络法在中风治疗中的应用.中医研究 2004,10,17(5):64～65
25 杨世兴.碥石集(第4集).西安:陕西科学技术出版社, 2003, (9): 66～68
26 焦树德.焦树德临床经验辑要.北京:中国医药科技出版社,1998,(1):82～83
27 茅晓.叶天士“络病”学说与痹证论治.山西中医,2004(6).
28 王明杰,黄淑芬,张琼.蛋白尿从络病论治探讨.四川中医, 2004,22(11):10～11
29 陈金亮,王殿华,张志慧.中医药学刊,2004,22(3):407～408.
30 刘为民.络病理论与肝纤维化的关系探讨.中医杂志, 2003, 44(2):85～87
31 李澎涛,王永炎,黄启福.“毒损脑络”病机假说的形成其理论与实践意义.北京中医药大学学报,2001,24 (1):l～6
2 张建斌,王玲玲.对《内经》中病理性络脉的分析.江苏中医,2001,22(10):43～45
3 王耀献,刘尚建,付天昊.肾络微型癥瘕探微.中医杂志,2006, 4, 47(4):247～249
4 颜德馨编著.活血化瘀疗法临床实践.增订本,云南人民出版社,1984 5(5):112～115
5 姜 春 华 主 编 . 活 血 化 瘀 研 究 . 上 海 科 技 出 版社,1981,(12):52～55
6 程建中.中医“久病必瘀”的机理探讨及临床应用体会.中医药研究,1996,( 2):6～8
7 秦丽玲,秦天富应用通络法治疗慢性病探析,中医研究, 2006,11, 19(11):50
8 叶天士.临证指南医案.上海:上海科技出版社,1959
9 清·林珮琴.类证治裁.北京:人民卫生出版社
10 邱幸凡,陈刚.“久病入络”理论探讨.中国中医基础医学杂志,2003,9(9):38～42
11 张嘉毅.邓尔禄诊治慢性肾病学术经验.陕西中医 2006, 27(4), 463～465
12 胡仲仪,唐利群,陈以平.益气活血系列方对膜性肾炎模型基底膜影响的实验研究.中国中西医结合杂志,1999,19 (2):96～99
13 卢玲,梁冰.中医药抗肾纤维化的研究进展.广西中医药,2001, 24(6):315
14 肖相如.肾病中的瘀血.辽宁中医杂志,2003,2, 30(2):85～86
15 余江毅.肾病湿热病理的临床分析和实验研究.中国中西医结合杂志,1992,12(8):458
16 熊宁宁.家兔肾炎湿热模型的实验研究.辽宁中医杂志,1991,18(4):42
17 朱戎.活血中药干预肾纤维化的实验研究进展.江苏中医药,2005,26(6):57～59
18 王颖航,潘志,王耀献.肾络癥瘕分子病理基础的诠释.北京中医药大学学报,2006,5, 29(5),301~303
19 Iwano M,Neilson EG Mechanisms of tubulointerstitial fibrosis Curr Opin Nephrol Hyperteng 2004, 13,279～284.
20 Liu Y.Epithelial to mesenchymal transition in renal fibrogenesis pathologic significance,molecular mechanism, and therapeutic intervention J Am Soc Nephrol,2004,15 1～12
21 Eddy AA.Molecular basis renal fibrosis.Pediatr Nephrol, 2000,15(34):290～301
22 王永钧,张敏鸥.痰瘀互结与肾内微型癥积.中国中西医结合肾病杂志,2003,4(1):1～3
23 于秀辰,吕仁和.糖尿病肾病的中西医结合治疗.中国医刊,2000,35(8):42～43
24 王耀献,周建华,赵进喜. 止消通脉宁对糖尿病大鼠肾小球细胞外基质成分的影响.北京中医药大学学报 2000,11, 23(6):38～40
25 刘萱争,邵国强.络病论治慢性肾病初探.中外健康文摘,2007(10)97～98
26 王明杰,黄淑芬,张琼.蛋白尿从络病论治探讨.四川中医,2004,22(11):10～11
27 李崇瑞,孟农.复方丹参注射液治疗慢性肾病疗效观察.新疆中医药,2002(3):22～23
28 刘宏伟,时振声.中医治疗原发性系膜增生性肾小球肾炎的临床与实验研究.中医杂志,1992,3(1):25～27
29 许建中.黄芪地龙汤与丹参改善高凝状态作用异同的实验研究.中成药,1994,16(1):34～35
30 王浴生,邓文龙,薛春生.中药药理与应用.北京:人民卫生出版社,2000:191～193
31 张雪梅,舒贵杨,严晓华等.中西医结合治疗系膜增生性 肾小球肾炎 85 例的临床分析.中华肾脏病杂志,1997,13 (4):225～228
32 宁英远,王俭勤,屈隧林.大黄素对人肾成纤维细胞增殖的影响.中国中西医结合杂志,2000,20(2):105～107
33 檀金川,段慧杰,白亚玲.赵玉庸教授运用通肾络法治疗慢性肾小球肾炎的经验.陕西中医,2005,26(4):346～347
1 茅晓.通络法历史沿革剖析.中医杂志,2002,43(7):485
2 吴以岭.中医络病理论研究的“三维立体网络系统”.首都医药,2003,1(2):48～50
3 仝小林.络病研究及治疗进展.首都医药.2005(16):45～47
4 徐光福.络病的内涵及其外延释义.中医药学刊,2005, (1):96～98
5 王永炎,常富业,杨宝琴.病络与络病对比研究.北京中医药大学学报,2005,28(3):1～6
6 丁元庆.从“百病生于气”探讨络病病机与治法.络病学基础与临床研究,2006(6):42～43
7 雷燕,王永炎,黄启福.络病理论探微.北京中医药大学学报,1998,21(2):18～24
8 郁保生.中医的络病理论与通络法.中国康复,2005,2, 20,(1):61～62
9 常富业,王永炎.浅谈急病入络.现代中西医结合杂志,2004, 13(9): 1152
10 周小青,刘建新,宁晓然.论初病入络.湖南中医学院学报,1997,17(3):4～5
11 汤铁城.络病学说临床运用举隅.江西中医药,2001,2,32 (1):16～17
12 周水平,仝小林,徐远.络病的基本概念与病理特点探析.中医药学刊, 2002,12, 20(6):724～726
13 徐光福.络病的内涵及其外延释义.中医药学刊 2005,(1): 96～98
14 刘绍能,刘为民.络脉病证治探讨.中医药研究, 2002, 18(4):2
15 仝小林,李洪皎,华传金.糖尿病络损的成因及治疗.第八次全国中医糖尿病学术大会论文汇编,2005,192～194
16 颜德馨.颜德馨临床经验辑要.北京:中国医药科技出版社,1998,(1):29～32
17 曾志勇等.中医络病研究现状的思考.成都中医药大学学报,2005,(6):1～2
18 雷燕,黄启福,王永炎.论瘀毒阻络是络病形成的病理基础.北京中医药大学学报,1999,22(3):8～11
19 雷燕,黄启福,王永炎.中医络病理论及相关实验研究.(学 位论文)北京中医药大学,1998
20 雷燕,王蕴红,黄启福.复圣散对高脂大鼠脑缺血再灌后红细胞变形性和血浆内皮素的影响.北京中医药大学学报,1998,21(5):20～22
21 李民,张旭,朱平.麦冬、生地药血清对血管内皮细胞增殖的影响.国医论坛, 2001,9, 16(5):43～44
22 李岩,赵雁,黄启福.中医络病的现代认识.北京中医药大学学报,2002,25(3):1～5
23 雷燕,郝钰,邱全瑛.等复圣散对中性粒细胞与血管内皮细胞粘附作用的影响.中国中西医结合杂志,1998,18(10): 612～615
24 王昌郁,王英丽,刘琦.通络法在中风治疗中的应用.中医研究 2004,10,17(5):64～65
25 杨世兴.碥石集(第4集).西安:陕西科学技术出版社, 2003, (9): 66～68
26 焦树德.焦树德临床经验辑要.北京:中国医药科技出版社,1998,(1):82～83
27 茅晓.叶天士“络病”学说与痹证论治.山西中医,2004(6).
28 王明杰,黄淑芬,张琼.蛋白尿从络病论治探讨.四川中医, 2004,22(11):10～11
29 陈金亮,王殿华,张志慧.中医药学刊,2004,22(3):407～408.
30 刘为民.络病理论与肝纤维化的关系探讨.中医杂志, 2003, 44(2):85～87
31 李澎涛,王永炎,黄启福.“毒损脑络”病机假说的形成其理论与实践意义.北京中医药大学学报,2001,24 (1):l～6