吕仁和教授从风论治慢性肾炎药对浅析
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摘要
背景：慢性肾小球肾炎(Chronic glomerulonephritis, CGN)简称慢性肾炎,是指以蛋白尿、血尿、高血压、水肿为基本临床表现,起病方式各有不同,病情迁延,病变缓慢进展,可有不同程度的肾功能减退,最终将发展为慢性肾衰竭的一组肾小球疾病。根据其临床表现的不同,本病可归属于中医学“水肿”、“腰痛”、“虚劳”、“血尿”、“慢肾风”等范畴。现代医学对慢性肾炎的治疗以防止或延缓肾功能进行性恶化、改善或缓解临床症状及防治严重并发症为主要目的。目前,透析和肾移植已经成为慢性肾炎肾功能衰竭终末期的替代治疗手段。但现代医学对慢性肾炎早、中期的治疗手段欠缺,ACEI、ARB等药物的作用有限,消除慢性肾炎潜血和尿蛋白的效果并不是很理想。而中医药治疗本病积累了丰富的经验,且对于慢性肾炎早、中期肾功能损伤较轻者有较好疗效,显示出一定优势。
目的：吕仁和教授现任北京中医药大学东直门医院糖尿病肾病研究室主任医师,博士生导师,为第三批全国名老中医专家学术经验继承工作指导老师,曾师从著名中医大师施今墨、秦伯未、祝谌予等人,数十年来始终位于中医临床、带教第一线,是北京地区声名卓著的糖尿病和肾脏病专家,对中医药治疗糖尿病、各种急慢性肾脏病、尿路感染、肾功能不全等疾病有深刻而独到的认识,并积累了丰富的临证经验。本论文着眼于吕仁和教授从风论治慢性肾炎的中医理论及其善于应用药对配伍的处方特色,总结了慢性肾炎与风邪密切相关的病因病机,较为深入地探讨了从“风”来治疗慢性肾炎的几组药对的用药思路,希望能取得触类旁通、举一反三之功。
本论文包括文献综述和经验总结两个部分。
第一部分：文献综述先将中医古籍对慢性肾炎的命名、现代中医对慢性肾炎的病因病机分析以及辨证分型做一概述。然后简要总结了近十年来一些名老中医治疗慢性肾炎的经验特色。慢性肾炎病性属本虚标实,本虚即肺、脾、肾三脏功能失调及气血阴阳的亏虚,标实乃因夹杂风邪、水湿、热毒、湿热、血瘀等。在治疗上应分清标本缓急,扶正祛邪,各有侧重。
第二部分：通过跟随吕仁和教授门诊抄方求教,收集整理慢性肾炎患者的门诊病历,找寻吕老治疗慢性肾炎临证规律,单从“风邪”这一角度总结了吕老从风论治慢性肾炎的学术特色,并从辛温散风、辛凉祛风、疏风清热、祛风除湿、活血灭风、祛风解毒、搜风通络七个方面阐述其常用药对的配伍及应用。
结论：吕仁和教授主张以辨证论治的思想作为指导,在临床治疗上,必须明辨病机,分清疾病的标本缓急,判别疾病的属性,根据患者的各属情况,对证治疗。“从风论治”是吕仁和教授治疗慢性肾炎的理论之一,在治疗的同时不能忽略慢性肾炎病性属本虚标实的特点,在“标实”之中,虽然风邪贯穿慢性肾炎的始终,但仍需注意久病多邪夹杂,产生水湿、湿热、热毒、瘀血等证候的情况。本论文仅从单方面论述了风邪对慢性肾炎的影响以及从风论治慢性肾炎的药对应用,并非适用于所有证型。借此希望通过这种思维方式,使中医学子在临床上辨证论治时有新的体会；也希望通过进一步整理和总结吕仁和教授临证治疗的其他经验,使中医学子能够更好地学习和传承名老中医的经验,并且通过大家的努力推动中医学事业的发展。
Background:Chronic glomerulonephritis (CGN) called chronic nephritis, which is persistent disease with onset in different ways. Its clinical manifestations are proteinuria, hematuria, hypertension and edema. This disease may have different degrees of renal dysfunction, eventually developing chronic renal failure. According to the different clinical manifestations, this can be attributable to the traditional Chinese medicine names "Edema", "Lumbago", "Consumption", "Hematuria", "Chronic kidney wind". Modern medicine in the treatment of chronic nephritis in order to prevent or delay function, improve the progressie worsening or alleviate clinical symptoms and severe complications. Nowadays, dialysis and kidney transplants have become chronic nephritis end-stage renal failure of alternative therapy. But modern medicine is not good at treatment of chronic nephritis early, middle stage. Such drugs like ACEI and ARB are limited, the effect eliminating the hematuria and urinary protein is not ideal. Chinese medicine treatment of this disease has accumulated rich experience, and has good curative effect which showing some advantage.
Objective:The professor Lv Renhe is director doctor of diabetic nephropathy laboratory in Dongzhimen hospital attached to Beijing university of Chinese medicine. He is the third group of national old doctor of traditional Chinese medicine experts academic experience inherited work guiding teacher, once learning from famous Chinese masters Shi Jinmo,Qin Bowei and Zhu Chenyu. For decades, professor Lv always in Chinese clinical teaching line, and has been an expert in Beijing area. He is good at the treatment of diabetes, acute or chronic kidney disease, urinary tract infection, renal insufficiency, and accumulated rich clinical experience. This thesis focusing on "Wind" from the theory of the traditional Chinese medicine treatment of chronic nephritis, and professor Lv using drug combinations in prescription, and summarizing the close relationship between chronic nephritis and "Wind". This thesis thoroughly discussed the drug combinations, and told us how to use them.
This thesis consists of two parts which include literature review and experience summary.
Part one:Literature review first discussed the naming, pathogeny and pathogenesis of chronic nephritis. Then briefly summarized some old doctor of traditional Chinese medicine in the treatment of chronic nephritis experience in recent years. Most physicians believe that the nature of chronic nephritis is weak basic with external factors invasiving. The weak basic means dysfunction of lung, spleen and kidney, which in weak with qi, blood, yin and yang. The external factors mean wind evil, water-damp, heat-poison, damp-heat, blood stasis etc. When the treatment should be paid attention to what is the main part.
Part two:Through studying with professor Lv Renhe, collecting outpatient records of patients with chronic nephritis, looking for the rules how professor Lv treat. Then summarize the characteristic treatment of professor Lv from "Wind" and discuss how to use the drug combinations in seven aspects.
Conclusion:Professor Lv Renhe advocate using treatment based on syndrome differentiation. In the clinical treatment, we must distinguish the pathogenesis and specimens of disease, discriminate attribute of the disease. According to the situation of the patients to treat. Treating from wind is one of the theory in the treatment of chronic nephritis of professor Lv. When we treat, we can't ignore the features of chronic nephritis, and we should consider other conditions like water-damp, heat-poison, damp-heat, blood stasis etc. This thesis just discourse the treatment of chronic nephritis from one side. I hope that through this way of thinking, the traditional Chinese medicine students can learn more about the experience of the famous old physician, and promote the development of traditional Chinese medicine with our efforts.
目的：吕仁和教授现任北京中医药大学东直门医院糖尿病肾病研究室主任医师,博士生导师,为第三批全国名老中医专家学术经验继承工作指导老师,曾师从著名中医大师施今墨、秦伯未、祝谌予等人,数十年来始终位于中医临床、带教第一线,是北京地区声名卓著的糖尿病和肾脏病专家,对中医药治疗糖尿病、各种急慢性肾脏病、尿路感染、肾功能不全等疾病有深刻而独到的认识,并积累了丰富的临证经验。本论文着眼于吕仁和教授从风论治慢性肾炎的中医理论及其善于应用药对配伍的处方特色,总结了慢性肾炎与风邪密切相关的病因病机,较为深入地探讨了从“风”来治疗慢性肾炎的几组药对的用药思路,希望能取得触类旁通、举一反三之功。
本论文包括文献综述和经验总结两个部分。
第一部分：文献综述先将中医古籍对慢性肾炎的命名、现代中医对慢性肾炎的病因病机分析以及辨证分型做一概述。然后简要总结了近十年来一些名老中医治疗慢性肾炎的经验特色。慢性肾炎病性属本虚标实,本虚即肺、脾、肾三脏功能失调及气血阴阳的亏虚,标实乃因夹杂风邪、水湿、热毒、湿热、血瘀等。在治疗上应分清标本缓急,扶正祛邪,各有侧重。
第二部分：通过跟随吕仁和教授门诊抄方求教,收集整理慢性肾炎患者的门诊病历,找寻吕老治疗慢性肾炎临证规律,单从“风邪”这一角度总结了吕老从风论治慢性肾炎的学术特色,并从辛温散风、辛凉祛风、疏风清热、祛风除湿、活血灭风、祛风解毒、搜风通络七个方面阐述其常用药对的配伍及应用。
结论：吕仁和教授主张以辨证论治的思想作为指导,在临床治疗上,必须明辨病机,分清疾病的标本缓急,判别疾病的属性,根据患者的各属情况,对证治疗。“从风论治”是吕仁和教授治疗慢性肾炎的理论之一,在治疗的同时不能忽略慢性肾炎病性属本虚标实的特点,在“标实”之中,虽然风邪贯穿慢性肾炎的始终,但仍需注意久病多邪夹杂,产生水湿、湿热、热毒、瘀血等证候的情况。本论文仅从单方面论述了风邪对慢性肾炎的影响以及从风论治慢性肾炎的药对应用,并非适用于所有证型。借此希望通过这种思维方式,使中医学子在临床上辨证论治时有新的体会；也希望通过进一步整理和总结吕仁和教授临证治疗的其他经验,使中医学子能够更好地学习和传承名老中医的经验,并且通过大家的努力推动中医学事业的发展。
Background:Chronic glomerulonephritis (CGN) called chronic nephritis, which is persistent disease with onset in different ways. Its clinical manifestations are proteinuria, hematuria, hypertension and edema. This disease may have different degrees of renal dysfunction, eventually developing chronic renal failure. According to the different clinical manifestations, this can be attributable to the traditional Chinese medicine names "Edema", "Lumbago", "Consumption", "Hematuria", "Chronic kidney wind". Modern medicine in the treatment of chronic nephritis in order to prevent or delay function, improve the progressie worsening or alleviate clinical symptoms and severe complications. Nowadays, dialysis and kidney transplants have become chronic nephritis end-stage renal failure of alternative therapy. But modern medicine is not good at treatment of chronic nephritis early, middle stage. Such drugs like ACEI and ARB are limited, the effect eliminating the hematuria and urinary protein is not ideal. Chinese medicine treatment of this disease has accumulated rich experience, and has good curative effect which showing some advantage.
Objective:The professor Lv Renhe is director doctor of diabetic nephropathy laboratory in Dongzhimen hospital attached to Beijing university of Chinese medicine. He is the third group of national old doctor of traditional Chinese medicine experts academic experience inherited work guiding teacher, once learning from famous Chinese masters Shi Jinmo,Qin Bowei and Zhu Chenyu. For decades, professor Lv always in Chinese clinical teaching line, and has been an expert in Beijing area. He is good at the treatment of diabetes, acute or chronic kidney disease, urinary tract infection, renal insufficiency, and accumulated rich clinical experience. This thesis focusing on "Wind" from the theory of the traditional Chinese medicine treatment of chronic nephritis, and professor Lv using drug combinations in prescription, and summarizing the close relationship between chronic nephritis and "Wind". This thesis thoroughly discussed the drug combinations, and told us how to use them.
This thesis consists of two parts which include literature review and experience summary.
Part one:Literature review first discussed the naming, pathogeny and pathogenesis of chronic nephritis. Then briefly summarized some old doctor of traditional Chinese medicine in the treatment of chronic nephritis experience in recent years. Most physicians believe that the nature of chronic nephritis is weak basic with external factors invasiving. The weak basic means dysfunction of lung, spleen and kidney, which in weak with qi, blood, yin and yang. The external factors mean wind evil, water-damp, heat-poison, damp-heat, blood stasis etc. When the treatment should be paid attention to what is the main part.
Part two:Through studying with professor Lv Renhe, collecting outpatient records of patients with chronic nephritis, looking for the rules how professor Lv treat. Then summarize the characteristic treatment of professor Lv from "Wind" and discuss how to use the drug combinations in seven aspects.
Conclusion:Professor Lv Renhe advocate using treatment based on syndrome differentiation. In the clinical treatment, we must distinguish the pathogenesis and specimens of disease, discriminate attribute of the disease. According to the situation of the patients to treat. Treating from wind is one of the theory in the treatment of chronic nephritis of professor Lv. When we treat, we can't ignore the features of chronic nephritis, and we should consider other conditions like water-damp, heat-poison, damp-heat, blood stasis etc. This thesis just discourse the treatment of chronic nephritis from one side. I hope that through this way of thinking, the traditional Chinese medicine students can learn more about the experience of the famous old physician, and promote the development of traditional Chinese medicine with our efforts.
引文
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[9]陈海生.慢性肾炎辨治体会[J].实用中医药杂志,2004,20(8)：464.
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[2]张振忠,赵明君.慢性肾炎的中医研究进展[J].陕西中医学院学报,1998,21(1)：3.
[3]刘新,李朝牛.刘宝厚教授慢性肾炎诊治经验[J].甘肃中医学院学报,1997,14(4)：19.
[4]刘胜芳.中医治疗慢性肾炎的思路和方法[J].中医杂志,1999,40(11)：690.
[5]刘玉宁,郭立中,王立红等.叶传蕙教授对慢性肾小球肾炎的中医治疗[J].中国中西医结合肾病杂志,2001,2(10)：562-565.
[6]周建伟.慢肾汤治疗慢性肾小球肾炎30例[J].湖南中医杂志,2002,18(1)：32.[7]周剑锋.肾宁汤治疗慢性肾小球肾炎48例.湖南中医杂志,2003,19(2)：43-44.
[8]李旭.中西医结合治疗慢性肾炎的心得体会[J].中华实用中西医杂志,2004,17(22)：3398.
[9]陈海生.慢性肾炎辨治体会[J].实用中医药杂志,2004,20(8)：464.
[10]康永.中西医结合治疗慢性肾小球肾炎.中国中医基础医学杂志[J],2006,12(12)：951-952.
[11]丁宁.刘明教授治疗慢性肾小球肾炎经验摭拾[J].实用中医内科杂志,2008,22(4)：16-17.
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