IgA肾病血尿从络辨治探析

Treatment of Hematuria Induced by IgA Nephropathy on the Basis of Collateral Syndrome Differentiation

在IgA肾病血尿的发生和发展过程中,先天禀赋薄弱、阴虚气少是疾病发生的始动因素;湿热毒瘀是疾病发生、更是病情恶变的主要病理因素;络息成积是贯穿疾病始终的病理学改变。提出辨证论治可分为热伤肾络、肾络瘀阻、络虚失荣三型。其中热伤肾络之热有风热、湿热、湿毒的区别;络虚失荣有脾肾气虚、肝肾阴虚、气阴两虚、脾肾阳虚等证型的不同。从络辨治本病应重视熄火宁络、强调化瘀通络、突出软坚化积、注重补虚充络。

The deficiency of inborn constitution as well as deficiency yin with Qi is the initial factor of hematuria induced by IgA nephropathy,accumulation of damp- heat and toxin with blood-stasis is the main pathogenic factors,and the affection of collateral is the basic pathological feature.It is suggested that IgA nephropathy hema- turia can be classified into syndrome patterns of heat affecting kidney collateral, blood-stasis blocking kidney collateral and collateral loss of nourishing.For the syn- drome pattern of heat affecting kidney collateral,there exist the differences of wind- heat,damp-heat and clamp-toxin.Collateral loss of nourishing results from defi- ciency of spleen-kidney Qi,deficiency of spleen-kidney yin,deficiency of both Qi and yin,and deficiency of spleen-kidney.Treatment of hematuria induced by IgA nephropathy based on collateral syndrome differentiation should emphasize on subsiding fire and calming collaterals,removing stasis and dredging collaterals,softening hard- ness and removing mass,especially strengthening deficiency and tonifying collaterals.