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2023, 08, v.42;No.430 851-856
丁樱基于“激清扬浊”辨治儿童肾病综合征尿浊经验
基金项目(Foundation): 国家自然科学基金项目(编号:81873343);; 全国名中医工作室建设项目(批文号:国中医药办人教函﹝2018﹞119号)
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DOI: 10.16295/j.cnki.0257-358x.2023.08.014
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摘要:

丁樱教授认为,儿童肾病综合征属本虚标实,关键病机为禀赋不足,外邪入里,虚实夹杂,正虚以肺脾肾阳虚为主,标实以外感、水湿、湿热、瘀血为要,重视瘀血在本病中的关键作用;辨证论治时需谨记阴中求阳、阳中求阴、血水相依、风激水浊等关键点。治疗的重点应放在温阳化瘀上,提出“激清扬浊,调和阴阳”的治疗原则,在准确辨证的基础上,针对不同兼证,综合运用疏风清热、祛湿通络等法以扬浊,缓解尿浊症状,尽可能减少精微流失,减轻其对机体正气的损害;整个治疗过程关键在于调整阴阳,使阴平阳秘,清源洁流,增强肺脾肾水液代谢功能,减少病情反复。同时创新应用雷公藤多苷。并以现代研究成果为佐证,极大地提高了临床疗效。

Abstract:

Professor DING Ying holds that pediatric nephrotic syndrome is deficient in the root and excessive in the branch,and the key disease mechanism is deficient endowment with internal invasion of external evil,manifesting as mixed deficiency and excess. Deficiency of healthy qi mainly involves yang deficiency of lung,spleen and kidney,and excessive branch mainly involves external attack,water dampness,damp heat and blood stasis which is emphasized for it plays a key role in pediatric nephrotic syndrome. In the syndrome differentiation and treatment,seeking yang from yin,seeking yin from yang,blood water interdependence and wind stimulating and water turbidity should be followed,and warming yang and resolving stasis should be emphasized,and therefore Professor Ding proposes the treatment principle of “stimulating purity and dispelling turbidity,regulating yin and yang”. On the basis of accurate syndrome differentiation,according to different concurrent syndromes, dispersing wind and clearing heat, removing dampness and dredging channel should be applied for dispelling turbidity and eliminating urine turbidity,so as to minimize the loss of essence and reduce damages to the healthy qi as much as possible. The key of the whole treatment process is to regulate yin and yang so as to pacify yin and consolidate yang,clear the source and clean the stream,improve the metabolism of body fluids by lung,spleen and kidney,and reduce disease recurrence.Besides,tripterygium glycosides has been applied innovatively. The clinical efficacy has been greatly improved with the assistance and verification of modern research results.

参考文献

[1] EDDY A A,SYMONS J M. Nephrotic syndrome in childhood[J]. Lancet,2003,362(9384):629-639.

[2] NOONE D G,IIJIMA K,PAREKH R. Idiopathic nephrotic syndrome in children[J]. Lancet,2018,392(10141):61-74.

[3]全国儿童常见肾脏病诊治现状调研工作组.我国儿童激素敏感、复发/依赖肾病综合征诊疗现状的多中心研究[J].中华儿科杂志,2014,52(3):194-200.

[4] ORAY M,ABU SAMRA K,EBRAHIMIADIB N,et al.Long-term side effects of glucocorticoids[J]. Expert Opin Drug Saf,2016,15(4):457-465.

[5]曹广海,刘翠华,张小方.防己黄芪汤加减治疗小儿肾病综合征临床研究[J].中医学报,2017,32(10):2009-2012.

[6]任玉娇,张伟.从补肾益气论防治糖皮质激素的不良反应[J].中医杂志,2016,57(15):1345-1347.

[7]魏磊,刘翠华.温阳补肾法治疗儿童原发性难治性肾病综合征的疗效观察[J].中国中西医结合儿科学,2019,11(1):54-58.

[8]庄学波.温阳利水化瘀方治疗儿童原发性难治性肾病综合征的临床研究[J].中外医疗,2020,39(25):169-171.

[9]闫永彬,丁樱,任献青,等.丁樱教授肾病尿浊“风激水浊”病机说[J].中华中医药杂志,2013,28(11):3290-3292.

[10]丁樱.全国名中医五十年临证经验荟萃[M].北京:中国中医药出版社,2018:42-44.

[11] DE FATIMA PEREIRA W,BRITO-MELO GEA,GUIMARAES FTL,et al. The role of the immune system in idiopathic nephrotic syndrome:a review of clinical and experimental studies[J]. Inflamm Res,2014,63(1):1-12.

[12]姚磊,向阳,康铃,等.肾病综合征患者血清Ig和补体C3的测定及临床意义探讨[J].重庆医学,2006,35(18):1656-1657.

[13] DEBIEC H,NAUTA J,COULET F,et al. Role of truncating mutations in MME gene in fetomaternal alloimmunisation and antenatal glomerulopathies[J]. Lancet,2004,364(9441):1252-1259.

[14] GRIMBERT P, AUDARD V, REMY P, et al. Recent approaches to the pathogenesis of minimal-change nephrotic syndrome[J]. Nephrol Dial Transplant, 2003,18(2):245-248.

[15] LI J,ZHANG Q K,SU B F. Clinical characteristics and risk factors of severe infections in hospitalized adult patients with primary nephrotic syndrome[J]. J Int Med Res,2017,45(6):2139-2145.

[16]鲍春,周建华,莫科媛,等.儿童激素敏感性肾病综合征复发的原因和相关因素分析[J].临床肾脏病杂志,2012,12(4):159-161.

[17]沙吉,毛云英.小儿原发性肾病综合征46例复发原因分析[J].青海医药杂志,2007,37(3):31-32.

[18] ECKARDT K, KASISKE B. KDIGO clinical practice guideline for glomerulonephritis[J]. Kindey Int, 2012(S2):139-274.

[19]徐祖祺.肾病综合征血液高凝状态及其处理[J].实用儿科杂志,1990,5(1):8-9.

[20]丁樱,翟文生,任献青,等.雷公藤多苷联合清热止血方、香丹注射液治疗小儿紫癜性肾炎疗效观察[J].中国中西医结合杂志,2012,32(9):1290-1292.

[21]尤文雅,张亚昆,赵逍遥,等.中药牛蒡子主要活性成分微生物转化研究进展[J].药学进展,2020,44(2):112-118.

[22]徐江维,张永芳.防己黄芪汤加味联合西药治疗小儿肾病综合征疗效观察[J].现代中西医结合杂志,2017,26(17):1920-1922.

[23]张小方,赵影,曹广海,等.丹参注射液治疗小儿系膜增生性肾炎的临床观察[J].中成药,2017,39(8):1751-1753.

[24]杨敬伟.益气温阳补肾汤治疗难治性肾病综合征疗效及对T淋巴细胞亚群、细胞因子的影响[J].现代中西医结合杂志,2016,25(4):382-383,456.

[25]艾志琼,申元英,张态,等.黄芪对小鼠免疫功能影响的实验研究[J].军医进修学院学报,2010,31(8):805-807.

[26]高志杰,朱彤彤,牛新茹,等.鸡血藤化学成分及药理活性研究进展[J].辽宁中医药大学学报,2022,24(4):67-74.

基本信息:

DOI:10.16295/j.cnki.0257-358x.2023.08.014

中图分类号:R249;R272

引用信息:

[1]丁乐乐,韩姗姗,魏金辉,等.丁樱基于“激清扬浊”辨治儿童肾病综合征尿浊经验[J],2023,42(08):851-856.DOI:10.16295/j.cnki.0257-358x.2023.08.014.

基金信息:

国家自然科学基金项目(编号:81873343);; 全国名中医工作室建设项目(批文号:国中医药办人教函﹝2018﹞119号)

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