摘要
[目的]为中医药防治慢性肾脏病(chronic kidney disease,CKD)并发蛋白质能量消耗(protein energy wasting,PEW)提供新的思路与方法。[方法]从中医脾肾两脏分析讨论CKD并发PEW的病因病机,提出"祛瘀生新"和"脾主肌肉"的论治依据,据此运用益气健脾消瘀泄浊方治疗CKD并发PEW,并佐以一则医案加以验证。[结果]CKD并发PEW患者以脾肾亏虚、浊瘀壅滞为基本病因病机,此时先天之本已然衰败,治疗应以培补后天之本为重,并贯穿疾病治疗始终,同时还应兼顾随证而生的浊瘀之邪,将生新与祛瘀结合,以益气健脾消瘀泄浊方通畅肾络,健脾治痿。所举医案中患者诊断为慢性肾脏病4期并蛋白质能量消耗,中医辨为尿浊,属脾肾亏虚、浊瘀壅滞之证,治以益气健脾、消瘀泄浊,以益气健脾消瘀泄浊方为主方治疗,复建脾运,祛除肾中瘀浊,使气血津液化生运行如初,以后天脾气固补先天肾气,顽疾复有转机。[结论]从脾肾亏虚、浊瘀壅滞的基本病机出发,运用益气健脾、消瘀泄浊法治疗CKD并发PEW,可有效改善患者临床症状,稳定肾功能,临床疗效肯定,值得推广。
[Objective]To provide new ideas and methods for traditional Chinese medicine(TCM)prevention and treatment of chronic kidney disease(CKD)with protein energy wasting(PEW).[Methods]Discuss the etiology and pathogenesis of CKD complicated with PEW from the analysis of the spleen and kidney in TCM,put forward the theory of"removing blood stasis and generating newness"and"spleen governs muscles",and use Yiqi Jianpi Xiaoyu Xiezhuo Decoction to treat CKD complicated with PEW,and a medical record was presented to verify.[Results]In patients with CKD complicated with PEW,the basic etiology and pathogenesis of spleen and kidney deficiency and turbidity stagnation are the basic causes.At this time,the source of congenital constitution of CKD with PEW has already decayed.Treatment should focus on nourishing and replenishing the acquired constitution,it should run throughout the treatment of the disease.At the same time,the evil of turbidity and blood stasis should also be taken into account,which embodies the perfect combination of generating newness and removing blood stasis,using Yiqi Jianpi Xiaoyu Xiezhuo Decoction in order to smooth the kidneys,strengthen the spleen.In the medical records cited,the patient was diagnosed with chronic kidney disease stage 4 and PEW,there are diseases of turbid urine,syndromes of deficiency of spleen and kidney,and stagnation of turbidity and blood stasis.The main treatment method was to invigorate Qi and tonify the spleen,eliminate blood stasis and relieve turbidity,and Yiqi Jianpi Xiaoyu Xiezhuo Decoction was adopted as the main prescriptions to restore the function of spleen for transportation and transformation,remove turbidity in the kidney,and make the Qi,blood and body fluid transform and flow return to normal,so as to make the source of acquired spleen Qi to replenish the source of inherited kidney Qi,the serious chronic ailment has a turnaround.[Conclusion]The treatment of CKD with PEW through invigorating Qi and tonifying the spleen,eliminating blood stasis and relieving turbidity from the basic pathogenesis of deficiency of the spleen and kidney,stagnation of turbid and blood stasis can effectively relieve the clinical symptoms,stabilize renal function.The clinical effect is definite and it is worthy of promotion.
作者
杨丹
鲁科达
夏虹
貟修远
马书云
YANG Dan;LU Keda;XIA Hong(The First School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou,310053,China;The First Affiliated Hospital of Zhejiang Chinese Medical University)
出处
《浙江中医药大学学报》
CAS
2021年第9期962-967,976,共7页
Journal of Zhejiang Chinese Medical University
基金
浙江省中医药传承与创新“十百千”人才工程(杏林工程)省级中青年临床名中医项目(浙中医药[2017]22号)
消瘀泄浊饮干预慢性肾脏病3-4期的多中心临床研究(2021ZX007)。
关键词
慢性肾脏病
蛋白质能量消耗
脾肾亏虚
浊瘀壅滞
祛瘀生新
脾主肌肉
益气健脾消瘀泄浊方
医案
chronic kidney disease
protein energy wasting
deficiency of the spleen and kidney
stagnation of turbid and blood stasis
removing blood stasis and generating newness
spleen governs muscles
Yiqi Jianpi Xiaoyu Xiezhuo Decoction
medical record
