《慢性肾脏病34期中医诊疗方案》的优化研究

Optimization Study of TCM Therapy of Chronic Kidney Disease

目的:中医药防治慢性肾脏病取得了较肯定的疗效,但因慢性肾脏病的中医辨证论治尚不能在全国范围内达到统一,阻碍了中医药疗法的推广应用。本研究旨在对慢性肾脏病3、4期的中医诊疗方案进行优化,力求形成共识度较高的中医辨证论治诊疗方案。方法:采用专家咨询法,通过两轮专家咨询向全国20位资深中医专家发送问卷调查,从慢性肾脏病3、4期基本证型、基本方剂、方剂组成等方面进行咨询。结果:慢性肾脏病3、4期中医基本证型可分为本虚证(脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证、阴阳两虚证),标实证(湿浊证、湿热证、血瘀证、水气证、浊毒证)。脾肾气虚证可选用香砂六君子汤加减,气阴两虚证可选用参芪地黄丸加减,肝肾阴虚证可选用六味地黄丸合二至丸加减,脾肾阳虚证可选用济生肾气丸加减,阴阳两虚证可选用金匮肾气丸合二至丸加减。标实证均在本虚证的基础上加减用药。结论:通过此研究,初步制定了目前全国共识度较高的慢性肾脏病3、4期中医基本辨证分型及选方用药,有助于中医辨证论治防治慢性肾脏病的推广运用,为慢性肾脏病中医诊疗规范的制定提供基础。

Objective：The treatment of chronic kidney disease（CKD） with TCM has obtained definite effect.But the syndrome differentiation of CKD has not been identical in the countrywide.So its popularization and application are delayed.Our target is to optimize the TCM program of CKD so as to form it with higher consensus.Methods：With expert consultation,we consultative the basic types of syndromes,fundamental prescriptions,and the herbs by questionnaire to twenty experts.Results：The basic types of syndromes of CKD 3~4 period include the syndrome of deficiency Ben（deficiency of spleen and kidney cured with xiangshaliujunzi soup;deficiency of qi and yin cured with shenqidihuang pill;deficiency syndrome of both liver and kidney yin cured with liuweidihuang soup and erzhi pill;deficiency syndrome of both spleen and kidney yang cured with jishengshenqi pill;deficiency of yang and yin cured with jinkuishenqi pill and erzhi pill）,and the syndrome of excessive Biao（dampness syndrome;Dampness-heat syndrome;blood stasis syndrome;water-dampness syndrome;chaotic-toxic syndrome）.We treat the syndrome of excessive Biao through increasing and decreasing some traditional herbs according the syndrome of deficiency Ben.Conclusion：Our study initial develop the TCM program of CKD3~4 period,which has the high consensus in the countrywide.The program will help to popularize and apply the TCM to cure CKD.It will apply the basis for the formulation of the therapeutic standards of CKD with TCM.