摘要
尿酸性肾病是以大量尿酸盐结晶沉积为特征,最终导致肾脏结构和功能损伤的一类慢性疾病,临床以高尿酸血症、小管间质性肾炎及肾纤维化为主要特征。中医学认为,尿酸性肾病归属“痹证”“水肿”“腰痛”等范畴,该病以脾肾气虚为本,水湿、痰浊、瘀血为标,同时与饮食密切相关。文章介绍桂定坤主任医师运用益气养阴活血祛湿法治疗尿酸性肾病的相关经验。桂定坤主任认为,该病多因患者禀赋不足,肾元亏虚,加之饮食劳倦、外邪侵袭等影响,导致脾肾俱虚,运化失常,水湿停聚,日久则气血津液运行不畅,易郁久化热,耗气伤阴,进而形成痰浊、瘀血,痹阻于经络、关节等处,发为尿酸性肾病。因此治疗时应抓住气阴两虚、血瘀湿滞的关键病机,注重益气活血。临床遣方用药时,在辨清缓急、分期论治的基础上,需针对疾病各阶段兼证不同灵活运用中医辨证论治等方法,标本兼顾的同时又有侧重。重用黄芪益气健脾,配伍黄精滋阴护肾,狗脊补肾强腰,当归养血活血,虎杖清热利湿。另外嘱患者注意预防调摄,低嘌呤饮食,多饮水,促进尿酸排泄。临床运用上述方法能有效降低血尿酸,延缓患者肾功能虚衰进展,改善症状。另附医案二则,以阐述益气养阴活血祛湿法治疗尿酸性肾病的临床经验。
Uric acid nephropathy(UAN) is a chronic disease with a large amount of urate crystal deposition, which eventually leads to kidney damage. The main clinical features are hyperuricemia, tubulointerstitial nephritis and renal fibrosis. Traditional Chinese medicine believes that it belongs to Bi disease(痹病), “edema”, “lumbago” categories. The disease is based on deficiency of spleen-kidney Qi(气), accompanied by water dampness, phlegm turbidness and blood stasis, and is closely related to diet. The article introduces Chief Physician GUI Dingkun's experience in treating UAN by the method of supplementing Qi, nourishing Yin(阴), activating blood circulation and eliminating dampness. Chief Physician GUI Dingkun believes that the disease is mainly caused by the patients' insufficient resistance, deficiency of kidney, improper diet, invasion of external pathogens and other influences, resulting in deficiency of both spleen and kidney, abnormal transportation and accumulation of water and dampness. Over time, the blood and body fluid will not run smoothly, which will easily lead to depression and heat, and damage Qi and Yin. Then, phlegm and blood stasis will be formed, and obstruction will occur in meridians, joints, etc., which will lead to UAN. During the treatment, Chief Physician GUI believes that according to the different stages of the disease, we should flexibly use the methods of TCM syndrome differentiation and treatment to treat both root and branches simultaneously. In terms of medication, we can use Huangqi(Radix Astragali) to replenish Qi and strengthen spleen, Huangjing(Rhizoma Polygonati) to nourish Yin and protect kidney, Gouji(Rhizoma Cibotii) to strengthen kidney and waist, Danggui(Radix Angelicae Sinensis) to nourish blood and activate blood, and Huzhang(Rhizoma Polygoni Cuspidati) to clear heat and diuresis. In addition, patients should pay attention to prevention, low purine diet, and taking more water to promote uric acid excretion. Clinically, the above methods can effectively reduce blood uric acid, delay the progression of renal function and relieve symptoms. This article introduces the clinical experience of the method of supplementing Qi, nourishing Yin, activating blood circulation, and eliminating dampness in the treatment of UAN with two medical cases.
出处
《中医临床研究》
2024年第23期136-142,共7页
Clinical Journal Of Chinese Medicine
基金
国家重点研发计划项目(2019YFE0110500)。
关键词
尿酸性肾病
益气养阴活血祛湿法
治疗经验
Uric acid nephropathy
The Yiqi Yangyin Huoxue Qushi method
Clinical experience
