慢性肾脏病蛋白质-能量消耗的中医研究进展

Advances in Traditional Chinese Medicine Research on Protein-energy Wasting of Chronic Kidney Disease

[目的]总结慢性肾脏病蛋白质-能量消耗(protein-energy wasting,PEW)中医研究进展。[方法]阅读近年来PEW相关的国内外文献,对PEW的病因病机、治则治法、证候学,以及经方、复方、单味药、外治法在PEW中的应用进行整理、研究、归纳总结。[结果]PEW发病外因感受六淫邪气,内因脏腑虚损。病机总属本虚标实,脏腑衰败,气血阴阳不足为本,病位主要在"脾肾";湿热、痰浊、瘀血、水毒内停,毒损肾络为标。治疗当扶正祛邪,重视辨证,主要围绕"益肾健脾、补气养血、活血祛瘀、通腑泄浊、解毒和络"之法。PEW证候虚实并见,虚证以脾肾气虚证最多见;兼证则以湿浊、湿热、瘀血证多见。一些经方、复方、单味药及外治疗法能缓解PEW症状,提高营养相关指标,减轻微炎症反应,最终提高患者生活质量。[结论]中医药治疗PEW有一定的优势,取得一定成果,值得深入研究。

[Objective]To summarize the advances in traditional Chinese medicine research on protein-energy wasting（PEW） of chronic kidney disease（CKD）. [Methods]Read the domestic and foreign literature about PEW in recent years. Collate,study and summarize etiology and pathogenesis,therapeutie principle and symptomatology of PEW,as well as the application of classical prescriptions,compound prescriptions,single herbs and traditional Chinese external treatments about PEW.[Results]The external cause of PEW is feelings of six vessel disease,and the internal cause is weak and damage of Zang and Fu viscera.The pathogenesis consists of deficiency of Ben and repletion of Biao.Deficiency of Ben means dysfunction of Zang and Fu viscera,lack of Qi and blood, Yin and Yang.The disease mainly locates in the spleen and kidney;the retention of damp and hot,phlegm turbidity,blood stasis and water poison, damages the renal collaterals,which constitute Biao of PEW.The chief principle of treatment is to support the right and expel the evil. Emphasis on dialectical therapy,and center on ＂nourishing kidney and strengthening spleen,benefiting qi and nourishing blood,activating blood and removing stasis, cleaning bowel and dispelling turbidity,detoxificating and reconciling collaterals＂.Deficiency and excess exist simultaneously in the symptomatology of PEW. Qi deficiency of spleen and kidney is the most common deficiency syndrome,damp and turbidity,damp and hot and blood stasis are seen most of the time in accompanied symptom .Classical prescriptions,single traditional Chinese herb,and external therapy of TCM will be uesd to create good application prospect in the TCM treatments of PEW,which effectively improve clinical symptoms,increase nutrition related indicatom, reduce micro-inflammatory response, and finally raise living quality of patients. [Conclusion]Traditional Chinese medicine treatments of the PEW provide advantages and have made certain achievements, which are worth further studying.