杨霓芝运用益气活血蠲毒法论治尿毒症经验

Experience of Professor YANG Ni-Zhi in Treating Uremia with Therapy of Replenishing Qi,Activating Blood and Eliminating Toxicity

尿毒症是慢性肾功能衰竭(慢性肾衰)进入终末阶段时出现的临床综合征。杨霓芝教授认为尿毒症的基本病机是脾肾气虚,浊毒瘀阻,治疗以益气活血蠲毒法为基本法,应辨其正虚与邪实之轻重,强调分期论治。尿毒症早期正气虚为主,标实较轻,以四君子汤、香砂六君子汤加减治疗;尿毒症晚期以邪实为主,出现下关上格之象,常用实脾饮合肾气丸加减治疗。酌情选用针对慢性肾衰的药对如黄芪配三七、丹参配泽兰、女贞子配旱莲草。慢病需缓治,治疗尿毒症用药当平淡和缓,以使病情稳定或缓解,延缓患者进入透析阶段的时间。

Uremia is the clinical syndrome occurring at the end stage of chronic renal failure. Professor YANG NiZhi considers that the basic pathogenesis of uremia is spleen and kidney Qi deficiency resulting into blockage of turbidity,toxicity and blood stasis. Therefore,the therapeutic principles for uremia should be replenishing Qi,activating blood and eliminating toxicity, and then staging treatment should be performed on the basis of identifying the predominance of healthy Qi deficiency or pathogenic factors excess. Uremia at the early stage is characterized as the predominance of healthy Qi deficiency with less pathogenic Qi excess,and can be treated with the modification of Sijunzi Decoction and Xiangsha Liujunzi Decoction. Uremia at the late stage is characterized as the predominance of pathogenic Qi excess with obstruction-rejection(dysuria with incessant vomiting),and can be treated with the modification of Shipi Decoction plus Shenqi Pills. The commonly-used herb pairs for chronic renal failure are Huangqi(Radix Astragali)-Sanqi(Radix Notoginseng),Danshen(Radix Salviae Miltiorrhizae)-Peilan(Herba Eupatorii),Nyuzhenzi(Fructus Ligustri Lucidi)-Hanliancao(Herba Ecliptae),and the herb pairs can be chosen for the treatment according to the illness. For the medication for chronic diseases should be moderate, the herbs for uremia should be mild and slow in the properties and actions, which can stabilze or relieve the illness,and delay the time for performing dialysis.