中医药治疗儿童过敏性紫癜肾炎辨证及用药规律分析

Diagnosis of Syndrome in Treating Children Allergic Purpura Nephritis by TCM and Analyzing Using Drugs Regularity

目的:探讨中医药对过敏性紫癜肾炎的证治规律,为临床应用提供参考。方法:检索国内发表的使用中医药治疗本病的临床文献,对过敏性紫癜肾炎的主要证型及用药规律、激素使用不同阶段中药使用规律及随证加减规律进行分析。结果:符合标准的临床文献共79篇,涉及中药分15大类,居前5位的是清热药(28.8%)、补虚药(21.6%)、止血药(14.6%)、活血化瘀药(10.2%)、利水渗湿药(8.9%),辨证分型主要有风热伤络证(11.3%)、热毒迫血证(28.4%)、湿热瘀阻证(21.8%)、阴虚火旺证(11.9%)、脾气亏虚证(8.4%)、脾肾两虚证(14.8%)。归纳统计得出激素诱导期以清热、补阴药为主,减量期以补气、补阳药为主,维持期以归脾肾两经药物为主。结论:本研究验证了"风、湿、热、毒、瘀、虚"为过敏性紫癜肾炎的中医学病因,治疗上提倡早期清热解毒、凉血祛风,中期解毒化瘀、凉血止血,后期养阴活血、滋肾清利。使用激素的患儿可根据阶段不同而加用清热凉血药及补气血阴阳之品。

Objective：To explore tbe treatment regulation of children allergic purpura nephritis by TCM,which supplying the references for clinical application. Methods：Retrieving the clinical literatures which are published in China. For analyzing the main syndrome types of allergic purpura nephritis, using drugs regularity, different stages of using hormone, the regularity of TCM application and add and subtract. Results：Conform to the standard of clinical with 79 references, involved in 15 kinds of traditional Chinese medicine. The top five are heat-clearing drugs （28.8 % ）, tonify deficiency drugs （21.6%）, hemostatics （ 14.6% ） drugs for invigorating blood circulation and eliminating stasis （10.2%）, damp-clearing drug （8.9%）. The differentiation of symptoms and signs for classification of syndrome are wind heat injuried meridians（ 11.3% ） , bleed caused by heat toxic（28.4% ） , blood stasis caused by beat dampness（21.8% ）, fire excess from Yin deficiency（ 11.9% ）, deficiency of spleen Qi （8.4%） , deficiency of spleen and kidney （ 14.8% ）. Hormone induction period is given priority to with clear heat and Yin-tonifying drug, while the decrement period is given priority to with tonifying qi and Yang medicine, maintenance period mainly is given priority to with tonifying the spleen and kidney meridians by inductive measure- ment. Conclusion ： Verifieating the pathogenesis of henoeb-schonlein purpura nephritis is wind, damoness, heat, toxic, stasis, deficiency. In early should clearing away heat and toxic materials, cooling blood and dispel the wind. In medium-term theropy, should detoxify and dispersing blood stasis, cooling blood and hemostasis. In later period, should cultivate Yin and invigorate the circulation of blood, nouris- hing kidney. Using hormones of children can have clear heat cool blood drugs and tonifying Qi, blood, Yin, Yang according to different stages.