从久病入络探讨紫癜性肾炎肾小球新月体病变与血瘀的关系

Discussion on Relationship between Glomerular Crescent Lesions and Blood Stasis in Henoch-Schonlein Purpura Nephritis from Chronic Disease Entering Collaterals

肾小球新月体病变是紫癜性肾炎(HSPN)重要的病理表现之一,随着HSPN发病率的升高,减少或延缓肾损伤的发生已成为防治HSPN的共识。"久病入络"理念来自叶天士《临证指南医案》,强调了病久入络,由气至血的传变规律,阐明了络脉损伤、络脉瘀阻等病理变化。HSPN属于"络病"范畴,病变部位在于肾络(肾小球毛细血管),肾络纤细迂曲,盘根错杂,血行缓慢而易瘀滞。伏邪触动、正气不足、脏腑本虚可致体内精微物质代谢失常、脏腑结构功能改变,为瘀血的产生创造了条件,成为了肾小球新月体病变的基础。病程的长短、病情的轻重均可致瘀,病程长、病情重者则瘀更甚,病情发展也越快,治疗上需把握"络通则瘀去"的原则,肾络畅行,血不瘀滞,则可延缓疾病进展。

Glomerular crescent disease is one of the important pathological manifestations of Henoch-Schonlein purpura nephritis(HSPN).With the increase of HSPN incidence,reducing or delaying the occurrence of renal injury has become the consensus of prevention and treatment HSPN.The concept of“chronic disease entering collaterals”comes from YE Tianshi′s The Medical Record of Clinical Guide.It emphasizes the law of transmission from Qi to blood when the disease enters the collaterals for a long time,and expounds the pathological changes such as collateral injury and blood stasis in collateral.HSPN belongs to the category of“collateral disease”.The lesion site lies in the kidney collateral(glomerular capillaries).The kidney collateral is thin and tortuous,and the blood flow is slow and easy to have blood stasis.The latent evil,the deficiency of healthy Qi and the deficiency of Zang-Fu organs can lead to the abnormal metabolism of fine substances in the body and the structural and functional changes of Zang-Fu organs,which create conditions for the generation of blood stasis and become the basis of glomerular crescent lesions.The length of the disease course and the severity of the disease can cause blood stasis.The longer the disease process is,the more serious the disease is,and the faster the development of the disease is.In treatment,it is necessary to grasp the principle that“collaterals are unblocked,blood stasis is removed”.If the kidney collaterals are smooth,and the blood is not stagnant,the progress of the disease can be delayed.